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

Helene Gjervig Hansen; Ole Köhler-Forsberg; Liselotte Petersen; Merete Nordentoft; Teodor T Postolache; Annette Erlangsen; Michael E Benros

doi:10.1016/j.biopsych.2018.11.008

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

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

Authors

Helene Gjervig Hansen¹, Ole Köhler-Forsberg², Liselotte Petersen³, Merete Nordentoft⁴, Teodor T Postolache⁵, Annette Erlangsen⁶, Michael E Benros⁷

Affiliations

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.

PMID: 30563760
DOI: 10.1016/j.biopsych.2018.11.008

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.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Anti-Infective Agents / therapeutic use*
Cohort Studies
Denmark / epidemiology
Female
Humans
Infections / complications
Infections / drug therapy*
Infections / epidemiology*
Male
Proportional Hazards Models
Registries
Risk Factors
Self-Injurious Behavior / complications
Self-Injurious Behavior / epidemiology*
Suicide / statistics & numerical data*

Substances

Anti-Infective Agents