B Yueh, VA Puget Sound; DH Au, VA Puget Sound; EM Weaver, VA Puget Sound; MP Murphy, University of Washington; SD Fihn, VA Puget Sound

Objectives: Providers have long been aware that a substantial proportion of patients with chronic sinusitis (CS) symptoms have co-morbid psychiatric disease. An ongoing analysis of insurance claims data suggests that patients diagnosed with CS indeed have significantly greater odds of carrying diagnoses of depression and anxiety disorders. The goal of this study was to determine whether veterans with CS who receive primary care from the VA also have greater odds of having diagnoses of depression or anxiety, personality, or stress disorders.

Methods: We performed a cross-sectional analysis of outpatient ICD-9 diagnosis codes of patients who were enrolled in the Ambulatory Quality Improvement Project from 1996 to 2000. Veterans were classified as having CS if they had any ICD-9 code for chronic sinusitis ("473.x"). Similarly, the corresponding ICD-9 codes for selected psychiatric diseases (depression, anxiety disorders, personality disorders, and stress disorders) were used to identify veterans diagnosed with these disorders. We quantified the association between chronic sinusitis and psychiatric disorders with unadjusted odds ratios from contingency tables. Multivariate logistic regression was then used to compute the odds of CS patients having individual psychiatric disorders, adjusting for age and additional co-morbid illnesses (COPD, ischemic heart disease, peripheral vascular disease, congestive heart failure, hypertension, and diabetes). To accentuate the expected relationships with psychiatric disease, we performed similar analyses with non psychiatric neurological diseases (cerebrovascular accidents, dementia) that we did not expect to be associated with chronic sinusitis.

Results: Of 90,063 veterans, 4,712 (5.2%) patients had an ICD-9 code consistent with chronic sinusitis. In unadjusted analyses, veterans diagnosed with CS had 1.80 fold greater odds (P<.001, by chi squared test) of having a diagnosis of depression than those without CS. The unadjusted odds ratios for anxiety disorders (2.04), personality disorders (2.00), and stress disorders (2.67) were significantly elevated as well (P<.001). The odds of having the neurological diagnoses, however, were near unity: CVA, 1.01 (P=.81); and dementia, 0.97 (P=.74). After adjusting for age and co-morbid illnesses, veterans diagnosed with CS remained at significantly higher odds of being diagnosed with depression (OR=1.50; 95% confidence intervals, 1.40 to 1.60), anxiety (1.70; 1.58 to 1.83), personality disorder (1.55; 1.36 to 1.78), and stress disorders (2.16; 1.68 to 2.77).

Conclusions: Veterans diagnosed with chronic sinusitis have significantly higher odds of being diagnosed with psychiatric conditions such as depression, and anxiety, personality, and stress disorders. No conclusions about the nature of this association can be made with this cross-sectional analysis, but further efforts are underway to gain insight into this intriguing relationship.

Impact: No published studies have documented this association between chronic sinusitis and psychiatric disorders. Clinicians treating CS should be aware of the potential for co-morbid psychiatric conditions, in order to select effective treatment for both chronic sinusitis and also concomitant psychiatric disease.