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Risk of Depressive Disorder Among Patients With Herpes Zoster: A Nationwide Population-Based Prospective Study

Chen, Mu-Hong MD; Wei, Han-Ting MD; Su, Tung-Ping MD; Li, Cheng-Ta MD, PhD; Lin, Wei-Chen MD; Chang, Wen-Han MSc; Chen, Tzeng-Ji MD, PhD; Bai, Ya-Mei MD, PhD

doi: 10.1097/PSY.0000000000000051
Original Articles

Objective Herpes zoster results from reactivation of the endogenous varicella zoster virus infection. Previous studies have shown that herpes zoster and postherpetic neuralgia were associated with anxiety, depression, and insomnia. However, no prospective study has investigated the association between herpes zoster and the development of depressive disorder.

Methods Subjects were identified through the Taiwan National Health Insurance Research Database. Patients 18 years or older with a diagnosis of herpes zoster and without a psychiatric history were enrolled in 2000 and compared with age-/sex-matched controls (1:4). These participants were followed up to the end of 2010 for new-onset depressive disorder.

Results A total of 1888 patients with herpes zoster were identified and compared with 7552 age-/sex-matched controls in 2000. Those with herpes zoster had a higher incidence of developing major depression (2.2% versus 1.4%, p = .018) and any depressive disorder (4.3% versus 3.2%, p = .020) than did the control group. The follow-up showed that herpes zoster was an independent risk factor for major depression (hazard ratio = 1.49, 95% confidence interval = 1.04–2.13) and any depressive disorder (hazard ratio = 1.32, 95% confidence interval = 1.03–1.70), after adjusting demographic data and comorbid medical diseases.

Conclusions This is the first study to investigate the temporal association between herpes zoster and depressive disorder. Further studies would be required to clarify the underlying pathophysiology about this association and whether proper treatment of herpes zoster could decrease the long-term risk of depressive disorder.

From the Departments of Psychiatry (M-H.C., H-T.W., T-P.S., C-T.L,W-C.L.,W-H.C.,Y-M.B.), Family Medicine (T-J.C.), and Psychiatry, Yuanshan Branch (H-T.W.), Taipei Veterans General Hospital, Taipei, Taiwan; and Psychiatry, College of Medicine (M-H.C.,H-T.W.,T-P.S.,C-T.L,W-C.L.,Y-M.B.), Institutesof Brain Science (T-P.S.,C-T.L,W-C.L.), and Institutes of Hospital and Health Care Administration (T-J.C.), National Yang-Ming University, Taipei, Taiwan.

Address correspondence and reprint requests to Ya-Mei Bai, MD, PhD, Department of Psychiatry, No. 201, Shih-Pai Road, Sec. 2, 11217 Taipei, Taiwan. E-mail:; Mu-Hong Chen, MD, Department of Psychiatry, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan. E-mail:

Received for publication July 19, 2013; revision received December 20, 2013.

Copyright © 2014 by American Psychosomatic Society
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