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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparison of depression risk and depression-related ambulatory care utilization in sarcopenia patients with and without Chinese herbal medicine
Hang-Che Li, Hanoch Livneh, Wei-Chiao Chang, Yu-Han Wang, Ming-Hsien Yeh, Bo-Chyuan Chen, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai
Hang-Che Li, Wei-Chiao Chang, Ming-Hsien Yeh, Bo-Chyuan Chen, Department of Chinese Medicine, Dalin Tzu Chi Hospital, Chiayi 62247, Taiwan
Hanoch Livneh, Department of Special and Counselor Education, Portland State University, Portland, OR 97207, United States
Yu-Han Wang, Wei-Jen Chen, Department of Sports Medicine Center, Dalin Tzu Chi Hospital, Chiayi 62247, Taiwan
Ming-Chi Lu, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
Ming-Chi Lu, Department of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
Wei-Jen Chen, School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan
Tzung-Yi Tsai, Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
Tzung-Yi Tsai, Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan
Co-corresponding authors: Wei-Jen Chen and Tzung-Yi Tsai.
Author contributions: Li HC, Livneh H, Chang WC, Chen WJ, and Tsai TY were involved in the study design and drafted the manuscript; Li HC, Wang YH, Chen WJ, and Tsai TY contributed to data analysis and revised the manuscript; Livneh H, Chang WC, Yeh MH, Chen BC, Chen WJ, and Tsai TY contributed to the interpretation of data and provided comments on the final draft of the manuscript; Lu MC provided administrative support along with revision of the study. All authors gave final approval to the version to be published and agree to be accountable for all aspects of the work. Li HC, Livneh H, and Chang WC contributed equally to this work. Chen WJ and Tsai TY contributed equally to this manuscript and are co-corresponding authors.
Institutional review board statement: This study was approved by the Institutional Review Board of Buddhist Dalin Tzu Chi Hospital (No. B11004025-1). This study was conducted in accordance with the guidelines of the Declaration of Helsinki.
Informed consent statement: Since the data were anonymized before public release, individual identifying information cannot be identified from the database. As such, the Institutional Review Board of Buddhist Dalin Tzu Chi Hospital confirmed that this study was exempt from full review along with the need for informed consent in this investigation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: This study obtained data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, managed by the Department of Health and Welfare, Taiwan. As the release of “Personal Information Protection Act” law, the relevant data can’t be publicly obtained. Requisition for usage of datasets should be directed to the Bureau of National Health Insurance and the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Tzung-Yi Tsai, PhD, Assistant Professor, Researcher, Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2 Minsheng Road, Chiayi 62247, Taiwan.
dm732024@tzuchi.com.tw
Received: June 16, 2025
Revised: July 11, 2025
Accepted: September 3, 2025
Published online: November 19, 2025
Processing time: 143 Days and 19.5 Hours
BACKGROUND
The impact of psychiatric disorder, especially depression, on the prognosis of sarcopenic patients is gaining prominence. Yet, there have been very few studies focusing on this issue, let alone the related targeted mental health prevention. This cohort-based nested case-control study is geared to compare risk of depression and the depression-related ambulatory care utilization for sarcopenia persons with and without receiving add-on Chinese herbal medicines (CHMs) treatment.
AIM
To compare risk of depression and the depression-related ambulatory care utilization for sarcopenia persons with and without receiving add-on CHMs treatment.
METHODS
In the beginning, we recruited those aged 20-70 years with newly diagnosed sarcopenia and free of depression between 2002 and 2010 from a nationwide insurance database. From them, we identified cases with depression onset occurring after sarcopenia until December 31, 2013. To cautiously isolate the effect of CHMs, we established the matched sets of treated and untreated subjects with CHMs use by randomly frequency matching. A conditional logistic regression was executed to explore the association of CHMs to depression risk, and the frequency and costs of depression-related ambulatory care were compared using Mann-Whitney U test.
RESULTS
Addition of CHMs to routine care of sarcopenia notably correlated with a lower risk of depression. A remarkable effect of CHMs in reducing depression was detected when sarcopenia subjects received CHMs for more than three years, lowering depression risk by as much as 65%. As compared to CHMs users, the non-CHMs users indeed incurred higher frequency and costs of depression-related ambulatory care after depression attack (P < 0.05). Notably, the costs for per depression-related ambulatory care profoundly increased with the years after depression attack.
CONCLUSION
Sarcopenic patients can greatly benefit from add-on CHMs treatment, underscoring the urgent need for interdisciplinary collaboration and proactive treatment planning.
Core Tip: Findings derived from this population-based nested case-control study revealed that blending Chinese herbal medicines (CHMs) into routine care can benefit sarcopenia patients in the prevention of subsequent depression risk. Importantly, early commencement CHMs treatment further profoundly decreases the following consumption of depression-related ambulatory care. Identification of advantages of integrating CHMs may pin down the urgent need of interdisciplinary collaboration when managing symptoms of sarcopenia, especially depression.
