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Infections and risk of common mental health disorders: a population-based matched cohort study using linked
Georgia R Gore-Langton1, Sharon L Cadogan1, Kathryn E Mansfield2
1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Background:
Annually, one in four UK adults experience common mental disorders (CMD), i.e., anxiety or depression. While central nervous system infections are associated with an increased CMD risk, the relationship between other infections and CMD is unclear.
Methods:
We conducted six matched cohort studies using data from the Clinical Practice Research Datalink Aurum (01/01/2007-15/06/2024). Adults (≥18 years) with skin/soft tissue (SSTI), lower respiratory tract (LRTI) and urinary tract (UTI) infections, gastroenteritis (GE), sepsis, and meningitis/encephalitis (positive control exposure) were matched on sex, age, general practice, and calendar period with up to five adults without that infection. We used Cox regression, stratified by matched set, adjusted for deprivation, Charlson comorbidity index, alcohol, smoking, body mass index, and ethnicity to estimate hazard ratios (HRs) for incident CMD comparing adults with and without infection.
Outcomes:
Numbers of individuals included in infection-specific cohorts ranged from 13,196 with meningitis/encephalitis matched to 54,946 without, to 304,770 individuals with SSTI matched to 1,130,070 without. Median follow-up ranged from 3.8 years (interquartile range [IQR]: 1.7,6.6) in the sepsis cohort, to 5.0 years (IQR: 2.0,9.3) in the LRTI cohort. Median age ranged from 44 years (IQR: 30,63) in the meningitis/encephalitis cohort to 74 (IQR 62,83) in the sepsis cohort; 44-52% of all cohorts were women, except for the UTI cohort (76% women). After adjustment, each infection was associated with increased risk of CMD, ranging from HR 1.29(95%CI 1.28, 1.31) for SSTI, to HR 1.58 (95%CI 1.55,1.61) for sepsis.
Interpretation:
Our findings suggest adults with acute infections are at greater risk of CMD than adults without infection. Evidence was stronger for more severe infections (e.g., sepsis). Mental health screening and intervention during and after infections, timely infection treatment and vaccination, may improve mental health.
Insights
Adults with infections, including skin, respiratory, and urinary tract infections, face a higher risk of common mental disorders (CMD). More severe infections like sepsis showed a stronger association with increased CMD risk.
Area of Science:
- Public Health
- Infectious Diseases
- Mental Health Epidemiology
Background:
- Common mental disorders (CMD), such as anxiety and depression, affect one in four UK adults annually.
- While central nervous system infections are known risk factors for CMD, the impact of other infections remains unclear.
Purpose of the Study:
- To investigate the association between common infections (skin/soft tissue, lower respiratory tract, urinary tract, gastroenteritis, sepsis, meningitis/encephalitis) and the risk of developing CMD.
- To quantify the risk of CMD associated with various infections in adults.
Main Methods:
- Six matched cohort studies were conducted using the Clinical Practice Research Datalink Aurum database.
- Adults with specific infections were matched with up to five adults without the infection based on sex, age, general practice, and calendar period.
- Cox regression analysis, adjusted for multiple covariates, was used to estimate hazard ratios (HRs) for incident CMD.
Main Results:
- All investigated infections were associated with an increased risk of CMD.
- Hazard ratios ranged from 1.29 for skin/soft tissue infections (SSTI) to 1.58 for sepsis.
- The association between infection and CMD risk was stronger for more severe infections.
Conclusions:
- Adults experiencing acute infections have a significantly greater risk of developing CMD compared to those without infections.
- Findings suggest a potential benefit from mental health screening and intervention during and after infection episodes.
- Timely treatment of infections and vaccination may play a role in mitigating mental health risks.
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