Department of Pediatrics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
bDepartment of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
J Clin Psychiatry. 2021 Feb 23;82(2):19m13126. doi: 10.4088/JCP.19m13126.
The tetralogy of Fallot (TOF) has been reported to be associated with some neurodevelopmental impairment and psychiatric disorders. Nevertheless, a nationwide study to clarify the risk between TOF and comorbid psychiatric disorders is lacking. Using a nationwide database in Taiwan, this study aimed to explore the role of TOF in various psychiatric disorders and analyze whether there are patient-related risk factors.
A total of 16,824 enrolled patients, including 4,206 study subjects who were diagnosed with TOF and 12,618 controls with TOF matched (1:3) for sex, age, hospital visits, and index year, were randomly selected from the Taiwanese National Health Insurance Research Database (NHIRD) between 2000 and 2015. Patients' diagnoses in the NHIRD were encoded using International Classification of Diseases, 9th Revision, Clinical Modification codes.
Of patients with TOF, 256 (6.09%) developed psychiatric disorders compared to 394 (3.12%) in the control group. After adjusting for covariates, the adjusted hazard ratio of psychiatric disorders for patients with TOF was 3.192 (95% CI, 2.683-3.798; P < .001). After exclusion of psychiatric diagnoses within the first 5 years, TOF was associated with an increased risk of anxiety (P < .001), depression (P < .001), bipolar disorder (P < .001), and sleep disorders (P = .005).
This study revealed that TOF patients have a nearly 3-fold higher risk of psychiatric disorders, including anxiety, depressive, bipolar, and sleep disorders, than the general population. Therefore, continued mental health screening and surveillance are warranted in TOF patients.
法洛四联症（TOF）已被报道与一些神经发育损伤和精神障碍有关。然而，缺乏一项全国性研究来阐明 TOF 与合并精神障碍的风险。本研究利用台湾的全国性数据库，旨在探讨 TOF 在各种精神障碍中的作用，并分析是否存在与患者相关的风险因素。
共纳入 16824 名患者，包括 4206 名被诊断为 TOF 的研究对象和 12618 名 TOF 匹配（1:3）的对照，匹配性别、年龄、就诊次数和索引年份，这些患者均于 2000 年至 2015 年期间从台湾全民健康保险研究数据库（NHIRD）中随机选择。NHIRD 中的患者诊断采用国际疾病分类，第 9 修订版，临床修正码进行编码。
在 TOF 患者中，有 256 例（6.09%）发生了精神障碍，而对照组为 394 例（3.12%）。在调整了混杂因素后，TOF 患者发生精神障碍的调整后的风险比为 3.192（95%CI，2.683-3.798；P<0.001）。在排除前 5 年内的精神科诊断后，TOF 与焦虑症（P<0.001）、抑郁症（P<0.001）、双相情感障碍（P<0.001）和睡眠障碍（P=0.005）的风险增加相关。
本研究表明，TOF 患者发生精神障碍的风险几乎增加了 3 倍，包括焦虑症、抑郁症、双相情感障碍和睡眠障碍，高于一般人群。因此，TOF 患者需要持续进行心理健康筛查和监测。
