The Association between Depression, Anxiety, and Thyroid Disease: A UK Biobank Prospective Cohort Study

Abstract

Background: There is a lack of comprehensive data regarding the association of depression and anxiety for the subsequent risk of thyroid disease. Aim: To examine this prospective association between depression and anxiety and the risk of potential thyroid diseases, a large prospective study was conducted using data from UK Biobank. Materials and Methods: Depression and anxiety were measured through self-reported Patient Health Questionnaire-4 (PHQ-4) at baseline, thyroid disease was diagnosed by corresponding hospital data documented through International Classification of Diseases (ICD)-10 codes. Cox proportional hazard models and restricted cubic splines were employed to analyze the associations. Results: In a 13-year follow-up cohort study involving 349,993 participants, 9,877 (2.82%) individuals developed thyroid disease. Significant associations were observed between depression, anxiety, and risk of both hypothyroidism and hyperthyroidism among all participants, the adjusted hazard ratios (HRs) for PHQ scores were as follows: mild 1.27 (95% CI, 1.20-1.36), moderate 1.33 (95% CI, 1.17-1.51), and severe 1.56 (95% CI, 1.31-1.85). For hyperthyroidism, the HRs were mild 1.19 (95% CI, 1.03-1.38), moderate 1.43 (95% CI, 1.08-1.90), and severe 1.84 (95% CI, 1.28-2.66). The adjusted HRs indicating the association between depression, anxiety, and hypothyroidism remained significant for both males and females. The relationship between PHQ score and the risk of thyroid disease shows linear in restricted cubic spline. Conclusion: Depression and anxiety exposure is associated with subsequent risk of thyroid diseases, the more severe the depression and anxiety, the greater the associated risk. Therefore, any level of depression and anxiety should be taken into consideration in thyroid disease risk prediction and prevention.