{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:02:22Z","timestamp":1772517742321,"version":"3.50.1"},"reference-count":43,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"unspecified","delay-in-days":61,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol Psychiatr Sci"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2045796026100481_sec1a\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2045796026100481_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used Taiwan\u2019s National Health Insurance Research Database (2000\u20132022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2045796026100481_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a mean follow-up of 8\u00a0years, PTSD was associated with excess all-cause mortality (AHR\u00a0=\u00a01.32, 95% CI 1.24\u20131.41) driven by markedly increased unnatural deaths (AHR\u00a0=\u00a05.93, 5.13\u20136.85), especially suicide (AHR\u00a0=\u00a010.36, 8.41\u201312.76) and accidental deaths (AHR\u00a0=\u00a02.18, 1.67\u20132.86). Natural-cause mortality showed no consistent increase (AHR\u00a0=\u00a00.91, 0.85\u20130.98). In sibling analyses, excess risks persisted for all-cause (AHR\u00a0=\u00a02.48, 2.04\u20133.01), unnatural deaths (AHR\u00a0=\u00a04.76, 3.58\u20136.34) and suicide mortality (AHR\u00a0=\u00a07.90, 5.21\u201311.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2045796026100481_sec4d\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s2045796026100481","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T05:27:49Z","timestamp":1772515669000},"source":"Crossref","is-referenced-by-count":0,"title":["Post-traumatic stress disorder and risk of all-cause and cause-specific mortality: a nationwide population and sibling-controlled cohort study in Taiwan"],"prefix":"10.1017","volume":"35","author":[{"given":"Chih-Wei","family":"Hsu","sequence":"first","affiliation":[{"name":"Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0622-9175","authenticated-orcid":false,"given":"Yang-Chieh Brian","family":"Chen","sequence":"additional","affiliation":[{"name":"Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine"},{"name":"The University of Texas Health Science Center at Houston"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5320-1151","authenticated-orcid":false,"given":"Liang-Jen","family":"Wang","sequence":"additional","affiliation":[{"name":"Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6516-1073","authenticated-orcid":false,"given":"Mu-Hong","family":"Chen","sequence":"additional","affiliation":[{"name":"Taipei Veterans General Hospital"},{"name":"College of Medicine, National Yang Ming Chiao Tung University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao-Hsu","family":"Yang","sequence":"additional","affiliation":[{"name":"Chiayi Chang Gung Memorial Hospital"},{"name":"Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital"},{"name":"College of Medicine, Chang Gung University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1138-5586","authenticated-orcid":false,"given":"Chih-Sung","family":"Liang","sequence":"additional","affiliation":[{"name":"Beitou Branch, Tri-Service General Hospital, National Defense Medical University"},{"name":"National Defense Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5852-7652","authenticated-orcid":false,"given":"Edward Chia-Cheng","family":"Lai","sequence":"additional","affiliation":[{"name":"College of Medicine, National Cheng Kung University"},{"name":"National Cheng Kung University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"S2045796026100481_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2018.11.010"},{"key":"S2045796026100481_ref11","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4793-7"},{"key":"S2045796026100481_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2011.08.007"},{"key":"S2045796026100481_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.09.117"},{"key":"S2045796026100481_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.10.009"},{"key":"S2045796026100481_ref13","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2013.13030325"},{"key":"S2045796026100481_ref30","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.115.171975"},{"key":"S2045796026100481_ref6","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291703001612"},{"key":"S2045796026100481_ref34","first-page":"980","article-title":"A prospective study of mortality and trauma-related risk factors among a nationally representative sample of Vietnam veterans","volume":"182","author":"Schlenger","year":"2015","journal-title":"American Journal of Epidemiology"},{"key":"S2045796026100481_ref41","first-page":"231","volume-title":"Urban Agglomeration","author":"Tsai","year":"2017"},{"key":"S2045796026100481_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/0006-3223(95)00451-3"},{"key":"S2045796026100481_ref20","first-page":"1046","article-title":"Treatment of posttraumatic stress disorder reduces suicidal ideation","volume":"30","author":"Gradus","year":"2013","journal-title":"Depression and Anxiety"},{"key":"S2045796026100481_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2019.03.014"},{"key":"S2045796026100481_ref31","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-023-04716-w"},{"key":"S2045796026100481_ref33","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-022-00635-8"},{"key":"S2045796026100481_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"S2045796026100481_ref14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-077564"},{"key":"S2045796026100481_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2005.03.009"},{"key":"S2045796026100481_ref29","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1217750110"},{"key":"S2045796026100481_ref19","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv066"},{"key":"S2045796026100481_ref15","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2022.110"},{"key":"S2045796026100481_ref18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.20476"},{"key":"S2045796026100481_ref27","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.17550"},{"key":"S2045796026100481_ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2024.0378"},{"key":"S2045796026100481_ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s13524-015-0377-2"},{"key":"S2045796026100481_ref7","doi-asserted-by":"publisher","DOI":"10.1002\/wps.21269"},{"key":"S2045796026100481_ref22","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-022-02094-7"},{"key":"S2045796026100481_ref1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp20X712289"},{"key":"S2045796026100481_ref25","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717000708"},{"key":"S2045796026100481_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2019.11.005"},{"key":"S2045796026100481_ref21","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.36771"},{"key":"S2045796026100481_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.4170"},{"key":"S2045796026100481_ref36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5784"},{"key":"S2045796026100481_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100402"},{"key":"S2045796026100481_ref12","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20994"},{"key":"S2045796026100481_ref37","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.10.1675"},{"key":"S2045796026100481_ref32","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"S2045796026100481_ref3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"S2045796026100481_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2018.02.002"},{"key":"S2045796026100481_ref40","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.132.6.959"},{"key":"S2045796026100481_ref42","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2015.57"},{"key":"S2045796026100481_ref8","doi-asserted-by":"publisher","DOI":"10.1159\/000535777"},{"key":"S2045796026100481_ref4","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-023-02109-9"}],"container-title":["Epidemiology and Psychiatric Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2045796026100481","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T05:27:51Z","timestamp":1772515671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2045796026100481\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":43,"alternative-id":["S2045796026100481"],"URL":"https:\/\/doi.org\/10.1017\/s2045796026100481","relation":{},"ISSN":["2045-7960","2045-7979"],"issn-type":[{"value":"2045-7960","type":"print"},{"value":"2045-7979","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e12"}}