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) |