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Relationship between antibiotic exposure and subsequent mental health disorders in a primary care health system
Laura M Prichett1, Robert H Yolken2, Linxuan Wu1
1Biostatistics, Epidemiology, and Data Management (BEAD) Core, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Insights
Antibiotic use, particularly broad-spectrum antibiotics, is linked to a higher risk of anxiety and depression in children, especially males. Further research into antibiotic exposure and pediatric mental health is recommended.
Area of Science:
- Pediatric primary care
- Psychiatry
- Infectious disease
Background:
- Antibiotic exposure is common in pediatric primary care.
- The potential impact of antibiotics on mental health is an emerging area of research.
- Understanding this relationship is crucial for optimizing pediatric care.
Purpose of the Study:
- To investigate the association between antibiotic exposure and the development of psychiatric disorders in children.
- To determine if specific types of antibiotics or prescribing patterns correlate with increased risk.
- To explore potential sex-based differences in this association.
Main Methods:
- Retrospective cohort study utilizing electronic health records from a large urban primary care practice.
- Inclusion of patients aged 8-20 years with data spanning from January 1, 2013, to December 1, 2018.
- Adjusted Cox regression analyses to assess the relationship between anti-infective prescriptions and subsequent anxiety or depression diagnoses.
Main Results:
- Antibiotic prescription was associated with a 21% increased hazard rate for psychiatric disorders (HRR 1.21).
- Broad-spectrum antibiotic use showed a higher association (HRR 1.27) compared to no, narrow-spectrum, or topical prescriptions.
- The risk was significantly elevated in males (HRR 1.45) and increased with the number of antibiotic prescriptions.
Conclusions:
- Treatment of infections with broad-spectrum antibiotics is linked to increased risks of anxiety and/or depression in children.
- The association appears particularly pronounced in male pediatric patients.
- Further investigation into antibiotic-mental health links is warranted, alongside cautious antibiotic prescribing in children.
Objective:
To evaluate the relationship between antibiotic exposure and subsequent psychiatric disorders in a Pediatric primary care setting.
Study Design:
We conducted a retrospective cohort study using electronic clinical record data for patients ages 8-20 years seen in the outpatient setting of a large urban primary health care practice from 1/1/13 to 12/1/2018. We employed adjusted Cox regression analyses to study the relationship between prescriptions for anti-infective agents and subsequent diagnosis of anxiety or depression.
Results:
Prescription of anti-infective medication was associated with a hazard rate ratio (HRR) of 1.21 (95%-CI = 1.00-1.45). A first prescription for a broad-spectrum antibiotic (compared to those with no prescription, narrow-spectrum prescription, or topical prescription) was associated with an HRR of 1.27 (95%-CI = 1.04-1.54). The number of anti-infectives prescribed over the course of the study period was associated with an HRR of 1.05 (95%-CI = 1.00-1.10). There was no significant relationship between prescription of topical or narrow-spectrum antibiotics, antifungal, or antiviral medication and subsequent diagnosis of anxiety or depression. Stratified analysis revealed that the association between anti-infective prescription and anxiety and depression was driven by males, among whom prescription of any antibiotic was associated with an HRR of 1.45 (95%-CI = 1.05-1.99).
Conclusions:
Infections treated with broad-spectrum antibiotics were associated with increased risks of anxiety and/or depression, especially in males. Exploration of the relationship between antibiotic exposure and subsequent mental health disorders is warranted along with continued vigilance in antibiotic prescribing practices in children.
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