Objective To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections.
Design Population and sibling matched cohort study.
Setting Swedish population.
Participants 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population.
Main outcome measures A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections.
Results The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios.
Conclusion In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.

目的评估对创伤和其他逆境的严重精神病反应是否与随后威胁生命的感染风险相关。
设计人群和同胞匹配的队列研究。
设定瑞典人口。
参与者从1987年至2013年确定了与压力有关的疾病（创伤后压力障碍（PTSD），急性压力反应，适应障碍和其他压力反应）的144 919个人，而诊断出与压力有关的疾病的个人同胞为184 612个同胞，没有从一般人群中得到这种诊断的1 449 190个匹配个体。
主要观察指标首次住院或门诊就诊，主要诊断为瑞典国家患者登记簿中具有高死亡率的严重感染（即败血症，心内膜炎和脑膜炎或其他中枢神经系统感染），以及这些感染或任何来源的感染导致的死亡从死亡原因登记簿中获得。在控制了多个混杂因素之后，使用Cox模型来估计这些威胁生命的感染的危险比。
结果诊断为压力相关疾病的平均年龄为37岁（55 541，男性38.3％）。在平均八年的随访中，每千人生命威胁感染的发生率在患有压力相关疾病的个体中为2.9，在未诊断的兄弟姐妹中为1.7，在未诊断的配对个体中为1.3。与没有诊断出与压力有关的疾病的全兄弟姐妹相比，具有这种诊断的个体罹患威胁生命的感染的风险增加（任何与压力有关的疾病的危险比为1.47（95％置信区间为1.37至1.58），而PTSD为1.92（1.46至2.52））。在基于人群的分析中，与压力相关的疾病的相应估计值相似（1.58（1.51至1.65），对兄弟姐妹和基于人群的比较之间的差异，P = 0.09； 1.95（1.66至2）。28）（对于PTSD），P = 0.92（对于差异）。与压力有关的疾病与所有研究威胁生命的感染有关，脑膜炎（基于兄弟姐妹的分析为1.63（1.23至2.16））和心内膜炎（1.57（1.08至2.30））的相对风险最高。诊断为压力相关疾病时年龄偏小以及存在精神病合并症，尤其是药物滥用疾病，与较高的危险比相关，而在诊断为压力相关疾病后的第一年，使用选择性5-羟色胺再摄取抑制剂与缓解相关危险比。08至2.30））。诊断为压力相关疾病时年龄偏小和精神病合并症（尤其是药物滥用疾病）与较高的危险比相关，而在诊断为压力相关疾病后的第一年使用选择性5-羟色胺再摄取抑制剂与减弱相关危险比。08至2.30））。诊断为压力相关疾病时年龄偏小以及存在精神病合并症，尤其是药物滥用疾病，与较高的危险比相关，而在诊断为压力相关疾病后的第一年，使用选择性5-羟色胺再摄取抑制剂与缓解相关危险比。
结论在控制了家族背景和身体或精神疾病合并症之后，在瑞典人群中，与压力相关的疾病与随后的威胁生命的感染风险有关。