The Risk of Depression in a Large Huntington Disease Population Compared With Controls: Analysis of the Enroll-HD Registry Data
Shoshana Reshef1, Gerald Smith2, Ofir Harari2, Mark Gordon3, Rinat Ribalov4, Tamar Lengil5, Sam Leo6, Rosa Willock7, Jose Zurita7, Erin Furr-Stimming8, Victor Sung9
1Teva Branded Pharmaceutical Products R&D, Inc., Epidemiology and Global Health Economics and Outcomes Research, 2Cytel, 3Teva Branded Pharmaceutical Products R&D, Inc., Specialty Clinical Development, 4Teva Pharmaceutical Industries Ltd., Global Health Economics and Outcomes Research, 5Teva Pharmaceutical Industries Ltd., Global Medical Affairs, 6Teva Branded Pharmaceutical Products R&D, Inc., Global Health Economics and Outcomes Research, 7HCD Economics Ltd., 8UTHealth, McGovern Medical School, 9University of Alabama At Birmingham
Objective:
To describe the risk of depression among individuals with Huntington disease (HD; manifest) versus non-HD registry controls utilizing Enroll-HD data.
Background:
While high rates of depression have been reported in HD, real-world data on depression risk and risk factors in individuals with versus without HD by disease stage are incomplete.
Design/Methods:
Enroll-HD is a global observational registry for individuals with or at risk for HD, and their relatives. Data were collected annually (2013–31 October 2020; manifest, n=10,917; non-HD, n=4996). HD stage was estimated via Total Functional Capacity (TFC) score and Shoulson-Fahn staging: TFC 7–13/stage 1–2 (early), TFC 3–6/stage 3 (middle), TFC 0–2/stage 4–5 (late). Chorea severity was measured by Total Maximal Chorea (TMC) score (TMC 0–7/mild; TMC 8 –28/moderate-to-severe), and depression by the Problem Behavioral Assessment binary scale. Odds ratios (ORs) were estimated via a logistic regression model controlling for multiple risk factors.
Results:
Early (OR, 1.84) and middle (1.45) TFC groups were associated with significantly higher risk of depression relative to the non-HD group (both P<.001), but not the late group (1.10; P>.25). Depression risk was lower in moderate-to-severe versus mild chorea (0.81, P<.001), and for higher versus lower education (0.84, P<.001). Depression risk was higher for the following (all P<.01): ages 31–60 versus ≤30 years (1.18), females (1.53), overweight versus normal weight (1.13), obese versus normal weight (1.19), antipsychotic agents use (1.27), antidepressant agents use (1.58), smoking (1.18), alcohol problems (1.26), and drug abuse (1.32).
Conclusions:
Depression risk was higher in participants with versus without HD, with an increased risk during early HD stages, even after controlling for relevant risk factors for depression. These findings emphasize the need for attention to depression in early HD.