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Biol Psychiatry. 2019 May 1;85(9):744-751. doi: 10.1016/j.biopsych.2018.11.008. Epub 2018 Nov 22.

Infections, Anti-infective Agents, and Risk of Deliberate Self-harm and Suicide in a Young Cohort: A Nationwide Study.

Author information

1
Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark. Electronic address: helene.hilsen@gmail.com.
2
Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark.
3
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
4
Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.
5
University of Maryland School of Medicine, Baltimore, Maryland; Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, Colorado; The Military and Veteran Microbiome Consortium for Research and Education, Denver, Colorado.
6
Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
7
Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.

Abstract

BACKGROUND:

Evidence links infections to mental disorders and suicidal behavior. However, knowledge is sparse regarding less severe infections, anti-infective treatment, and deliberate self-harm. Using nationwide Danish longitudinal registers, we estimated associations between infections treated with anti-infective agents and infections requiring hospitalization with the risk of deliberate self-harm.

METHODS:

A total of 1.3 million people born between 1977 and 2002 were followed during the period from 1995 to 2013. In total, 15,042 individuals were recorded with deliberate self-harm (92% had been treated with anti-infective agents and 19% had been hospitalized for infections) and 114 died by suicide (64% had been treated with anti-infective agents and 13% had been hospitalized for infections). Hazard rate ratios were obtained while adjusting for age, gender, calendar period, education, hospitalizations with infections, prescribed anti-infective agents during childhood, parental mental disorders, and parental deliberate self-harm.

RESULTS:

Individuals with infections treated with anti-infective agents had an increased risk of deliberate self-harm with a hazard rate ratio of 1.80 (95% confidence interval = 1.68-1.91). The associations fitted a dose-response relationship (p < .001) and remained significant up to 5 years after last infection. An additive effect was found for individuals with an additional hospitalization for infections with an increased hazard rate ratio of 3.20 (95% confidence interval = 2.96-3.45) for deliberate self-harm.

CONCLUSIONS:

An increased risk of deliberate self-harm was found among individuals with infections treated with anti-infective agents in temporal and dose-response associations. These results add to the growing literature on a possible link between infections and the pathophysiological mechanisms of suicidal behavior.

KEYWORDS:

Anti-infective agents; Deliberate self-harm; Infections; Inflammation; Primary care sector; Suicide

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