2.50
Hdl Handle:
http://hdl.handle.net/2336/620641
Title:
Association of Stress-Related Disorders With Subsequent Autoimmune Disease.
Authors:
Song, Huan; Fang, Fang; Tomasson, Gunnar; Arnberg, Filip K; Mataix-Cols, David; Fernández de la Cruz, Lorena; Almqvist, Catarina; Fall, Katja; Valdimarsdóttir, Unnur A
Citation:
Association of Stress-Related Disorders With Subsequent Autoimmune Disease. 2018, 319 (23):2388-2400 JAMA
Issue Date:
2018
Abstract:
Psychiatric reactions to life stressors are common in the general population and may result in immune dysfunction. Whether such reactions contribute to the risk of autoimmune disease remains unclear.; To determine whether there is an association between stress-related disorders and subsequent autoimmune disease.; Population- and sibling-matched retrospective cohort study conducted in Sweden from January 1, 1981, to December 31, 2013. The cohort included 106 464 exposed patients with stress-related disorders, with 1 064 640 matched unexposed persons and 126 652 full siblings of these patients.; Diagnosis of stress-related disorders, ie, posttraumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions.; Stress-related disorder and autoimmune diseases were identified through the National Patient Register. The Cox model was used to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.; The median age at diagnosis of stress-related disorders was 41 years (interquartile range, 33-50 years) and 40% of the exposed patients were male. During a mean follow-up of 10 years, the incidence rate of autoimmune diseases was 9.1, 6.0, and 6.5 per 1000 person-years among the exposed, matched unexposed, and sibling cohorts, respectively (absolute rate difference, 3.12 [95% CI, 2.99-3.25] and 2.49 [95% CI, 2.23-2.76] per 1000 person-years compared with the population- and sibling-based reference groups, respectively). Compared with the unexposed population, patients with stress-related disorders were at increased risk of autoimmune disease (HR, 1.36 [95% CI, 1.33-1.40]). The HRs for patients with posttraumatic stress disorder were 1.46 (95% CI, 1.32-1.61) for any and 2.29 (95% CI, 1.72-3.04) for multiple (≥3) autoimmune diseases. These associations were consistent in the sibling-based comparison. Relative risk elevations were more pronounced among younger patients (HR, 1.48 [95% CI, 1.42-1.55]; 1.41 [95% CI, 1.33-1.48]; 1.31 [95% CI, 1.24-1.37]; and 1.23 [95% CI, 1.17-1.30] for age at ≤33, 34-41, 42-50, and ≥51 years, respectively; P for interaction < .001). Persistent use of selective serotonin reuptake inhibitors during the first year of posttraumatic stress disorder diagnosis was associated with attenuated relative risk of autoimmune disease (HR, 3.64 [95% CI, 2.00-6.62]; 2.65 [95% CI, 1.57-4.45]; and 1.82 [95% CI, 1.09-3.02] for duration ≤179, 180-319, and ≥320 days, respectively; P for trend = .03).; In this Swedish cohort, exposure to a stress-related disorder was significantly associated with increased risk of subsequent autoimmune disease, compared with matched unexposed individuals and with full siblings. Further studies are needed to better understand the underlying mechanisms.
Description:
To access publisher's full text version of this article click on the hyperlink below
Additional Links:
https://jamanetwork.com/journals/jama/fullarticle/2685155
Rights:
Archived with thanks to JAMA

