Department of Economics and Business Economics

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

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Helene Gjervig Hansen, Copenhagen University
  • ,
  • Ole Köhler-Forsberg
  • Liselotte Petersen
  • Merete Nordentoft, Copenhagen University
  • ,
  • Teodor T Postolache, 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.
  • ,
  • Annette Erlangsen, Copenhagen University, University of Southern Denmark,
  • Michael E Benros, Copenhagen University

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.

Original languageEnglish
JournalBiological Psychiatry
Pages (from-to)744-751
Number of pages8
Publication statusPublished - May 2019

    Research areas

  • Anti-infective agents, Deliberate self-harm, Infections, Inflammation, Primary care sector, Suicide

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