ImportanceTraumatic events have been associated with elevated risks of psychiatric disorders, while the contributions of familial factors to these associations remain less clear.ObjectiveTo determine the contribution of familial factors to long-term incidence trajectories of psychiatric disorders following potentially traumatic events.Design, Setting, and ParticipantsThis cohort study evaluated 3 separate cohorts of individuals residing in Sweden who were free of previous diagnosed psychiatric disorders when first exposed to assault (n = 49 957), injury (n = 555 314), or bereavement (n = 321 263) from January 1987 to December 2013, together with their unexposed full siblings, and 10 age-, sex-, and birthplace-matched unexposed individuals (per exposed individual). Cohorts were created from the Swedish Total Population Register linked to health and population registers. Data were analyzed from March 2022 to April 2023.ExposuresPotentially traumatic events, including various types of assault, injuries, and bereavement (death of a child or of a spouse or partner), were ascertained from the Swedish national registers.Main Outcomes and MeasuresIncident psychiatric disorders were ascertained from the Swedish Patient Register. Flexible parametric and Cox models were used to estimate associations of potentially traumatic events with incident psychiatric disorders after multivariable adjustment.ResultsThe median (IQR) age at exposure to assault, injury, and bereavement was 22 (18-31), 19 (8-40), and 60 (51-68) years, respectively. During a median (IQR) follow-up of 4.9 (2.2-8.2), 9.1 (4.1-15.6), and 8.1 (3.4-14.8) years, the incidence rates of any psychiatric disorder were 38.1, 13.9, and 9.0 per 1000 person-years for the exposed groups of the 3 cohorts, respectively. Elevated risk of any psychiatric disorder was observed during the first year after exposure to any assault (hazard ratio [HR], 4.55; 95% CI, 4.34-4.77), injury (HR, 3.31; 95% CI,3.23-3.38), or bereavement (HR, 2.81; 95% CI, 2.72-2.91) and thereafter (assault HR, 2.50; 95% CI, 2.43-2.56; injury HR, 1.69; 95% CI, 1.68-1.70; bereavement HR, 1.42; 95% CI, 1.40-1.44). Comparable associations were obtained in sibling comparison (first year: assault HR, 3.70; 95% CI, 3.37-4.05; injury HR, 2.98; 95% CI, 2.85-3.12; bereavement HR, 2.72; 95% CI, 2.54-2.91; thereafter: assault HR, 1.93; 95% CI, 1.84-2.02; injury HR, 1.51; 95% CI, 1.48-1.53; bereavement HR, 1.35; 95% CI, 1.31-1.38). The risk elevation varied somewhat by type of traumatic events and psychiatric disorders, with the greatest HR noted for posttraumatic stress disorder after sexual assault (sibling comparison HR, 4.52; 95% CI, 3.56-5.73 during entire follow-up period).Conclusions and RelevanceIn this study, the long-term risk elevation of psychiatric disorders after potentially traumatic events was largely independent of familial factors. The risk elevation observed immediately after these events motivates early clinical surveillance and mental health services for these vulnerable populations.

中文翻译：

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袭击、受伤和丧亲之痛后精神疾病的发病轨迹

重要性创伤事件与精神疾病风险升高有关，而家庭因素对这些关联的影响仍不太清楚。目的确定家庭因素对潜在创伤事件后精神疾病长期发病轨迹的影响。设计、设置、这项队列研究评估了居住在瑞典的 3 个独立队列，这些人在首次遭受攻击 (n = 49 957)、受伤 (n = 555 314) 或丧亲之痛 (n = 321 263) 时没有先前诊断出的精神疾病。 1987 年 1 月至 2013 年 12 月，连同他们未暴露的同胞兄弟姐妹，以及 10 名年龄、性别和出生地匹配的未暴露个体（每个暴露个体）。队列是根据与健康和人口登记相关的瑞典总人口登记创建的。数据分析时间为 2022 年 3 月至 2023 年 4 月。从瑞典国家登记册中确定了潜在的创伤事件，包括各种类型的袭击、伤害和丧亲之痛（儿童或配偶或伴侣的死亡）。主要结果和措施事件精神科疾病是通过瑞典患者登记册确定的。灵活的参数模型和 Cox 模型用于估计多变量调整后潜在创伤事件与突发精神疾病的关联。结果遭受攻击、伤害和丧亲之痛的中位 (IQR) 年龄分别为 22 岁 (18-31 岁)、19 岁 (8-40 岁) ) 和 60 (51-68) 岁。在中位 (IQR) 随访 4.9 (2.2-8.2)、9.1 (4.1-15.6) 和 8.1 (3.4-14.8) 年期间，任何精神疾病的发病率分别为每 1000 人 38.1、13.9 和 9.0 3 个队列中的暴露组分别为 - 年。在遭受任何攻击（风险比 [HR]，4.55；95% CI，4.34-4.77）、受伤（HR，3.31；95% CI，3.23-3.38）、或丧亲（HR，2.81；95% CI，2.72-2.91）及其后（袭击 HR，2.50；95% CI，2.43-2.56；受伤 HR，1.69；95% CI，1.68-1.70；丧亲 HR，1.42；95 % CI，1.40-1.44）。在兄弟姐妹比较中获得了可比较的关联（第一年：攻击 HR，3.70；95% CI，3.37-4.05；受伤 HR，2.98；95% CI，2.85-3.12；丧亲 HR，2.72；95% CI，2.54-2.91；此后：攻击 HR，1.93；95% CI，1.84-2.02；伤害 HR，1.51；95% CI，1.48-1.53​​；丧亲 HR，1.35；95% CI，1.31-1.38）。风险升高因创伤事件和精神疾病的类型而有所不同，性侵犯后创伤后应激障碍的 HR 最大（整个随访期间兄弟姐妹比较 HR，4.52；95% CI，3.56-5.73）。结论和相关性在这项研究中，潜在创伤事件后精神疾病的长期风险升高在很大程度上与家庭因素无关。