Chronic Periodontitis Is Associated with the Risk of Bipolar Disorder: A Population-Based Cohort Study

Abstract

Bipolar disorder (BD) is a psychiatric mood disturbance manifested by manic, hypomanic, or major depressive periods. Chronic inflammation was evidenced as an important etiologic factor of BD. Chronic periodontitis (CP) is an inflammatory disease triggered by bacterial products, leading to the destruction of periodontium. The relationship between BD and CP is of interest to investigate. Therefore, a nationwide population-based cohort study was used to investigate the risk of BD and CP exposure from 2001 to 2012. We identified 61,608 patients with CP from the Taiwanese National Health Insurance Research Database (NHIRD). The 123,216 controls were randomly captured and matched by age, sex, index year, and co-morbidities. The association between CP exposure and BD risk was examined by Cox proportional hazards regression models. In this study, 61,608 CP patients and 123,216 controls were followed up for 7.45 and 7.36 years, respectively. In total, 138 BD patients were identified in the CP cohort and 187 BD cases were found in the non-CP cohort. The incidence rate of BD was significantly higher in the CP cohort than in the non-CP cohort (adjusted HR: 1.46, 95% CI: 1.17-1.81) according to the multivariate Cox regression analysis. Females had a 1.47-fold increased risk (95% CI: 1.16-1.86) for BD compared to males. Taken together, CP may be associated with an increased risk of subsequent BD in Taiwan.

Keywords: Taiwan; bipolar disorder; chronic periodontitis; cohort study.

Figure 1

Procedures used for selection of cases from the Longitudinal Health Insurance Database 2010.

Figure 2

The Kaplan–Meier plot for the cumulative incidence of BD in patients with CP and control subjects.