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Infections and exposure to anti-infective agents and the risk of severe mental disorders: a nationwide study

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  • O Köhler
  • L Petersen
  • O Mors
  • P B Mortensen
  • R H Yolken
  • C Gasse
  • M E Benros
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OBJECTIVE: Severe infections are associated with increased risks of mental disorders; however, this is the first large-scale study investigating whether infections treated with anti-infective agents in the primary care setting increase the risks of schizophrenia and affective disorders.

METHOD: We identified all individuals born in Denmark 1985-2002 (N = 1 015 447) and studied the association between infections treated with anti-infective agents and the subsequent risk of schizophrenia and affective disorders during 1995-2013. Cox regression analyses were adjusted for important confounders.

RESULTS: Infections treated with anti-infective agents were associated with increased risks of schizophrenia by a hazard rate ratio (HRR) of 1.37 (95%-CI = 1.20-1.57) and affective disorders by a HRR of 1.64 (95%-CI = 1.48-1.82), fitting a dose-response and temporal relationship (P < 0.001). The excess risk was primarily driven by infections treated with antibiotics, whereas infections treated with antivirals, antimycotics, and antiparasitic agents were not significant after mutual adjustment. Individuals with infections requiring hospitalization had the highest risks for schizophrenia (HRR = 2.05; 95%-CI = 1.77-2.38) and affective disorders (HRR = 2.59; 95%-CI = 2.31-2.89).

CONCLUSION: Infections treated with anti-infective agents and particularly infections requiring hospitalizations were associated with increased risks of schizophrenia and affective disorders, which may be mediated by effects of infections/inflammation on the brain, alterations of the microbiome, genetics, or other environmental factors.

Original languageEnglish
JournalActa Psychiatrica Scandinavica
Volume135
Issue number2
Pages (from-to)97-105
Number of pages9
ISSN0001-690X
DOIs
Publication statusPublished - Feb 2017

    Research areas

  • Adolescent, Adult, Anti-Infective Agents, Communicable Diseases, Denmark, Female, Hospitalization, Humans, Incidence, Male, Middle Aged, Mood Disorders, Proportional Hazards Models, Registries, Risk Factors, Schizophrenia, Young Adult, Journal Article

ID: 51909445