Increased risk of depression before and after unilateral or bilateral oophorectomy: A self-controlled case series study using a nationwide cohort in South Korea.

Affiliation

Kim H(1), Kim Y(2), Fava M(3), Mischoulon D(3), Shin MH(4), Lee DY(5), Jeon HJ(6).
Author information:
(1)Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
(2)Department of Data Science, Evidnet, Seongnam, South Korea.
(3)Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
(4)Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea.
(5)Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, South Korea. Electronic address: [Email]
(6)Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology
(SAIHST), Sungkyunkwan University, Seoul, South Korea. Electronic address: [Email]

Abstract

BACKGROUND: There is insufficient evidence of the association between oophorectomy and depression. METHODS: A nationwide medical records database of South Korea was used to investigate incidence rate ratios (IRRs) of major depressive disorder before and after oophorectomy (n = 36,284) using a self-controlled case series design. Outcomes before and after hysterectomy (n = 25,415) were identified to compare with those around oophorectomy. RESULTS: In all oophorectomy and hysterectomy groups, the risk of depression was increased before and after surgery, peaking immediately before or after the operation, with no significant difference in the pattern of the results according to type of surgery. In the bilateral oophorectomy group, the IRR was increased between 2-3 months before the surgery, peaking immediately before surgery at 1.39 (95% CI: 1.30-1.49, p < .0001), and remained heightened for one-year postexposure. Subgroup analyses performed according to ovarian cancer, age group, and hormone replacement therapy produced results similar to those of the main outcome. LIMITATIONS: Because we used claims data, the detailed clinical information related to oophorectomy is lacking. There is possibility that time-varying confounder besides age and season might have affected the results CONCLUSIONS: The risk of depression increased before and after oophorectomy. The increase in risk of depression started before oophorectomy and peaked immediately before or after the operation, but no significant differences between unilateral and bilateral surgery and cancer and noncancer or among age groups were noted.