Background: Patients with primary immune thrombocytopenia (ITP) suffer from fatigue, reduced quality of life, and social isolation - well-known risks factors for depression. High-dose corticosteroids remains first-line treatment of ITP, but prolonged exposure to steroids is associated with psychiatric side-effects such as sleep disturbances, mania, and depression. However, it is not known whether the combination of disease and treatment exposure in ITP leads to a higher use of prescriptionary psychotropic drugs, or an increased incidence of psychiatric conditions.

Aims: In this nationwide study we examined mental health burden in patients with ITP compared with the general population by quantifying the use of psychotropic drugs and incidences of psychiatric conditions.

Methods: We established a cohort of patients aged 18+ years with ITP using the designated ICD-10 diagnosis in the Danish National Patient Register 1997-2016, and age-sex-matched each patient with up to 40 comparators from the general population.

Start of follow-up was date of first ITP registration and comparators were assigned the same start date. Patients and comparators were followed in parallel from start date until the registration of new psychiatric conditions and prescriptions of a psychotropic drug. Accumulated numbers of dispensed psychotropic drug prescriptions were also estimated for each individual.

We grouped psychotropic drugs into six categories: antidepressants, antipsychotics, opioids, melatonin, benzodiazepines, and an accumulated group of the first encountered of any of the mentioned. We registered all dispensed prescriptions after start date within each category for each individual. We estimated incidence-rates per 100 person-years, incidence-rate-ratios (IRR) and incidence-rate-differences (IRD) in 6-month and monthly intervals two years before and after start date. We also calculated prevalence proportions of patients and comparators receiving a minimum of one prescription of a given group of psychotropic drugs in the years before and after inclusion.

Psychiatric conditions were categorized into six categories: schizophrenia/psychoses, depression, mania/bipolarity, anxiety/obsessive-compulsive disorder (OCD), fatigue, and an accumulated group consisting of the first encountered of any of the mentioned. We estimated 1, 5, 10-year, and overall cumulative incidences, Cox cause-specific hazard (csHR) and Fine-Gray subhazard ratios (subHR).

Results: We identified 3,749 patients and 149,849 comparators. In both groups, median age was 59.9 years and 53% were women.

Use of any psychotropic drug was increased amongst patients and highest in the first 6 months after ITP diagnosis, IRR0-6: 1.79 [1.69; 1.89], but dropped to 1.33 [1.24; 1.42] in the 18-24 months interval after diagnosis. This also applied to benzodiazepines, IRR0-6: 1.85 [1.69; 2.02], and to opioids, IRR0-6: 2.21 [1.97; 2.47]. Prevalence proportions for use of any psychiatric drug increased in temporal relation to diagnosis of ITP (Figure 1), but diminished thereafter.

Cumulative incidences of psychiatric conditions were generally higher in years following ITP diagnosis, particularly for depression, anxiety/OCD and fatigue. Differences diminished, but remained overt over time (Figure 2).

First year adjusted csHR for any psychiatric disease was 3.57 [2.84; 4.50], while the same adjusted csHR for any psychiatric disease across entire study period was 1.56 [1.38; 1.76]. There were no differences between age groups or sex. Adjusted overall csHR was 1.36 [1.14; 1.63] for depression, 1.81 [1.43; 2.28] for anxiety/OCD, and 1.86 [1.56; 2.22] for fatigue, with highest risks found during the first year for all.

Conclusions: The use of psychotropic drugs and the risk of incident psychiatric conditions are elevated in patients with primary ITP compared with the general population, particularly shortly after ITP diagnosis. Providing clinicians with this new knowledge can help introduce preventive measures in clinical practice and improve mental outcomes for patients with primary ITP. Detailed data and results for subgroups of psychotropic drugs and psychiatric conditions will be presented with the abstract.

Figure 1
Figure 1
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Hansen:Alexion: Research Funding; Novartis: Research Funding; EUSA Pharma: Other: Conference Fee.

Author notes

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Asterisk with author names denotes non-ASH members.

© 2022 by The American Society of Hematology
2022
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