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dc.contributor.authorSong, Huan
dc.contributor.authorFall, Katja
dc.contributor.authorFang, Fang
dc.contributor.authorErlendsdóttir, Helga
dc.contributor.authorLu, Donghao
dc.contributor.authorMataix-Cols, David
dc.contributor.authorFernández de la Cruz, Lorena
dc.contributor.authorD'Onofrio, Brian M
dc.contributor.authorLichtenstein, Paul
dc.contributor.authorGottfreðsson, Magnús
dc.contributor.authorAlmqvist, Catarina
dc.contributor.authorValdimarsdóttir, Unnur A
dc.date.accessioned2019-11-19T15:15:53Z
dc.date.available2019-11-19T15:15:53Z
dc.date.issued2019-10-23
dc.date.submitted2019-11
dc.identifier.citationSong H, Fall K, Fang F, Erlendsdóttir H, Lu D, Mataix-Cols D, Fernández de la Cruz L, D'Onofrio BM, Lichtenstein P, Gottfreðsson M, Almqvist C, Valdimarsdóttir UA. Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study. BMJ. 2019 Oct 23;367:l5784. doi: 10.1136/bmj.l5784en_US
dc.identifier.issn1756-1833
dc.identifier.pmid31645334
dc.identifier.doi10.1136/bmj.l5784
dc.identifier.urihttp://hdl.handle.net/2336/621185
dc.descriptionTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Downloaden_US
dc.description.abstractOBJECTIVE: 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.en_US
dc.description.sponsorshipGrant of Excellence, Icelandic Research Fund European Research Council (ERC) Karolinska Institutet Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) West China Hospital, Sichuan University (1.3.5 Project for Disciplines of Excellence)en_US
dc.language.isoenen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.urlhttps://www.bmj.com/content/367/bmj.l5784en_US
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812608/en_US
dc.subjectÁfallastreitaen_US
dc.subjectSýkingaren_US
dc.subjectLífslíkuren_US
dc.subject.meshStress Disorders, Post-Traumaticen_US
dc.subject.meshBacterial Infectionsen_US
dc.subject.meshSurvival Rateen_US
dc.subject.meshStress, Psychologicalen_US
dc.titleStress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study.en_US
dc.typeArticleen_US
dc.contributor.department1 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavík, Iceland huan@hi.is. 2 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 3 West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China. 4 Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden. 5 Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 6 Department of Clinical Microbiology, Landspítali University Hospital, Reykjavík, Iceland. 7 Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden. 8 Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden. 9 Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA. 10 Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland. 11 Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. 12 Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavík, Iceland. 13 Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.en_US
dc.identifier.journalBritish Medical Journalen_US
dc.rights.accessOpen Access - Opinn aðganguren_US
dc.departmentcodeNAF12
dc.departmentcodeTMD12
dc.departmentcodeRES12
dc.source.journaltitleBMJ (Clinical research ed.)
refterms.dateFOA2019-11-19T15:15:54Z


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