Severe stress increases risk for life-threatening infections

  • Song H, et al
  • BMJ
  • 23 Oct 2019

  • International Clinical Digest
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  • Severe stress reactions in clinically diagnosed stress-related disorders (especially those diagnosed in early life) increase the risk of life-threatening infections in short- and long-term.
  • Editorial.

Why this matters

  • Persistent use of selective serotonin reuptake inhibitors (SSRIs) in first year following diagnosis helps attenuate life-threatening infections risk.
  • Consider consult with psychiatric specialist, regular mental-health follow-up, especially in childhood/adolescence.

Key results

  • 144,919 stress-related disorders cohort, 1,449,190 matched cohort (184,612 siblings).
  • 4843 with incident life-threatening infections (2197 stress disorders, 2656 unaffected siblings) identified.
  • Life-threatening infections risk: any stress-related disorder (HR, 1.47; 95% CI, 1.37-1.58), posttraumatic stress disorder (HR, 1.92; 95% CI, 1.46-2.52), acute stress reaction (HR, 1.43; 95% CI, 1.29-1.58), adjustment disorder/others (HR, 1.48; 95% CI, 1.33-1.64).
  • Overall, stress-related disorders linked to all studied life-threatening infections, with strongest association observed in persons without other severe somatic diseases/other psychiatric disorders (P<.001 within first year postdiagnosis>
  • SSRI use linked to lower infection risk after 1 year (HR, 0.81; 95% CI, 0.66-0.98; P=.03).

Study design

  • Population-based, sibling-controlled Swedish cohort study exploring link between stress-related disorders, life-threatening infections (e.g., sepsis, endocarditis, central nervous system, fatal infections) risk, 1987-2013.
  • Funding: Grant of Excellence, others.


  • Observational.
  • Underestimated case numbers.
  • Limited confounders data (including behaviors, therapy, etc.).
  • Limited generalisability.