ESPE Abstracts

Background: Individuals with congenital adrenal hyperplasia (CAH), a form of adrenal insufficiency, are exposed to daily non-physiologic, non-circadian cortisol profiles due to both the disease and therapeutic limitations. Dysfunction in the hypothalamic-pituitary-adrenal axis is strongly associated with depressive disorders. However, little is known about the prevalence of depression among children and young adults with CAH. We investigated the prevalence of depressive disorders in a large administrative sample of insured children and young adults with CAH as compared to their peers without CAH in the United States.

Methods: We used the Treatment Pathways® interface to analyze claims data for individuals enrolled in employer-sponsored health insurance plans. We reviewed claims between October 1, 2015 and December 31, 2019 for subjects between the ages of 4 and 25 years. CAH prevalence was measured as the percentage of subjects with ≥2 claims with E25.0 ICD-10 codes for CAH and ≥2 glucocorticoid prescriptions filled during the study period. Depression prevalence was measured as the percentage of subjects with ≥2 outpatient claims or ≥1 inpatient claim with an ICD-10 code for a depressive disorder. We compared the prevalence of diagnosed depressive disorders in subjects with and without treated CAH, both overall and stratified by age group (4-11 years, 12-17 years, and 18-25 years). A combined adolescent and young adult group (12-25 years) was used to stratify by gender.

Results: The study period prevalence of CAH for individuals aged 4-25 years was 1/11,660 (n = 1,056). Among those with CAH, there was a higher unadjusted prevalence of depression (7.8%, n = 82, prevalence ratio (PR) =1.57, 95% confidence interval (CI): 1.28-1.94, P < 0.001) as compared to their peers without CAH (4.9%, n = 607,692). The prevalence of depression was higher among those with CAH across all age groups; however, this difference reached statistical significance only in the young adult group (12.6% vs. 6.9%, PR = 1.57, 95%CI: 1.28-1.94, P < 0.001). The prevalence was also significantly higher among both males (PR = 2.24, 95%CI: 1.62-3.09, P < 0.001) and females (PR = 1.34, 95%CI: 1.04-1.74, P < 0.05) in the combined adolescent and young adult group with CAH.

Conclusions: Using a large administrative sample of privately insured children and young adults in the United States, we found that the prevalence of depression was significantly higher among those with CAH. Enhanced screening for symptoms of depression among the pediatric and young adult population with CAH may be warranted if these associations are confirmed in further research.