Abstract
BACKGROUND: Chronic rhinosinusitis (CRS), a common inflammatory disorder of the sinonasal mucosa, is associated with significant morbidity and impaired quality of life. Emerging evidence suggests a link between systemic inflammation and neuropsychiatric disorders, including depression and suicide risk. This study examines whether phenotypic differences in CRS, specifically CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP), are associated with differing psychiatric outcomes. OBJECTIVE: The objective of this study was to evaluate whether CRSwNP and CRSsNP are differentially associated with suicidality and psychiatric disorders. METHODS: A retrospective cohort analysis was conducted using the TriNetX research network. Adults diagnosed with CRSwNP or CRSsNP between 2010 and 2023 were identified via the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. Propensity score matching was used to control for demographics and comorbidities, yielding two matched cohorts (n=130,769 each). Primary outcomes included suicidal ideation and suicide attempts. Secondary outcomes included depression, generalized anxiety disorder, bipolar disorder, schizophrenia, schizoaffective disorder, and psychosis. Risk differences, risk ratios, and odds ratios were calculated with 95% confidence intervals. RESULTS: Patients with CRSwNP demonstrated significantly lower risks of suicidal ideation (risk ratio (RR) 0.66) and suicide attempt (RR 0.63) compared to those with CRSsNP (all p<0.001). CRSwNP was also associated with lower risks of developing depression (RR 0.80), generalized anxiety disorder (RR 0.75), bipolar disorder (RR 0.72), schizophrenia (RR 0.63), schizoaffective disorder (RR 0.63), and psychosis (RR 0.64), although absolute risk differences were small. CONCLUSION: CRSwNP is associated with a significantly lower risk of several psychiatric disorders compared to CRSsNP, potentially due to differences in underlying inflammatory pathways or treatment effects. These findings support the integration of psychiatric screening in CRS management and warrant further investigation into immune modulation as a potential strategy to reduce neuropsychiatric risk.