A Nationwide Cohort Study of the Association Between Hospitalization With Infection and Risk of Death by Suicide

Lund-Sørensen, Helene; Benros, Michael E.; Madsen, Trine; Sørensen, Holger J.; Eaton, William W.; Postolache, Teodor T.; Nordentoft, Merete; Erlangsen, Annette

doi:10.1001/jamapsychiatry.2016.1594

Cited by 108 publications

(74 citation statements)

References 42 publications

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“…Hospitalization for severe sepsis increases the prevalence of moderate to severe cognitive decline by more than 10% [19]. An episode of acute brain dysfunction may lead to anxiety, depression, post‐traumatic stress disorders [20] and self‐harm [21]. Two out of five patients who have had sepsis are subsequently unable to return to full‐time employment [22].…”

Section: Syndromesmentioning

confidence: 99%

Neuroanatomy of sepsis-associated encephalopathy

et al. 2017

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This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at http://ccforum.com/series/annualupdate2017. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.Originally published in the Annual Update in Intensive Care and Emergency Medicine 2017. The number of authors differs in the two versions due to constraints regarding the number of authors in the Annual Update in Intensive Care and Emergency Medicine. In the Annual Update version of the review, the three senior authors appear in the acknowledgement section. In the Critical Care version, these three senior authors appear as full authors of the manuscript. All authors helped draft and revise the manuscript for critical intellectual content.

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Section: Syndromesmentioning

confidence: 99%

Neuroanatomy of sepsis-associated encephalopathy

et al. 2017

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“…There is increased risk for suicidal behavior with the activation of inflammatory responses following treatment with interferon for patients with cancer, hepatitis C, and multiple sclerosis (Baron et al, 1993; Fragoso et al, 2010; Janssen et al, 1994); in autoimmune disorders (Fuller-Thomson et al, 2016; Ludvigsson et al, 2011); in infections (Brundin and Grit, 2016; Lund-Sorensen et al, 2016); and in diseases that involve exaggerated immune responses, such as allergies and asthma (Goodwin, 2012). Inflammation is also associated with impulsivity and aggression (Coccaro et al, 2014; Isung et al, 2014), which predict suicidal behavior (Melhem et al, 2007); and with sleep problems (Prather et al, 2009), which often precede suicidal behavior.…”

Section: Introductionmentioning

confidence: 99%

Blunted HPA axis activity prior to suicide attempt and increased inflammation in attempters

Melhem

Munroe

Marsland

et al. 2017

Psychoneuroendocrinology

105

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Background Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation is associated with increased risk for suicidal behavior. However, it is not clear whether such dysregulation exists prior to or is a consequence of attempt. Studies also show an activation of inflammatory responses in suicidal behavior but often combine attempters with those with ideation. Methods The sample consisted of psychiatric inpatients, aged 15-30 years, admitted for suicide attempt (SA, n=38), inpatients admitted for suicidal ideation with no prior history of attempts (SI, n=40), and healthy controls (n=37). We compared SA, SI, and controls on hair cortisol concentrations (HCC), which provides retrospective levels of cortisol and thus prior to the attempt in SA. We also compared them on the expression of genes in the HPA axis and inflammatory pathways previously implicated in suicidal behavior (GR or NR3C1, SKA2, FKBP5, IL-1β, TNF-α); plasma C-Reactive Protein (CRP); and cellular measures of glucocorticoid receptor (GR) sensitivity and stimulated production of IL-6. Results We found lower HCC [β=−0.55, 95% CI (−0.96, −0.13), p=0.01, ES=−0.54] in first-time SA compared to SI and controls. In addition, SA showed lower GR or NR3C1 (α isoform) mRNA [β=−5.11, 95% CI (−10.9, 0.73), p=0.09, ES=−0.46], higher CRP [β=0.94, 95% CI (−0.004, 1.9), p=0.05, ES=0.60], and higher TNF-α mRNA [β=26.4, 95% CI (7.7, 45.2), p=0.006, ES=0.73]. Conclusions This is the first study to differentiate youth who attempt suicide from those with suicidal ideation on HCC and to show that low HCC precedes suicide attempt. Suicide attempters also showed a distinct biological profile on several markers in both the HPA axis and inflammatory pathways. Future longitudinal studies are needed to examine the ability of these biomarkers to predict suicidal behavior.

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“…The authors said “The highest risks of suicide were found among individuals with hepatitis infection and HIV/AIDS infection” and “It will be important to understand how milder and long-term infections contribute to depression and suicidality. Such infections often go untreated and remain latent in the body for years.”76…”

Section: Introductionmentioning

confidence: 99%

Suicide and Lyme and associated diseases

Bransfield¹

2017

NDT

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PurposeThe aim of this paper is to investigate the association between suicide and Lyme and associated diseases (LAD). No journal article has previously performed a comprehensive assessment of this subject.IntroductionMultiple case reports and other references demonstrate a causal association between suicidal risk and LAD. Suicide risk is greater in outdoor workers and veterans, both with greater LAD exposure. Multiple studies demonstrate many infections and the associated proinflammatory cytokines, inflammatory-mediated metabolic changes, and quinolinic acid and glutamate changes alter neural circuits which increase suicidality. A similar pathophysiology occurs in LAD.MethodA retrospective chart review and epidemiological calculations were performed.ResultsLAD contributed to suicidality, and sometimes homicidality, in individuals who were not suicidal before infection. A higher level of risk to self and others is associated with multiple symptoms developing after acquiring LAD, in particular, explosive anger, intrusive images, sudden mood swings, paranoia, dissociative episodes, hallucinations, disinhibition, panic disorder, rapid cycling bipolar, depersonalization, social anxiety disorder, substance abuse, hypervigilance, generalized anxiety disorder, genital–urinary symptoms, chronic pain, anhedonia, depression, low frustration tolerance, and posttraumatic stress disorder. Negative attitudes about LAD from family, friends, doctors, and the health care system may also contribute to suicide risk. By indirect calculations, it is estimated there are possibly over 1,200 LAD suicides in the US per year.ConclusionSuicidality seen in LAD contributes to causing a significant number of previously unexplained suicides and is associated with immune-mediated and metabolic changes resulting in psychiatric and other symptoms which are possibly intensified by negative attitudes about LAD from others. Some LAD suicides are associated with being overwhelmed by multiple debilitating symptoms, and others are impulsive, bizarre, and unpredictable. Greater understanding and a direct method of acquiring LAD suicide statistics is needed. It is suggested that medical examiners, the Centers for Disease Control and Prevention, and other epidemiological organizations proactively evaluate the association between LAD and suicide.

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A Nationwide Cohort Study of the Association Between Hospitalization With Infection and Risk of Death by Suicide

Abstract: An increased risk of death by suicide was found among individuals hospitalized with infection in prospective and dose-response relationships. These findings indicate that infections may have a relevant role in the pathophysiological mechanisms of suicidal behavior.

Cited by 108 publications

References 42 publications

Neuroanatomy of sepsis-associated encephalopathy

Neuroanatomy of sepsis-associated encephalopathy

Blunted HPA axis activity prior to suicide attempt and increased inflammation in attempters

Suicide and Lyme and associated diseases

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