Depressive Disorder and Elevated Risk of Bell's Palsy: a Nationwide Propensity Score-weighting Study

Overview

Journal BMC Psychiatry

Publisher Biomed Central

Specialty Psychiatry

Date 2024 Apr 16

PMID 38627723

Authors

Li-Yun Fann

Yuan-Liang Wen

Yu-Chieh Huang

Chih-Chien Cheng

Ying-Che Huang

Chih-Chia Fang

Wan-Ting Chen

Pei-Yeh Yu

Hsiang-Yi Pan

Li-Ting Kao

Affiliations

Soon will be listed here.

Abstract

Background: Prior studies have reported a potential relationship between depressive disorder (DD), immune function, and inflammatory response. Some studies have also confirmed the correlation between immune and inflammatory responses and Bell's palsy. Considering that the pathophysiology of these two diseases has several similarities, this study investigates if DD raises the risk of developing Bell's palsy.

Methods: This nationwide propensity score-weighting cohort study utilized Taiwan National Health Insurance data. 44,198 patients with DD were identified as the DD cohort and 1,433,650 adult subjects without DD were identified as the comparison cohort. The inverse probability of treatment weighting (IPTW) strategy was used to balance the differences of covariates between two groups. The 5-year incidence of Bell's palsy was evaluated using the Cox proportional-hazard model, presenting results in terms of hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: The average age of DD patients was 48.3 ± 17.3 years, and 61.86% were female. After propensity score-weighting strategy, no significant demographic differences emerged between the DD and comparison cohort. The Cox proportional hazards model revealed a statistically significant adjusted IPTW-HR of 1.315 (95% CI: 1.168-1.481) for Bell's palsy in DD patients compared to comparison subjects. Further independent factors for Bell's palsy in this model were age (IPTW-HR: 1.012, 95% CI: 1.010-1.013, p < 0.0001), sex (IPTW-HR: 0.909, 95% CI: 0.869-0.952, p < 0.0001), hypertension (IPTW-HR: 1.268, 95% CI: 1.186-1.355, p < 0.0001), hyperlipidemia (IPTW-HR: 1.084, 95% CI: 1.001-1.173, p = 0.047), and diabetes (IPTW-HR: 1.513, 95% CI: 1.398-1.637, p < 0.0001) CONCLUSION: This Study confirmed that individuals with DD face an elevated risk of developing Bell's palsy. These findings hold significant implications for both clinicians and researchers, shedding light on the potential interplay between mental health and the risk of certain physical health outcomes.

References

Vedeler C, Matre R, Nyland H, Moller P . Immunoglobulins, complement components and lymphocyte subpopulations in Bell's palsy. Eur Neurol. 1986; 25(3):177-82. DOI: 10.1159/000116006. View

Bremmer M, Beekman A, Deeg D, Penninx B, Dik M, Hack C . Inflammatory markers in late-life depression: results from a population-based study. J Affect Disord. 2007; 106(3):249-55. DOI: 10.1016/j.jad.2007.07.002. View

Zmudzka E, Salaciak K, Sapa J, Pytka K . Serotonin receptors in depression and anxiety: Insights from animal studies. Life Sci. 2018; 210:106-124. DOI: 10.1016/j.lfs.2018.08.050. View

Kessler R, Ormel J, Petukhova M, McLaughlin K, Green J, Russo L . Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry. 2011; 68(1):90-100. PMC: 3057480. DOI: 10.1001/archgenpsychiatry.2010.180. View

Holland N, Weiner G . Recent developments in Bell's palsy. BMJ. 2004; 329(7465):553-7. PMC: 516110. DOI: 10.1136/bmj.329.7465.553. View

Herrman H, Kieling C, McGorry P, Horton R, Sargent J, Patel V . Reducing the global burden of depression: a Lancet-World Psychiatric Association Commission. Lancet. 2018; 393(10189):e42-e43. DOI: 10.1016/S0140-6736(18)32408-5. View

Greco A, Gallo A, Fusconi M, Marinelli C, Macri G, De Vincentiis M . Bell's palsy and autoimmunity. Autoimmun Rev. 2012; 12(2):323-8. DOI: 10.1016/j.autrev.2012.05.008. View

Zhao H, Zhang X, Tang Y, Zhu J, Wang X, Li S . Bell's Palsy: Clinical Analysis of 372 Cases and Review of Related Literature. Eur Neurol. 2017; 77(3-4):168-172. DOI: 10.1159/000455073. View

Yilmaz M, Tarakcioglu M, Bayazit N, Bayazit Y, Namiduru M, Kanlikama M . Serum cytokine levels in Bell's palsy. J Neurol Sci. 2002; 197(1-2):69-72. DOI: 10.1016/s0022-510x(02)00049-7. View

10.

Insel T, Charney D . Research on major depression: strategies and priorities. JAMA. 2003; 289(23):3167-8. DOI: 10.1001/jama.289.23.3167. View

11.

Tiemstra J, Khatkhate N . Bell's palsy: diagnosis and management. Am Fam Physician. 2007; 76(7):997-1002. View

12.

Grace A . Dysregulation of the dopamine system in the pathophysiology of schizophrenia and depression. Nat Rev Neurosci. 2016; 17(8):524-32. PMC: 5166560. DOI: 10.1038/nrn.2016.57. View

13.

Lee S, Kong I, Oh D, Choi H . Increased risk of depression in Bell's palsy: Two longitudinal follow-up studies using a national sample cohort. J Affect Disord. 2019; 251:256-262. DOI: 10.1016/j.jad.2019.03.059. View

14.

Sforzini L, Cattaneo A, Ferrari C, Turner L, Mariani N, Enache D . Higher immune-related gene expression in major depression is independent of CRP levels: results from the BIODEP study. Transl Psychiatry. 2023; 13(1):185. PMC: 10235092. DOI: 10.1038/s41398-023-02438-x. View

15.

Beurel E, Toups M, Nemeroff C . The Bidirectional Relationship of Depression and Inflammation: Double Trouble. Neuron. 2020; 107(2):234-256. PMC: 7381373. DOI: 10.1016/j.neuron.2020.06.002. View

16.

Aviel A, OSTFELD E, Burstein R, MARSHAK G, Bentwich Z . Peripheral blood T and B lymphocyte subpopulations in Bell's palsy. Ann Otol Rhinol Laryngol. 1983; 92(2 Pt 1):187-91. DOI: 10.1177/000348948309200218. View

17.

Gilden D . Clinical practice. Bell's Palsy. N Engl J Med. 2004; 351(13):1323-31. DOI: 10.1056/NEJMcp041120. View

18.

Cayir S, Hizli O, Kayabasi S . Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy?. Eur Arch Otorhinolaryngol. 2019; 277(1):115-119. DOI: 10.1007/s00405-019-05691-3. View

19.

Stewart J, Rand K, Muldoon M, Kamarck T . A prospective evaluation of the directionality of the depression-inflammation relationship. Brain Behav Immun. 2009; 23(7):936-44. PMC: 2749896. DOI: 10.1016/j.bbi.2009.04.011. View

20.

Chamberlain S, Cavanagh J, de Boer P, Mondelli V, Jones D, Drevets W . Treatment-resistant depression and peripheral C-reactive protein. Br J Psychiatry. 2018; 214(1):11-19. PMC: 6124647. DOI: 10.1192/bjp.2018.66. View