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Stress-related disorder increases risk of subsequent autoimmune disease
Clinical Question
Are adults with a stress-related disorder at increased risk of subsequent autoimmune disease?
Bottom line
This study found that adults with a new onset stress-related disorder are at significantly increased risk of a subsequent autoimmune disease. Risk is highest among patients 33 years and younger and with a comorbid psychiatric disorder. Patients given a diagnosis of post-traumatic stress disorder (PTSD) who receive treatment with selective serotonin reuptake inhibitors (SSRIs) for at least 1 year have a reduced risk of subsequent autoimmune disease. 2b
Reference
Study design: Cohort (retrospective)
Funding: Foundation
Setting: Population-based
Synopsis
Acute and chronic stress-related disorders may influence the immune system and subsequently increase the risk of autoimmune disease. These investigators assessed data from multiple health registries of Swedish-born individuals living in Sweden from January 1, 1981, to December 31, 2013. The exposed cohort (n = 106,464) consisted of all individuals receiving an initial diagnosis of a stress-related disorder in either an inpatient or outpatient setting. Stress-related disorders were identified using a standard international classification system and subdivided into PTSD, acute stress reaction, and adjustment disorder and other stress reactions. Since SSRIs are the recommended first-line pharmacotherapy for PTSD the investigators also obtained data on prescriptions and dispensing of SSRIs. Randomly selected individuals, 10 persons per exposed patient (n = 1,064,640), with matched birth year and sex who were free of stress-related disorders and autoimmune diseases served as control patients. In addition, where possible, comparisons occurred between exposed patients and their full biologic siblings (n = 126,652). Follow-up occurred for a mean of 10 years. After stratifying for education level, family income, marital status, family history of autoimmune disease, and other psychiatric disorders, newly diagnosed autoimmune disease occurred significantly more often among exposed patients than among matched unexposed individuals and siblings (hazard ratio [HR] = 1.36; absolute rate difference of 3.12 [95% CI 2.99 - 3.25] and 2.49 [2.23 - 2.76] per 1000 person-years, respectively). The association of a stress-related disorder with subsequent autoimmune disease was significantly stronger among patients exposed at a younger age and with the presence of a comorbid psychiatric disorder. Specifically for patients with PTSD, the risk of a subsequent autoimmune disease decreased with persistent use of SSRIs during the first year after diagnosis.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
I treat chronic pain patients, many of whom suffer PTSD, particularly the Armed Forces and this is a very interesting finding.
Very interesting study!
I’ve been incorporating a style of yoga (Kundalini) into my treatment of stress states, that emphasizes the benefits to the immune & nervous system while lowering anxiety & stress states through its practice. This study is very helpful in adding to the evidence based literature on how stress states can influence the immune system and subsequently increase the risk of autoimmune disease (many of the patients I see for stress states & substance use issues have or end up with autoimmune disease).
I appreciate that they looked at SSRI use in the first year as potentially being protective against later onset of an autoimmune disease in those with a PTSD diagnosis. However, given that I get quite a few patients who prefer not to use pharmacotherapy as a first line option I’m also wondering what they would find if they looked at non-pharmacological treatments that specifically address stress states (e.g., somatic psychotherapy, Kundalini yoga) alone or combined with pharmacotherapy. Thank you
This summary would be improved by defining specific conditions identified as "autoimmune" - as was done for "stress-related disorders".
Very informative
This has got to be flawed. I don't believe a word of it. And SSRIs reversing the problem? Highly unlikely.
Good poem
is this true? does this mean we should consider TREATING stress disorders more aggressively? Like, will this REDUCE future auto-immune?? VERY INTERESTING!! especially given that i was under the impression we were OVER PRESCRIBING SSRIs.