A Nationwide Cohort Study of the Association Between Hospitalization With Infection and Risk of Death by Suicide
A Nationwide Cohort Study of the Association Between Hospitalization With Infection and Risk of Death by Suicide
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DOI：
10.1001/jamapsychiatry.2016.1594
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发表时间：
2016-09-01
期刊：
影响因子：
25.8
通讯作者：
Erlangsen, Annette
中科院分区：
文献类型：
--
作者：
Lund-Sorensen, Helene;Benros, Michael E.;Erlangsen, Annette
重要的研究结果表明，感染可能与精神障碍和自杀行为的发展有关。需要大规模的研究来调查感染对自杀风险的影响。目的评估感染住院与自杀死亡风险之间的关系。设计、设置和参与者全国范围内、基于人群的前瞻性队列研究，随访超过1.49亿人年。使用生存分析技术对数据进行分析，并根据性别、年龄、历期、同居状况、社会经济状况和查尔森合并症指数进行调整。个人数据取自丹麦纵向登记册。在长达32年的随访期内，共有722万名15岁或以上的丹麦人在1980年1月1日至2011年12月31日期间生活在丹麦。丹麦死因登记中确定了MAIN的结果和自杀死亡风险的衡量标准。结果共观察7221 578人(男3 601 653人，女3 619 925人)，共149 061 786人年，随访期内有32 683人自杀。在自杀者中，7892人(24.1%)以前在住院期间被诊断为感染。有感染的住院与自杀风险增加有关，与没有感染的患者相比，IRR为1.42(95%CI，1.38-1.46)。根据不同感染的医院接触人数，观察了剂量-反应关系。例如，有7次或更多感染与2.90的IRR有关(95%可信区间，2.14-3.93)。在剂量-反应关系中，感染治疗天数与自杀风险增加相关。住院治疗3个月以上与IRR为2.38有关(95%可信区间为2.05-2.76)。与感染住院相关的人群归因风险占自杀的10.1%。结论与相关性研究发现，在前瞻性和剂量-反应关系中，感染住院的个体自杀死亡风险增加。这些发现表明，感染可能在自杀行为的病理生理机制中起着相关的作用。
IMPORTANCE Findings suggest that infections might be linked to the development of psychiatric disorders and suicidal behavior. Large-scale studies are needed to investigate the effect of infection on the risk of suicide.OBJECTIVE To estimate the association between hospitalization with infection and the risk of death by suicide.DESIGN, SETTING, AND PARTICIPANTS Nationwide, population-based, prospective cohort study with more than 149 million person-years of follow-up. Data were analyzed with survival analysis techniques and were adjusted for sex, age, calendar period, cohabitation status, socioeconomic status, and the Charlson Comorbidity Index. Individual data were drawn from Danish longitudinal registers. A total of 7.22 million individuals 15 years or older living in Denmark between January 1, 1980, and December 31, 2011, were observed during a 32-year follow-up period.MAIN OUTCOMES AND MEASURES The risk of death by suicide was identified in the Danish Cause of Death Register. Incidence rate ratios (IRRs) and accompanying 95% CIs were used as measures of relative risk.RESULTS In 7 221 578 individuals (3 601 653 men and 3 619 925 women) observed for a total of 149 061 786 person-years, 32 683 suicides were observed during the follow-up period. Among the suicides, 7892 (24.1%) individuals had previously been diagnosed as having an infection during a hospitalization. Hospitalization with infection was linked to an elevated risk of suicide, with an IRR of 1.42 (95% CI, 1.38-1.46) compared with those without prior infection. Dose-response relationships were observed with respect to the number of hospital contacts for different infections. For example, having 7 or more infections was linked to an IRR of 2.90 (95% CI, 2.14-3.93). The number of days of treatment for infections was associated with an elevated risk of suicide in a dose-response relationship. More than 3 months of hospital treatment was linked to an IRR of 2.38 (95% CI, 2.05-2.76). The population-attributable risk associated with hospitalization with infection accounted for 10.1% of suicides.CONCLUSIONS AND RELEVANCE An increased risk of death by suicide was found among individuals hospitalized with infection in prospective and dose-response relationships. These findings indicate that infections may have a relevant role in the pathophysiological mechanisms of suicidal behavior.