The Risk of Herpes Zoster in Patients with Depressive Disorders: A German Claims Database Analysis

Patients with depression were shown to be at increased risk of herpes zoster (HZ). However, an in-depth description of depression as a risk factor for HZ, postherpetic neuralgia (PHN), and HZ recurrence is lacking. The goal of this study was to quantify the risk of HZ, PHN, and HZ recurrence in people with depression and among depression-related subgroups in Germany.

Using health insurance claims data from 2012 to 2021 from a large German claims database, people ≥ 18 years old diagnosed with depression were identified and matched to control persons without depression using a rolling cohort design. Incidence rates (cases per 1000 person-years [PYs]) and incidence rate ratios (IRRs) were calculated using Poisson models.

Overall, 1,768,701 people with depression were matched to controls without depression. HZ incidence rates were higher in people with depression (10.51 cases/1000 PYs) than in people without depression (9.04 cases/1000 PYs). Overall, people with depression had a significantly increased risk of HZ (IRR = 1.16; p < 0.0001), PHN (IRR = 1.16; p < 0.0001), and HZ recurrence (IRR = 1.22; p < 0.0001). IRRs were highest in the 18 to 49 years age group (IRR HZ = 1.24; p < 0.0001; IRR PHN = 1.35; p < 0.0001). IRRs for HZ were highest in people with mental disorder comorbidities (IRR = 1.23; p < 0.0001).

A diagnosis of depression is associated with an increased risk of HZ, PHN, and HZ recurrence. People with depression should be considered when developing HZ vaccination recommendations.