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Risk of autoimmune diseases after post-traumatic stress disorder: a nationwide cohort study

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European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

This longitudinal study aimed to investigate the risk of subsequent autoimmune disease in patients with post-traumatic stress disorder (PTSD) in Asian population. Between 2002 and 2009, we enrolled 5273 patients with PTSD and 1:4 matched controls from the National Health Insurance Database of Taiwan, and followed up the patients until December 31, 2011, or death. The investigated autoimmune diseases included thyroiditis, lupus, rheumatic arthritis, inflammatory bowel disease, Sjogren’s syndrome, dermatomyositis, and polymyositis. The Cox regression model was used to estimate the risk of developing autoimmune diseases, with adjustment for demographics and psychiatric and medical comorbidities. Furthermore, we examined the psychiatric clinics utility of patients with PTSD indicating the severity of PTSD in association with autoimmune diseases. After adjusting for confounders, patients with PTSD had a 2.26-fold higher risk of developing any autoimmune diseases (reported as hazard ratios with 95% confidence intervals: 1.82–2.80) than the controls. For specific autoimmune diseases, patients with PTSD had a 2.70-fold higher risk (1.98–3.68) of thyroiditis, a 2.95-fold higher risk (1.20–7.30) of lupus, and a 6.32-fold higher risk (3.44–11.60) of Sjogren’s syndrome. Moreover, the PTSD severity was associated with the risk of autoimmune diseases in a dose-dependent manner. The patient with the highest psychiatric clinics utility was associated with an 8.23-fold higher risk (6.21–10.90) of any autoimmune diseases than the controls. Patients with PTSD had an increased risk of autoimmune diseases, and such risk was associated with the severity of PTSD in a dose-dependent manner. However, the present study did not provide a direct effect between PTSD and autoimmune diseases, but rather an association. Further studies are warranted to examine the underlying pathophysiological mechanisms.

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Acknowledgements

The authors thank Mr. I-Fan Hu, MA (Courtauld Institute of Art, University of London; National Taiwan University) for his friendship and support. Mr. Hu declares no conflicts of interest.

Funding

The study was supported by grant from Taipei Veterans General Hospital (V106B-020, V107B-010, V107C-181, V108B-012, V110C-025, V110B-002), Yen Tjing Ling Medical Foundation (CI-109-21, CI-109-22, CI-110-30) and Ministry of Science and Technology, Taiwan (107-2314-B-075-063-MY3, 108-2314-B-075-037). The funding source had no role in any process of our study.

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Authors and Affiliations

  1. Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Tien-Wei Hsu

  2. Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan

    Ya-Mei Bai, Shih-Jen Tsai & Mu-Hong Chen

  3. Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Ya-Mei Bai, Shih-Jen Tsai & Mu-Hong Chen

  4. Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan

    Ya-Mei Bai, Shih-Jen Tsai & Mu-Hong Chen

  5. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Tzeng-Ji Chen

  6. Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan

    Tzeng-Ji Chen

  7. Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, No. 60, Xinmin Road, Beitou District, Taipei, 11243, Taiwan

    Chih-Sung Liang

  8. Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan

    Chih-Sung Liang

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Contributions

T-WH drafted the manuscript. C-SL designed the study and assisted the preparation of the manuscript. M-HC designed the study and analyzed the data. T-JC provided advices on statistical analysis. Y-MB provided important intellectual content. S-JT managed and coordinated responsibility for the research activity planning and execution.

Corresponding authors

Correspondence to Mu-Hong Chen or Chih-Sung Liang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Institutional Review Board of Taipei Veterans General Hospital approved the study protocol (Approval No. 2018-07-016AC) and waived the requirement for informed consent, because this investigation used de-identified data without contacting human subjects.

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Hsu, TW., Bai, YM., Tsai, SJ. et al. Risk of autoimmune diseases after post-traumatic stress disorder: a nationwide cohort study. Eur Arch Psychiatry Clin Neurosci 274, 487–495 (2024). https://doi.org/10.1007/s00406-023-01639-1

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