Posttraumatic Stress Disorder and the Associated Risk of Autoimmune Skin Diseases: A Nationwide Population-Based Cohort Study

Systematic review and meta-analysis of post-traumatic stress disorder as a risk factor for multiple autoimmune diseases

Background

Post Traumatic Stress Disorder (PTSD) is a prevalent and debilitating psychiatric illness that has been linked to poor health outcomes and increased risk of developing chronic health conditions, including multiple autoimmune diseases such as Systemic Lupus Erythematosus (SLE), Inflammatory Bowel Disease (IBD), Rheumatoid Arthritis (RA), and Multiple Sclerosis (MS).

Aim

This meta-analysis assesses the epidemiological research in this field and briefly explores the hypothesized neurobiological and immunological mechanisms that may underlie the association between PTSD and the development of Autoimmune Disease.

Methods

PubMed, SCOPUS, and Cochrane Reviews databases were searched for all relevant articles in August 2023. Studies were systematically screened for relevance and inclusion criteria by two reviewers before quality assessment and data extraction were performed. Fixed and random-effect meta-analyses were performed to evaluate PTSD as a risk factor for the development of specific autoimmune diseases. Subgroup analyses examining the roles of biological sex and PTSD severity were also performed.

Results

The initial search yielded 3010 articles where only eight prospective and retrospective cohort studies met criteria for inclusion in the meta-analysis. These eight studies were subdivided based on specific disease outcomes. Random effects model for risk of developing any autoimmune disease in persons with PTSD vs. control was 1.291 (95% CI = 1.179 to 1.412; P <0.001; n=1,984,310; 4 studies included). The strength of the association between PTSD and risk of developing specific autoimmune diseases varied by outcome condition from 1.142 (95% CI = 1.085 to 1.202, P <0.001) for risk of IBD to 1.302 (1.037 to 1.635, P = 0.023) for risk of MS. Random effects models showed statistically significant associations between PTSD and IBD, SLE, RA, MS, and Thyroiditis.

Conclusion

These results suggest that the risk for developing autoimmune conditions, including SLE, MS, RA, and IBD, is significantly increased in the setting of PTSD. This association may have important implications on clinical practice and research into the pathophysiology of stress disorders.

Traumatic experiences, dissociative symptoms, and alexithymia in patients with alopecia areata

Although genetic, environmental, autoimmune, and psychological factors are believed to play a role in the onset of alopecia areata (AA), the exact cause remains unknown. This study aimed to investigate whether there are differences in traumatic experiences, dissociative symptoms, and alexithymia levels between groups. Fifty eight patients diagnosed with AA, 58 individuals with dermatological diseases thought to have a low psychosomatic component, and 58 individuals not diagnosed with any chronic disease were included in the study. All participants were assessed using the Childhood Trauma Questionnaire (CTQ-28), Dissociative Experiences Scale (DES), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and Toronto Alexithymia Scale (TAS-20). A Structured Clinical Interview for DSM-5 (SCID-5-CV) form was used to exclude additional psychiatric diagnoses. Mean scores on the CTQ-28 scale revealed differences between groups in terms of physical neglect and emotional neglect scores (p < 0.001; p = 0.022; p < 0.001). There were no differences in DES scores between groups (p = 0.085). When compared in terms of TAS-20 and PCL-5 scores, differences were found (p = 0.016; p = 0.024). As a result of this study, it was concluded that physical neglect and emotional neglect could play a significant role in the onset of AA. Alexithymia and traumatic stress disorder symptoms might be more prevalent in patients with AA.

Triggers for the onset and recurrence of psoriasis: a review and update

Psoriasis is an immune-mediated inflammatory skin disease, involving a complex interplay between genetic and environmental factors. Previous studies have demonstrated that genetic factors play a major role in the pathogenesis of psoriasis. However, non-genetic factors are also necessary to trigger the onset and recurrence of psoriasis in genetically predisposed individuals, which include infections, microbiota dysbiosis of the skin and gut, dysregulated lipid metabolism, dysregulated sex hormones, and mental illness. Psoriasis can also be induced by other environmental triggers, such as skin trauma, unhealthy lifestyles, and medications. Understanding how these triggers play a role in the onset and recurrence of psoriasis provides insights into psoriasis pathogenesis, as well as better clinical administration. In this review, we summarize the triggers for the onset and recurrence of psoriasis and update the current evidence on the underlying mechanism of how these factors elicit the disease. Video Abstract.

The Association between Sugar-Sweetened Beverages and Male Pattern Hair Loss in Young Men

We performed this study to investigate the association between sugar-sweetened beverage (SSB) consumption and male pattern hair loss (MPHL) in young men. We conducted this cross-sectional study from January to April 2022 in mainland China. Young people aged 18-45 years (n = 1951) were recruited from 31 provinces in China. We used a self-reported online survey for data collection. We explored the associations between the amount/frequency of SSB consumption and MPHL by using a binary logistic regression model, with adjustments for sociodemographic, hair status, dietary intake, lifestyle, and psychological factors. Among the 1028 participants (27.8 ± 7.2 years) in the final analysis, we found that high SSB consumption is associated with a higher risk of MPHL. We recommend more support to decrease SSB consumption among young people to minimize negative health outcomes.

Obsessive-compulsive disorder and the associated risk of autoimmune skin diseases: a nationwide population-based cohort study

BACKGROUND

The concurrent incidence of autoimmune comorbidities in obsessive-compulsive disorder (OCD) is known. However, the association between OCD and related autoimmune skin diseases (ASDs) has not been well studied.

OBJECTIVE

This study aimed to investigate the association between OCD and the risk of ASDs.

METHODS

To assess the risk of developing ASDs, we recruited 44 324 patients with OCD and 177 296 matched controls from the National Health Insurance Research Database in Taiwan. A Cox regression model was used for the analyses.

RESULTS

After adjusting for confounders, an increased risk of ASDs among the patients with OCD (adjusted hazard ratio [aHR]: 6.36; 95% confidence interval [CI]: 5.43-7.45) was found when compared to the controls. Statistically significant associations were found between OCD and seven individual ASDs, including psoriasis (aHR: 12.52; 95% CI: 8.78-17.85), lichen planus (aHR: 27.22; 95% CI: 13.09-56.60), alopecia areata (aHR: 13.69; 95% CI: 9.38-19.98), autoimmune bullous diseases (aHR: 4.30; 95% CI: 2.03-9.11), hidradenitis suppurativa (aHR: 29.95; 95% CI: 3.35-267.62), vitiligo (aHR: 9.35; 95% CI: 5.35-16.32), and lupus erythematosus (aHR: 2.10; 95% CI: 1.52-2.91).

CONCLUSIONS

Patients with OCD had an increased risk of developing ASDs compared to matched controls. Further studies are required to clarify the underlying mechanisms.