National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
JAMA Psychiatry. 2013 Aug;70(8):812-20. doi: 10.1001/jamapsychiatry.2013.1111.
Mood disorders frequently co-occur with medical diseases that involve inflammatory pathophysiologic mechanisms. Immune responses can affect the brain and might increase the risk of mood disorders, but longitudinal studies of comorbidity are lacking.
To estimate the effect of autoimmune diseases and infections on the risk of developing mood disorders.
Nationwide, population-based, prospective cohort study with 78 million person-years of follow-up. Data were analyzed with survival analysis techniques and adjusted for calendar year, age, and sex.
Individual data drawn from Danish longitudinal registers.
A total of 3.56 million people born between 1945 and 1996 were followed up from January 1, 1977, through December 31, 2010, with 91, 637 people having hospital contacts for mood disorders.
The risk of a first lifetime diagnosis of mood disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% CIs are used as measures of relative risk.
A prior hospital contact because of autoimmune disease increased the risk of a subsequent mood disorder diagnosis by 45% (IRR, 1.45; 95% CI, 1.39-1.52). Any history of hospitalization for infection increased the risk of later mood disorders by 62% (IRR, 1.62; 95% CI, 1.60-1.64). The 2 risk factors interacted in synergy and increased the risk of subsequent mood disorders even further (IRR, 2.35; 95% CI, 2.25-2.46). The number of infections and autoimmune diseases increased the risk of mood disorders in a dose-response relationship. Approximately one-third (32%) of the participants diagnosed as having a mood disorder had a previous hospital contact because of an infection, whereas 5% had a previous hospital contact because of an autoimmune disease.
Autoimmune diseases and infections are risk factors for subsequent mood disorder diagnosis. These associations seem compatible with an immunologic hypothesis for the development of mood disorders in subgroups of patients.
情绪障碍常与涉及炎症病理生理机制的医学疾病同时发生。免疫反应会影响大脑，并可能增加情绪障碍的风险，但目前缺乏关于共病的纵向研究。
评估自身免疫性疾病和感染对发生情绪障碍的风险的影响。
全国范围内，基于人群的前瞻性队列研究，随访时间为 7800 万人年。采用生存分析技术进行数据分析，并根据日历年份、年龄和性别进行调整。
个体数据来自丹麦纵向登记处。
1945 年至 1996 年期间出生的 356 万人，从 1977 年 1 月 1 日至 2010 年 12 月 31 日进行随访，其中有 91637 人因情绪障碍在医院接受治疗。
首次由精神病医生在医院、门诊或急诊环境下诊断为情绪障碍的终生风险。使用发病率比（IRR）和相应的 95%置信区间作为相对风险的衡量指标。
先前因自身免疫性疾病住院会使随后诊断为情绪障碍的风险增加 45%（IRR，1.45；95%CI，1.39-1.52）。任何因感染而住院的病史会使以后发生情绪障碍的风险增加 62%（IRR，1.62；95%CI，1.60-1.64）。这 2 个风险因素相互作用产生协同作用，使随后发生情绪障碍的风险进一步增加（IRR，2.35；95%CI，2.25-2.46）。感染和自身免疫性疾病的数量与情绪障碍的风险呈剂量-反应关系。大约三分之一（32%）被诊断为患有情绪障碍的患者之前因感染而住院，而 5%的患者之前因自身免疫性疾病而住院。
自身免疫性疾病和感染是随后诊断为情绪障碍的风险因素。这些关联似乎与免疫假说一致，即某些患者亚群的情绪障碍的发生与免疫有关。
