https://orcid.org/0000-0003-2585-8102
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Marie Lind-Holst, Dorte Hansen, Katharina Maria Main, Anders Juul, Marianne Skovsager Andersen, Morten Dunø, Åse Krogh Rasmussen, Niels Jørgensen, Claus Højbjerg Gravholt, Agnethe Berglund, Delineating the Psychiatric Morbidity Spectrum in Congenital Adrenal Hyperplasia: A Population-based Registry Study, The Journal of Clinical Endocrinology & Metabolism, 2024;, dgae780, https://doi.org/10.1210/clinem/dgae780
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Abstract
Clinical studies of psychiatric morbidity in patients with congenital adrenal hyperplasia (CAH) imply impaired mental health.
To delineate psychiatric morbidity in a national CAH cohort by using complete data on psychiatric diagnoses from all Danish hospitals between 1977 and 2018 and on all psychiatric medication prescribed between 1995 and 2018.
A registry-based cohort study.
A uniform public health care system.
Four hundred and forty-eight patients (females: n = 215) with CAH, of which 410 had 21-hydroxylase deficiency (21-OHD) (females: n = 255) and 44 527 were age- and sex-matched general population controls.
Diagnoses were analyzed by negative binomial regression yielding incidence rate ratios (IRR). Medication were analyzed by Cox regression yielding hazard ratios (HR).
21-OHD was associated with an increased risk of any psychiatric diagnosis; females: IRR = 2.32 (CI, 1.48-3.64), males: IRR = 2.74 (CI, 1.31-5.71) as well as of medication related to psychiatric disorders; females: HR = 1.74 (CI, 1.42-2.13), males: HR = 1.74 (CI, 1.30-2.33). Both females and males with 21-OHD had a significantly increased risk of alcohol use, stress and adjustment disorders, and of suicidal behavior. For patients with more rare forms of CAH (n = 24), the risk of any psychiatric diagnosis was significantly increased for males, IRR = 12.85 (CI, 1.78-92.87), but not for females, IRR = 0.54 (CI, 0.10-3.00). The risk of being prescribed psychiatric medication was not increased for neither females, HR = 1.05 (CI, 0.39-2.84), nor males, HR = 0.72 (CI, 0.10-5.13), with rare forms of CAH.
21-OHD is associated with a significantly increased psychiatric morbidity. This study underlines a need for awareness of mental health in patients with 21-OHD.
