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Infections, Anti-infective Agents, and Risk of Deliberate Self-harm and Suicide in a Young Cohort: A Nationwide Study

  • Helene Gjervig Hansen
    Correspondence
    Address correspondence to Helene Gjervig Hansen, M.D., Mental Health Centre Copenhagen, Kildegårdsvej 28, DK-2900 Hellerup, Capital Region of Denmark, Denmark.
    Affiliations
    Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark

    Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
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  • Ole Köhler-Forsberg
    Affiliations
    Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark

    Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
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  • Liselotte Petersen
    Affiliations
    National Centre for Register-based Research, Aarhus University, Aarhus, Denmark

    Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark

    iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
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  • Merete Nordentoft
    Affiliations
    Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark

    Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark

    iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
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  • Teodor T. Postolache
    Affiliations
    University of Maryland School of Medicine, Baltimore, Maryland

    Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, Colorado

    The Military and Veteran Microbiome Consortium for Research and Education, Denver, Colorado
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  • Annette Erlangsen
    Affiliations
    Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark

    Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark

    Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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  • Michael E. Benros
    Affiliations
    Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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Published:November 21, 2018DOI:https://doi.org/10.1016/j.biopsych.2018.11.008

      Abstract

      Background

      Evidence links infections to mental disorders and suicidal behavior. However, knowledge is sparse regarding less severe infections, anti-infective treatment, and deliberate self-harm. Using nationwide Danish longitudinal registers, we estimated associations between infections treated with anti-infective agents and infections requiring hospitalization with the risk of deliberate self-harm.

      Methods

      A total of 1.3 million people born between 1977 and 2002 were followed during the period from 1995 to 2013. In total, 15,042 individuals were recorded with deliberate self-harm (92% had been treated with anti-infective agents and 19% had been hospitalized for infections) and 114 died by suicide (64% had been treated with anti-infective agents and 13% had been hospitalized for infections). Hazard rate ratios were obtained while adjusting for age, gender, calendar period, education, hospitalizations with infections, prescribed anti-infective agents during childhood, parental mental disorders, and parental deliberate self-harm.

      Results

      Individuals with infections treated with anti-infective agents had an increased risk of deliberate self-harm with a hazard rate ratio of 1.80 (95% confidence interval = 1.68–1.91). The associations fitted a dose–response relationship (p < .001) and remained significant up to 5 years after last infection. An additive effect was found for individuals with an additional hospitalization for infections with an increased hazard rate ratio of 3.20 (95% confidence interval = 2.96–3.45) for deliberate self-harm.

      Conclusions

      An increased risk of deliberate self-harm was found among individuals with infections treated with anti-infective agents in temporal and dose–response associations. These results add to the growing literature on a possible link between infections and the pathophysiological mechanisms of suicidal behavior.

      Keywords

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      Linked Article

      • Infections, Anti-infective Medications, and Suicidal Behavior: An Association Bearing Further Investigation
        Biological PsychiatryVol. 85Issue 9
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          Deliberate self-harm, encompassing suicide attempts, completed suicides, and nonsuicidal self-injurious behavior, is a global public health problem with a particularly strong impact on the world’s youth and young adults. In the United States, suicide is the third leading cause of death among children 10 to 14 years of age and the second leading cause of death among adolescents and adults 15 to 34 years of age (1). Suicide attempts far outnumber completed suicides, and the personal, social, and economic costs of suicidal behavior are staggering.
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