Urticaria in adolescence increases the risk of developing new-onset depression

Objective: Urticaria is a common ailment encountered in pediatric outpatient or emergency departments. Although the symptoms of urticaria may increase stress, this association is not fully understood. Our aim was to analyze the risk of depression following a diagnosis of urticaria using a nationwide population-based study. Methods: We examined the Taiwan Longitudinal Health Insurance Database. Patients who had a history of urticaria or depression prior to the study period were excluded. A total of 6742 adolescents (aged 13-18 years) who were hospitalized for a first-attack urticaria episode between 2006 and 2009 were recruited as a study group, together with 20,226 matched nonurticaria enrollees as a control group. Each patient was prospectively followed for 1 year to identify episodes of depression. Cox proportional hazards models were used to compare the risk of depression between the study and control groups, making adjustments for the patients' places of residence and sociodemographic characteristics. Depression-free survival curves were also analyzed. Finally, the risks of depression were analyzed between various age groups. Results: A total of 63 (0.9%) adolescents with urticaria and 61 (0.3%) nonurticarial control individuals suffered a new-onset episode of depression during the follow-up period. The stratified Cox proportional analysis indicated that the crude hazard ratio of depression among adolescents with urticaria was 1.86 times (95% confidence interval, 1.25-2.98) that of the control individuals without urticaria. Patients who were 16-18 years of age and who had a history of asthma were more likely to suffer from depression (p<0.05 for both). Finally, urticaria was determined to be a risk factor for depression only during adolescence and not in patients aged <13 years (n=6745) or those aged between 19 years and 24 years (n=7185). Conclusion: Individuals who experience an initial attack of urticaria during adolescence are at a higher risk for developing depression.