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Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study

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dc.contributor Háskóli Íslands
dc.contributor University of Iceland
dc.contributor.author Song, Huan
dc.contributor.author Fall, Katja
dc.contributor.author Fang, Fang
dc.contributor.author Erlendsdóttir, Helga
dc.contributor.author Lu, Donghao
dc.contributor.author Mataix-Cols, David
dc.contributor.author Fernández de la Cruz, Lorena
dc.contributor.author D’Onofrio, Brian M.
dc.contributor.author Lichtenstein, Paul
dc.contributor.author Gottfredsson, Magnus
dc.contributor.author Almqvist, Catarina
dc.contributor.author Valdimarsdottir, Unnur
dc.date.accessioned 2020-06-22T13:23:08Z
dc.date.available 2020-06-22T13:23:08Z
dc.date.issued 2019-10-23
dc.identifier.citation Song Huan, Fall Katja, Fang Fang, Erlendsdóttir Helga, Lu Donghao, Mataix-Cols David et al. Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study BMJ 2019; 367 :l5784
dc.identifier.issn 0959-8138
dc.identifier.issn 1756-1833 (eISSN)
dc.identifier.uri https://hdl.handle.net/20.500.11815/1899
dc.description Publisher's version
dc.description.abstract Objective: To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections. Design: Population and sibling matched cohort study. Setting: Swedish population. Participants: 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population. Main outcome measures: A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections. Results: The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios. Conclusion: In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.
dc.description.sponsorship The study was supported by Grant of Excellence, Icelandic Research Fund (grant No 163362-051, UAV), and European Research Council (ERC) consolidator grant (StressGene, grant No 726413, UAV); the Karolinska Institutet (Senior Researcher Award and Strategic Research Area in Epidemiology, FF); the Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework (grant No 340-2013-5867, CA); and the West China Hospital, Sichuan University (1.3.5 Project for Disciplines of Excellence, grant No ZYJC18010, HS). This funding source had no role in study design, data collection, data analysis, data interpretation, writing of the scientific article, or the decision to submit the paper for publication.
dc.format.extent l5784
dc.language.iso en
dc.publisher BMJ
dc.relation.ispartofseries BMJ;367
dc.rights info:eu-repo/semantics/openAccess
dc.subject Trauma
dc.subject Infection
dc.subject PTSD
dc.subject Sálræn áföll
dc.subject Áfallastreita
dc.subject Sýkingar
dc.title Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study
dc.type info:eu-repo/semantics/article
dcterms.license This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/.
dc.description.version Peer Reviewed
dc.identifier.journal BMJ
dc.identifier.doi 10.1136/bmj.l5784
dc.relation.url https://www.bmj.com/content/367/bmj.l5784
dc.contributor.department Læknadeild (HÍ)
dc.contributor.department Faculty of Medicine (UI)
dc.contributor.school Heilbrigðisvísindasvið (HÍ)
dc.contributor.school School of Health Sciences (UI)

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