Intestinal infectious diseases increase the risk of psychiatric disorders: A nationwide population-based cohort study

Abstract

Intestinal infectious diseases (IIDs) are among the most common diseases and are prevalent worldwide. IIDs are also one of the major disease groups with the highest incidence worldwide, especially among children and older adults. We observed a higher probability of IIDs in patients from the psychiatric department of Tri-Service General Hospital. Therefore, our objective was to investigate if there is an association between IIDs and the risk of developing psychiatric disorders. This nationwide populationbased study used the database of the National Health Insurance (NHI) program in Taiwan. The study included 150,995 patients from 2000 to 2015, comprising 30,199 patients with IIDs as the study group and 120,796 patients without IIDs as the control group. Cox proportional hazards regression analysis was performed to calculate the hazard ratio of psychiatric disorders during the 16-year follow-up. Of the patients with IIDs, 4022 (13.32%) developed psychiatric disorders compared to 8119 (6.72%) who did not (P < .001). The adjusted hazard ratio (aHR) for overall psychiatric disorders in the study group was 2.724 (95% confidence interval [CI]: 2.482-2.976; P < .001). More specifically, the study group had a higher risk of developing a psychiatric disorder, including sleep disorders, depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD)/acute stress disorder (ASD), schizophrenia, mental retardation (MR), substance abuse, and other psychiatric disorders. Furthermore, refractory IIDs (seeking medical attention for IIDs 3 or more times) increased the risk (aHR: 3.918; 95% CI: 3.569-4.280; P < .001) of developing psychiatric disorders. There was an association between IIDs and the increased risk of developing psychiatric disorders. The novel role of etiological factors in the development of psychiatric disorders deserves more attention, and the control of pathogens that cause IIDs is of urgent public health importance.

Examining the Relationships between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data from the Global Burden of Disease Studies, 1990–2019

“…In the current study, enteric infections were negatively associated with the incidence of BD, and decreases in the incidence of enteric infections were associated with increases in both mood disorders, but more specifically with BD. These results are at variance with those of an earlier study, which found that intestinal infections were associated with an increase in subsequent mood disorders [ 76 ]. However, it is possible that variations in the incidence of enteric infections may be associated with variations in “non-pathogenic” components of the gut microbiota, which can influence symptomatology and treatment response in BD [ 154 , 155 ].…”

“…However, this study’s findings were not specific to mood disorders: elevated rates of subsequent diagnoses of autism spectrum disorder, attention-deficit/hyperactivity disorder, and obsessive-compulsive disorder were also associated with bacterial infection in this sample. A larger study from the same country, including both children and adults and focusing exclusively on intestinal infections, reported similar results; intestinal infections were associated non-specifically with a wide range of mental disorders, including a 1.5–2-fold increase in mood disorder risk [ 76 ]. This non-specific pattern of association was also observed in a study from the United States, where childhood infections were not only associated with an increased risk of MDD but also of anxiety disorders and oppositional-defiant disorder (ODD) [ 56 ].…”

“…Sixth, some researchers have suggested that links between infectious disease and mood disorders could be influenced by socioeconomic factors [ 32 , 44 ], but this could not be clearly established in the current study despite attempts to control for economic development and inequality. Seventh, it is possible that infectious diseases may non-specifically increase the risk for a wide range of mental disorders, and that the association with mood disorders is non-specific [ 56 , 76 , 178 , 179 ]. Finally, as the current study is preliminary and exploratory in nature, it was not yet possible to use the available data to estimate future trends in the association between infection and mood disorders [ 180 ].…”

“…A prospective study of patients with intestinal infections (bacterial, viral, or parasitic) found that this group of diseases was associated with a two-fold increase in both BD and MDD. The mean time lag between infection and the onset of mood disorder in this sample was 2.4 years, and this association remained significant after correction for sociodemographic variables [ 76 ]. Several case reports have suggested a possible causal association between enteric (typhoid) fever and both BD and MDD [ 77 , 78 , 79 ].…”

Examining the Relationships Between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data From the Global Burden of Disease Studies, 1990-2019

“…However, this study's findings were not specific to mood disorders: elevated rates of subsequent diagnoses of autism spectrum disorder, attentiondeficit/hyperactivity disorder, and obsessive-compulsive disorder were also associated with bacterial infection in this sample. A larger study from the same country, including both children and adults and focusing exclusively on intestinal infections, reported similar results; intestinal infections were associated non-specifically with a wide range of mental disorders, including a 1.5-2-fold increase in mood disorder risk [76]. This non-specific pattern of association was also observed in a study from the United States, where childhood infections were not only associated with an increased risk of MDD but also of anxiety disorders and oppositional-defiant disorder (ODD) [56].…”