Abstract: Tuberculosis (TB) disease may be transmitted to close
contacts of index cases, causing physical illness. No studies have
investigated the risk of developing depressive disorder among TB
contacts in a TB-endemic area.
Adult participants with a new diagnosis of TB contact (ICD-9-CM
codes V01.1 plus chest radiographic order) since January 1, 2008, were
identified from the National Health Insurance Research Database in
Taiwan. A control cohort matched for age ( 5 y), sex, enrolled years,
and income level was selected. These 2 cohorts were followed until
December 31, 2012, and observed for the development of depressive
disorder. The Kaplan-Meier method and the log-rank test were used to
examine the difference in cumulative incidences of depressive disorder
between groups. Cox proportional-hazard models were used to calculate
adjusted hazard ratios (aHRs) for depressive disorder.
The TB contact cohort consisted of 9046 patients and matched
controls of 36,184 ones. The mean age of TB contacts was 44.7 years,
and 56.0% of them were women. During a mean follow-up period of
2.5 years, 127 (1.40%) TB contacts and 521 (1.44%) matched controls
developed depressive disorder. TB exposure was found to be an
independent risk factor of depressive disorder in women (aHR
1.34, 95% confidence interval [CI] 1.07– 1.68), but not in men
(aHR 0.71, 95% CI 0.48–1.06) after adjusting for age, comorbidities,
and income levels. The risk of depression was significantly higher for
female TB contacts than for matched controls in the first and second
years (aHR 1.49, 95% CI 1.03–2.14; and aHR 1.53, 95% CI 1.05–
2.23, respectively), but not thereafter. Of note, 67 (0.74%) TB
contacts and 88 (0.24%) matched controls developed active TB,
but none of them had subsequent depressive disorder during follow-up
periods.
Female TB contacts had an increased risk of depression within the
first 2 years after exposure. Clinicians should consider conducting
depression evaluations in addition to routine TB contact investigations
in this subgroup population.