Infections and post-traumatic stress disorder: a population-based matched cohort study

Background

At some point in their lives 1 in 10 people in the UK are expected to experience posttraumatic stress disorder (PTSD). Critical illness and intensive care unit treatment have been associated with risk of PTSD. The relationship between acute infections and PTSD is not clear.

Methods

Using data from the Clinical Practice Research Datalink Aurum (01/01/2007-31/03/2023), we conducted six matched cohort studies. Adults with lower respiratory tract (LRTI), urinary tract (UTI) and skin/soft tissue (SSTI) infections, gastroenteritis (GE), sepsis, and meningitis/encephalitis (positive control) were matched on sex, age, general practice, and calendar period with up to five adults without infection. Using Cox regression, stratified by matched set, and adjusting for Charlson comorbidity index, harmful alcohol use, smoking, and obesity we estimated hazard ratios (HRs) for incident PTSD among adults with infection relative to those without.

Results

The smallest cohort consisted of 18,101 individuals with meningitis/encephalitis matched to 90,021 without, and the largest of 396,812 individuals with SSTI matched to 1,734,615 without. Median follow-up was shortest in the sepsis cohort (2.4 years) and longest in the GE cohort (4.2 years). Median age ranged from 43 to 72 years; 49-57% of all cohorts were women, except in the UTI cohort (80%). After adjustment, each infection was associated with an increased PTSD hazards: UTI: HR 1.56 (95%CI 1.38,1.75), LRTI: 1.64 (1.50, 1.78), SSTI: 1.64 (1.51,1.78), GE: 1.89 (1.74, 2.07), sepsis: 2.25 (1.89, 2.69), and meningitis/encephalitis: 2.43 (1.82, 3.25).

Conclusions

Our findings suggest that acute infections among adults may increase PTSD risk. Evidence was stronger for more severe infections, e.g. sepsis. Further research is needed to understand pathways between infections and PTSD.

Key messages

• A large electronic health records study among adults in the UK links acute infections to PTSD, particularly severe infections such as sepsis and meningitis/encephalitis.

• Mental health monitoring and interventions following severe infections may identify and support incident PTSD cases. Further research is needed to understand pathways between infections and PTSD.