Incidence Trajectories of Psychiatric Disorders After Assault, Injury, and BereavementShow others and affiliations
2024 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 81, no 4, p. 374-385Article in journal (Refereed) Published
Abstract [en]
IMPORTANCE: Traumatic events have been associated with elevated risks of psychiatric disorders, while the contributions of familial factors to these associations remain less clear.
OBJECTIVE: To determine the contribution of familial factors to long-term incidence trajectories of psychiatric disorders following potentially traumatic events.
DESIGN, SETTING, AND PARTICIPANTS: This 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.
EXPOSURES: Potentially 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 MEASURES: Incident 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.
RESULTS: The 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 RELEVANCE: In 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.
Place, publisher, year, edition, pages
American Medical Association (AMA), 2024. Vol. 81, no 4, p. 374-385
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-111023DOI: 10.1001/jamapsychiatry.2023.5156ISI: 001145581300002PubMedID: 38231519Scopus ID: 2-s2.0-85181006109OAI: oai:DiVA.org:oru-111023DiVA, id: diva2:1832717
Funder
EU, Horizon 2020, 847776EU, European Research Council, 726413
Note
This work was supported by EU Horizon 2020 Research and Innovation Action grant 847776 (Valdimarsdóttir), Grant of Excellence, Icelandic Research Fund grant 163362-051 (Valdimarsdóttir), European Research Council Consolidator grant 726413 (Valdimarsdóttir), the Project for Disciplines of Excellence, West China Hospital, Sichuan University grant ZYYC21005 (Song), the Outstanding Clinical Discipline Project of Shanghai Pudong grant PWYgy2021-02, and the Fundamental Research Funds for the Central Universities (Shen).
2024-01-302024-01-302024-04-11Bibliographically approved