{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:33:58Z","timestamp":1791916438915,"version":"4.3.4"},"reference-count":54,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T00:00:00Z","timestamp":1571788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population and sibling matched cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Swedish population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>144\u2009919 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\u2009612 full siblings of individuals with a diagnosed stress related disorder and 1\u2009449\u2009190 matched individuals without such a diagnosis from the general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average age at diagnosis of a stress related disorder was 37 years (55\u2009541, 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj.l5784","type":"journal-article","created":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T23:55:25Z","timestamp":1571874925000},"page":"l5784","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":70,"title":["Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3845-8079","authenticated-orcid":false,"given":"Huan","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Fall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Erlendsd\u00f3ttir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghao","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mataix-Cols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Fern\u00e1ndez de la Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"D\u2019Onofrio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lichtenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magn\u00fas","family":"Gottfre\u00f0sson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catarina","family":"Almqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Unnur A","family":"Valdimarsd\u00f3ttir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,10,23]]},"reference":[{"key":"key20191025000407_ref1","doi-asserted-by":"publisher","DOI":"10.1038\/nri1571"},{"key":"key20191025000407_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2009.10.019"},{"key":"key20191025000407_ref3","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.130.4.601"},{"key":"key20191025000407_ref4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108293250903"},{"key":"key20191025000407_ref5","doi-asserted-by":"publisher","DOI":"10.1097\/01.PSY.0000077508.57784.DA"},{"key":"key20191025000407_ref6","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1118355109"},{"key":"key20191025000407_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2009.01.004"},{"key":"key20191025000407_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)06098-X"},{"key":"key20191025000407_ref9","doi-asserted-by":"publisher","DOI":"10.1097\/00006842-199201000-00005"},{"key":"key20191025000407_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1705-x"},{"key":"key20191025000407_ref11","volume-title":"The ICD-10 classification of mental and behavioral disorders: Clinical description and diagnostic guidelines (ICD-10).","author":"WHO","year":"1992"},{"key":"key20191025000407_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(15)00309-0"},{"key":"key20191025000407_ref13","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0910794107"},{"key":"key20191025000407_ref14","doi-asserted-by":"publisher","DOI":"10.2147\/JIR.S155903"},{"key":"key20191025000407_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.7028"},{"key":"key20191025000407_ref16","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1097\/EDE.0000000000001071","article-title":"Posttraumatic Stress Disorder and Incident Infections: A Nationwide Cohort Study","volume":"30","author":"Jiang","year":"2019","journal-title":"Epidemiology"},{"key":"key20191025000407_ref17","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301252"},{"key":"key20191025000407_ref18","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-59745-423-0_10"},{"key":"key20191025000407_ref19","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.67.6.985"},{"key":"key20191025000407_ref20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i65"},{"key":"key20191025000407_ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-018-01269-2"},{"key":"key20191025000407_ref22","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2018.1556553"},{"key":"key20191025000407_ref23","doi-asserted-by":"publisher","DOI":"10.1177\/0269881114525674"},{"key":"key20191025000407_ref24","first-page":"3","article-title":"Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder","volume":"161","author":"Ursano","year":"2004","journal-title":"Am J Psychiatry"},{"key":"key20191025000407_ref25","doi-asserted-by":"publisher","DOI":"10.1186\/1745-0179-5-15"},{"key":"key20191025000407_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2011.10.022"},{"key":"key20191025000407_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"key20191025000407_ref28","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-311650"},{"key":"key20191025000407_ref29","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4757-3462-1","volume-title":"Regression modeling strategies, with applications to linear models, survival analysis and logistic regression.","author":"Harrell","year":"2001"},{"key":"key20191025000407_ref30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7382.219"},{"key":"key20191025000407_ref31","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9280.01452"},{"key":"key20191025000407_ref32","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e3181f1d003"},{"key":"key20191025000407_ref33","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000120"},{"key":"key20191025000407_ref34","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.74"},{"key":"key20191025000407_ref35","first-page":"53","article-title":"Risk factors for community-acquired bacterial meningitis in adults","volume":"73","author":"Adriani","year":"2015","journal-title":"Neth J Med"},{"key":"key20191025000407_ref36","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X690401"},{"key":"key20191025000407_ref37","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2157-z"},{"key":"key20191025000407_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30387-9"},{"key":"key20191025000407_ref39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2004.00463.x"},{"key":"key20191025000407_ref40","doi-asserted-by":"publisher","DOI":"10.1089\/088282403322017884"},{"key":"key20191025000407_ref41","doi-asserted-by":"publisher","DOI":"10.1089\/vim.2005.18.41"},{"key":"key20191025000407_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14904-5"},{"key":"key20191025000407_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8529(18)30091-4"},{"key":"key20191025000407_ref44","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2016.01.013"},{"key":"key20191025000407_ref45","doi-asserted-by":"publisher","DOI":"10.1097\/01.PSY.0000033123.70631.8E"},{"key":"key20191025000407_ref46","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker215"},{"key":"key20191025000407_ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2006.02.014"},{"key":"key20191025000407_ref48","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.84.6.920"},{"key":"key20191025000407_ref49","doi-asserted-by":"publisher","DOI":"10.1038\/nri803"},{"key":"key20191025000407_ref50","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2010.5"},{"key":"key20191025000407_ref51","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2015.67"},{"key":"key20191025000407_ref52","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2014.01.002"},{"key":"key20191025000407_ref53","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2018.02.002"},{"key":"key20191025000407_ref54","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1217750110"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.l5784","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.l5784","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T18:48:36Z","timestamp":1611600516000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.l5784"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,23]]},"references-count":54,"alternative-id":["10.1136\/bmj.l5784"],"URL":"https:\/\/doi.org\/10.1136\/bmj.l5784","relation":{},"ISSN":["0959-8138","1756-1833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,23]]}}}