Delineating the Psychiatric Morbidity Spectrum in Congenital Adrenal Hyperplasia: A Population-based Registry Study.

Context: Clinical studies of psychiatric morbidity in patients with congenital adrenal hyperplasia (CAH) imply impaired mental health.

Objective: To delineate psychiatric morbidity in a national CAH cohort by using complete data on psychiatric diagnoses from all Danish hospitals between 1977 and 2018 and on all psychiatric medication prescribed between 1995 and 2018.

Design: A registry-based cohort study.

Setting: A uniform public health care system.

Patients and controls: Four hundred and forty-eight patients (females: n = 215) with CAH, of which 410 had 21-hydroxylase deficiency (21-OHD) (females: n = 255) and 44 527 were age- and sex-matched general population controls.

Main outcome measures: Diagnoses were analyzed by negative binomial regression yielding incidence rate ratios (IRR). Medication were analyzed by Cox regression yielding hazard ratios (HR).

Results: 21-OHD was associated with an increased risk of any psychiatric diagnosis; females: IRR = 2.32 (CI, 1.48-3.64), males: IRR = 2.74 (CI, 1.31-5.71) as well as of medication related to psychiatric disorders; females: HR = 1.74 (CI, 1.42-2.13), males: HR = 1.74 (CI, 1.30-2.33). Both females and males with 21-OHD had a significantly increased risk of alcohol use, stress and adjustment disorders, and of suicidal behavior. For patients with more rare forms of CAH (n = 24), the risk of any psychiatric diagnosis was significantly increased for males, IRR = 12.85 (CI, 1.78-92.87), but not for females, IRR = 0.54 (CI, 0.10-3.00). The risk of being prescribed psychiatric medication was not increased for neither females, HR = 1.05 (CI, 0.39-2.84), nor males, HR = 0.72 (CI, 0.10-5.13), with rare forms of CAH.

Conclusion: 21-OHD is associated with a significantly increased psychiatric morbidity. This study underlines a need for awareness of mental health in patients with 21-OHD.