Full metadata record

DC FieldValue Language
dc.contributor.authorSong, Huanen
dc.contributor.authorFang, Fangen
dc.contributor.authorTomasson, Gunnaren
dc.contributor.authorArnberg, Filip Ken
dc.contributor.authorMataix-Cols, Daviden
dc.contributor.authorFernández de la Cruz, Lorenaen
dc.contributor.authorAlmqvist, Catarinaen
dc.contributor.authorFall, Katjaen
dc.contributor.authorValdimarsdóttir, Unnur Aen
dc.date.accessioned2018-07-05T15:50:28Z-
dc.date.available2018-07-05T15:50:28Z-
dc.date.issued2018-
dc.date.submitted2018-
dc.identifier.citationAssociation of Stress-Related Disorders With Subsequent Autoimmune Disease. 2018, 319 (23):2388-2400 JAMAen
dc.identifier.issn1538-3598-
dc.identifier.pmid29922828-
dc.identifier.doi10.1001/jama.2018.7028-
dc.identifier.urihttp://hdl.handle.net/2336/620641-
dc.descriptionTo access publisher's full text version of this article click on the hyperlink belowen
dc.description.abstractPsychiatric reactions to life stressors are common in the general population and may result in immune dysfunction. Whether such reactions contribute to the risk of autoimmune disease remains unclear.en
dc.description.abstractTo determine whether there is an association between stress-related disorders and subsequent autoimmune disease.en
dc.description.abstractPopulation- and sibling-matched retrospective cohort study conducted in Sweden from January 1, 1981, to December 31, 2013. The cohort included 106 464 exposed patients with stress-related disorders, with 1 064 640 matched unexposed persons and 126 652 full siblings of these patients.en
dc.description.abstractDiagnosis of stress-related disorders, ie, posttraumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions.en
dc.description.abstractStress-related disorder and autoimmune diseases were identified through the National Patient Register. The Cox model was used to estimate hazard ratios (HRs) with 95% CIs of 41 autoimmune diseases beyond 1 year after the diagnosis of stress-related disorders, controlling for multiple risk factors.en
dc.description.abstractThe median age at diagnosis of stress-related disorders was 41 years (interquartile range, 33-50 years) and 40% of the exposed patients were male. During a mean follow-up of 10 years, the incidence rate of autoimmune diseases was 9.1, 6.0, and 6.5 per 1000 person-years among the exposed, matched unexposed, and sibling cohorts, respectively (absolute rate difference, 3.12 [95% CI, 2.99-3.25] and 2.49 [95% CI, 2.23-2.76] per 1000 person-years compared with the population- and sibling-based reference groups, respectively). Compared with the unexposed population, patients with stress-related disorders were at increased risk of autoimmune disease (HR, 1.36 [95% CI, 1.33-1.40]). The HRs for patients with posttraumatic stress disorder were 1.46 (95% CI, 1.32-1.61) for any and 2.29 (95% CI, 1.72-3.04) for multiple (≥3) autoimmune diseases. These associations were consistent in the sibling-based comparison. Relative risk elevations were more pronounced among younger patients (HR, 1.48 [95% CI, 1.42-1.55]; 1.41 [95% CI, 1.33-1.48]; 1.31 [95% CI, 1.24-1.37]; and 1.23 [95% CI, 1.17-1.30] for age at ≤33, 34-41, 42-50, and ≥51 years, respectively; P for interaction < .001). Persistent use of selective serotonin reuptake inhibitors during the first year of posttraumatic stress disorder diagnosis was associated with attenuated relative risk of autoimmune disease (HR, 3.64 [95% CI, 2.00-6.62]; 2.65 [95% CI, 1.57-4.45]; and 1.82 [95% CI, 1.09-3.02] for duration ≤179, 180-319, and ≥320 days, respectively; P for trend = .03).en
dc.description.abstractIn this Swedish cohort, exposure to a stress-related disorder was significantly associated with increased risk of subsequent autoimmune disease, compared with matched unexposed individuals and with full siblings. Further studies are needed to better understand the underlying mechanisms.en
dc.description.sponsorshipGrant of Excellence, Icelandic Research Fund European Research Council Karolinska Institutet Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM)en
dc.language.isoenen
dc.publisherAmerican Medical Associationen
dc.relation.urlhttps://jamanetwork.com/journals/jama/fullarticle/2685155en
dc.rightsArchived with thanks to JAMAen
dc.subjectSjálfsofnæmissjúkdómaren
dc.subjectSálræn áföllen
dc.subjectRHE12en
dc.subject.meshAdulten
dc.subject.meshAutoimmune Diseasesen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHumansen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshProportional Hazards Modelsen
dc.subject.meshRegistriesen
dc.subject.meshRetrospective Studiesen
dc.subject.meshRisk Factorsen
dc.subject.meshSerotonin Uptake Inhibitorsen
dc.subject.meshSiblingsen
dc.subject.meshSocioeconomic Factorsen
dc.subject.meshStress Disorders, Post-Traumaticen
dc.subject.meshStress Disorders, Traumaticen
dc.subject.meshStress, Psychologicalen
dc.subject.meshSwedenen
dc.titleAssociation of Stress-Related Disorders With Subsequent Autoimmune Disease.en
dc.typeArticleen
dc.contributor.department1 Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 2 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 3 Department of Epidemiology and Biostatistics, Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 4 Department of Rheumatology, University Hospital, Reykjavík, Iceland. 5 Centre for Rheumatology Research, University Hospital, Reykjavík, Iceland. 6 National Centre for Disaster Psychiatry, Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden. 7 Stress Research Institute, Stockholm University, Stockholm, Sweden. 8 Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 9 Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden. 10 Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. 11 Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden. 12 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.en
dc.identifier.journalJAMAen
dc.rights.accessLandspitali Access - LSH-aðganguren
dc.departmentcodeRHE12-

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