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Posttraumatic Stress Disorder and Incident Infections

A Nationwide Cohort Study

Jiang, Tammya; Farkas, Dóra Körmendinéb; Ahern, Thomas P.c,d; Lash, Timothy L.b,e; Sørensen, Henrik T.a,b; Gradus, Jaimie L.a,b,f

doi: 10.1097/EDE.0000000000001071
Infectious Diseases
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Background: It is unknown whether posttraumatic stress disorder (PTSD) is associated with incident infections. This study’s objectives were to examine (1) the association between PTSD diagnosis and 28 types of infections and (2) the interaction between PTSD diagnosis and sex on the rate of infections.

Methods: The study population consisted of a longitudinal nationwide cohort of all residents of Denmark who received a PTSD diagnosis between 1995 and 2011, and an age- and sex-matched general population comparison cohort. We fit Cox proportional hazards regression models to examine associations between PTSD diagnosis and infections. To account for multiple estimation, we adjusted the hazard ratios (HRs) using semi-Bayes shrinkage. We calculated interaction contrasts to assess the presence of interaction between PTSD diagnosis and sex.

Results: After semi-Bayes shrinkage, the HR for any type of infection was 1.8 (95% confidence interval: 1.6, 2.0), adjusting for marital status, non-psychiatric comorbidity, and diagnoses of substance abuse, substance dependence, and depression. The association between PTSD diagnosis and some infections (e.g., urinary tract infections) were stronger among women, whereas other associations were stronger among men (e.g., skin infections).

Conclusions: This study’s findings suggest that PTSD diagnosis is a risk factor for numerous infection types and that the associations between PTSD diagnosis and infections are modified by sex.

From the aDepartment of Epidemiology, Boston University School of Public Health, Boston, MA

bDepartment of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark

cDepartment of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT

dDepartment of Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT

eDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA

fDepartment of Psychiatry, Boston University, Boston, MA

Submitted October 29, 2018; accepted July 22, 2019.

This work was supported by the Lundbeck Foundation (grant number R248-2017–521); the National Institute of Mental Health at the National Institutes of Health (grant numbers 1R01 MH110453-01A1 and 1R21 MH094551-01A1 to J.L.G.) and the National Institute of General Medical Sciences at the National Institutes of Health (grant number P20 GM103644 to T.P.A.).

The authors report no conflicts of interest.

Data and computing code: For access to data, please contact the Department of Clinical Epidemiology at Aarhus University Hospital. The analytic code used for the analyses contained in this article is presented in the appendix.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).

Correspondence: Tammy Jiang, Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, T321E, Boston, MA 02118. E-mail: Tjiang1@bu.edu.

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