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- Title
Incidence Trajectories of Psychiatric Disorders After Assault, Injury, and Bereavement.
- Authors
Chen, Yufeng; Shen, Qing; Lichtenstein, Paul; Gradus, Jaimie L.; Arnberg, Filip K.; Larsson, Henrik; D'Onofrio, Brian M.; Fang, Fang; Song, Huan; Valdimarsdottir, Unnur A.
- Abstract
Key Points: Question: Are potentially traumatic events associated with a subsequent risk of psychiatric disorders independent of familial factors? Findings: In this Swedish nationwide cohort study using a sibling-comparison design to adjust for familial factors, physical and sexual assault (n = 49 957), injury (n = 555 314), and bereavement (n = 321 263) were associated with an increased risk of subsequent psychiatric disorders for more than 2 decades of observation and in particular during the first year following the event. Meaning: These findings suggest that early clinical surveillance and targeted mental health services may be advisable among individuals who experience assault, injury, or bereavement. This cohort study evaluates risk of psychiatric disorders following the potentially traumatic events of assault, injury, and bereavement apart from familial factors. Importance: Traumatic events have been associated with elevated risks of psychiatric disorders, while the contributions of familial factors to these associations remain less clear. Objective: To determine the contribution of familial factors to long-term incidence trajectories of psychiatric disorders following potentially traumatic events. Design, Setting, and Participants: This cohort study evaluated 3 separate cohorts of individuals residing in Sweden who were free of previous diagnosed psychiatric disorders when first exposed to assault (n = 49 957), injury (n = 555 314), or bereavement (n = 321 263) from January 1987 to December 2013, together with their unexposed full siblings, and 10 age-, sex-, and birthplace-matched unexposed individuals (per exposed individual). Cohorts were created from the Swedish Total Population Register linked to health and population registers. Data were analyzed from March 2022 to April 2023. Exposures: Potentially traumatic events, including various types of assault, injuries, and bereavement (death of a child or of a spouse or partner), were ascertained from the Swedish national registers. Main Outcomes and Measures: Incident psychiatric disorders were ascertained from the Swedish Patient Register. Flexible parametric and Cox models were used to estimate associations of potentially traumatic events with incident psychiatric disorders after multivariable adjustment. Results: The median (IQR) age at exposure to assault, injury, and bereavement was 22 (18-31), 19 (8-40), and 60 (51-68) years, respectively. During a median (IQR) follow-up of 4.9 (2.2-8.2), 9.1 (4.1-15.6), and 8.1 (3.4-14.8) years, the incidence rates of any psychiatric disorder were 38.1, 13.9, and 9.0 per 1000 person-years for the exposed groups of the 3 cohorts, respectively. Elevated risk of any psychiatric disorder was observed during the first year after exposure to any assault (hazard ratio [HR], 4.55; 95% CI, 4.34-4.77), injury (HR, 3.31; 95% CI,3.23-3.38), or bereavement (HR, 2.81; 95% CI, 2.72-2.91) and thereafter (assault HR, 2.50; 95% CI, 2.43-2.56; injury HR, 1.69; 95% CI, 1.68-1.70; bereavement HR, 1.42; 95% CI, 1.40-1.44). Comparable associations were obtained in sibling comparison (first year: assault HR, 3.70; 95% CI, 3.37-4.05; injury HR, 2.98; 95% CI, 2.85-3.12; bereavement HR, 2.72; 95% CI, 2.54-2.91; thereafter: assault HR, 1.93; 95% CI, 1.84-2.02; injury HR, 1.51; 95% CI, 1.48-1.53; bereavement HR, 1.35; 95% CI, 1.31-1.38). The risk elevation varied somewhat by type of traumatic events and psychiatric disorders, with the greatest HR noted for posttraumatic stress disorder after sexual assault (sibling comparison HR, 4.52; 95% CI, 3.56-5.73 during entire follow-up period). Conclusions and Relevance: In this study, the long-term risk elevation of psychiatric disorders after potentially traumatic events was largely independent of familial factors. The risk elevation observed immediately after these events motivates early clinical surveillance and mental health services for these vulnerable populations.
- Subjects
SWEDEN; MENTAL illness; MENTAL health services; BEREAVEMENT; POST-traumatic stress disorder; CHILD death; PERINATAL mood &; anxiety disorders
- Publication
JAMA Psychiatry, 2024, Vol 81, Issue 4, p374
- ISSN
2168-622X
- Publication type
Article
- DOI
10.1001/jamapsychiatry.2023.5156