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Abstract
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.
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Luetke M, Judge A, Kianersi S, Jules R, Rosenberg M. Hurricane impact associated with transactional sex and moderated, but not mediated, by economic factors in Okay, Haiti. Soc Sci Med 2020; 261:113189. [PMID: 32745820 PMCID: PMC8220409 DOI: 10.1016/j.socscimed.2020.113189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
Abstract
Natural disasters, such as hurricanes, often negatively affect the economic wellbeing of affected individuals. Under such conditions, women may engage in transactional sexual behaviors in order to compensate for lost income and provide for their households. In this study, we evaluated the relationship between hurricane impact and transactional sex and if this relationship was moderated, or mediated, through economic factors. Between December 2017 and February 2018, approximately one year after the area was hit by a category 4 hurricane (Hurricane Matthew), we interviewed a random sample of female microfinance members (n = 304) in Okay, Haiti. We estimated the association between hurricane impact and transactional sex using log-binomial regression. Next, we tested for economic moderation of this relationship by incorporating interaction terms between hurricane impact and food insecurity, poverty, and loss of income generating materials in three separate log-binomial models. Finally, we assessed possible mediation of this relationship by loss of income generating resources and a latent variable, economic stress, using a structural equation model. We found participants who had experienced hurricane impact were 58% more likely to have engaged in transactional sex [prevalence ratio (95% confidence interval): 1.58 (1.19-2.09)]. This relationship was significant and strongly positive among women who were food insecure and had high poverty but not so among women who were food secure and had low poverty, respectively. The final structural equation model (with fit: χ2 = 19.700, degrees of freedom = 15; CFI = 0.958; TLI = 0.941; RMSEA = 0.040) revealed that the relationship was not mediated through economic factors. However, the association between hurricane impact and transactional sex remained significant while controlling for these economic factors. Notably, the findings that the relationship between hurricane impact and transactional sex was moderated, but not mediated, by economic factors implies populations at-risk of experiencing natural disasters should be preemptively targeted with economic interventions to build capacity and resilience before such a disaster hits.
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Affiliation(s)
- Maya Luetke
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA.
| | - Ashley Judge
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
| | | | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, USA
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Song H, Fall K, Fang F, Erlendsdóttir H, Lu D, Mataix-Cols D, Fernández de la Cruz L, D'Onofrio BM, Lichtenstein P, Gottfreðsson M, Almqvist C, Valdimarsdóttir UA. Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study. BMJ 2019; 367:l5784. [PMID: 31645334 PMCID: PMC6812608 DOI: 10.1136/bmj.l5784] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections. DESIGN Population and sibling matched cohort study. SETTING Swedish population. PARTICIPANTS 144 919 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 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population. MAIN OUTCOME MEASURES 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. RESULTS The average age at diagnosis of a stress related disorder was 37 years (55 541, 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. CONCLUSION 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.
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Affiliation(s)
- Huan Song
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavík, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- West China Biomedical Big Data Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Katja Fall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Fang Fang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helga Erlendsdóttir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Clinical Microbiology, Landspítali University Hospital, Reykjavík, Iceland
| | - Donghao Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magnús Gottfreðsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Infectious Diseases, Landspítali University Hospital, Reykjavik, Iceland
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavík, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
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Turpin R, Brotman RM, Miller RS, Klebanoff MA, He X, Slopen N. Perceived stress and incident sexually transmitted infections in a prospective cohort. Ann Epidemiol 2019; 32:20-27. [PMID: 30799204 DOI: 10.1016/j.annepidem.2019.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/02/2018] [Accepted: 01/15/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Psychosocial stress has been associated with susceptibility to many infectious pathogens. We evaluated the association between perceived stress and incident sexually transmitted infections (STIs; Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis genital infections) in a prospective study of women. Stress may increase vulnerability to STIs by suppressing immune function and altering the protective vaginal microbiota. METHODS Using the 1999 Longitudinal Study of Vaginal Flora (n = 2439), a primarily African American cohort of women, we fitted Cox proportional hazards models to examine the association between perceived stress and incident STIs. We tested bacterial vaginosis (measured by Nugent Score) and sexual behaviors (condom use, number of partners, and partner concurrence) as mediators using VanderWeele's difference method. RESULTS Baseline perceived stress was associated with incident STIs both before and after adjusting for confounders (adjusted hazard ratio = 1.015; 95% confidence interval, 1.005-1.026). Nugent score and sexual behaviors significantly mediated 21% and 65% of this adjusted association, respectively, and 78% when included together in the adjusted model. CONCLUSIONS This study advances understanding of the relationship between perceived stress and STIs and identifies high-risk sexual behaviors and development of bacterial vaginosis-both known risk factors for STIs-as mechanisms underlying this association.
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Affiliation(s)
- Rodman Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD.
| | - Rebecca M Brotman
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD
| | - Ryan S Miller
- Division of Pediatric Endocrinology, University of Maryland School of Medicine, Baltimore, MD
| | - Mark A Klebanoff
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Xin He
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
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