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Unspecified stress disorders and risk of arterial and venous thromboembolic disease in the Danish population

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Unspecified stress disorders and risk of arterial and venous thromboembolic disease in the Danish population. / Smith, Meghan L.; Farkas, Dóra Körmendiné; Sumner, Jennifer A.; Valdimarsdóttir, Unnur; Lash, Timothy L.; Sørensen, Henrik Toft; Gradus, Jaimie L.

In: Journal of Affective Disorders, Vol. 282, 03.2021, p. 712-716.

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Smith, Meghan L. ; Farkas, Dóra Körmendiné ; Sumner, Jennifer A. ; Valdimarsdóttir, Unnur ; Lash, Timothy L. ; Sørensen, Henrik Toft ; Gradus, Jaimie L. / Unspecified stress disorders and risk of arterial and venous thromboembolic disease in the Danish population. In: Journal of Affective Disorders. 2021 ; Vol. 282. pp. 712-716.

Bibtex

@article{099c4b169a514ad58eddb4db65ec4b65,
title = "Unspecified stress disorders and risk of arterial and venous thromboembolic disease in the Danish population",
abstract = "Background: Posttraumatic stress disorder is a well-documented risk factor for cardiovascular disease. Whether non-specific stress-related psychopathology also increases risk is less well known. Methods: In a cohort of adult Danish-born residents of Denmark with an incident diagnosis of unspecified reaction to severe stress (“unspecified stress reaction”) between 1995 and 2011 (N = 24,534), we assessed incidence of seven arterial and venous cardiovascular events/conditions between 1996 and 2013. We calculated standardized incidence ratios (SIRs) comparing incidence of each outcome among the cohort to expected incidence based on sex-, age-, and calendar-time-specific national rates. We conducted stratified analyses by demographic characteristics, comorbidities, and length of follow-up time. Results: Incidence over the study period ranged from 1.1% for provoked VTE to 5.7% for stroke, adjusting for competing risk of death. Unspecified stress reaction was associated with all outcomes (SIRs ranging from 1.3, 95% confidence interval (CI): 1.1–1.4 for atrial fibrillation/flutter to 1.9, 95% CI: 1.7–2.2 for unprovoked VTE and 1.9, 95% CI: 1.6–2.3 for provoked VTE). Associations persisted, but were attenuated, when restricting to persons without alcohol use disorder and to persons without physical health comorbidities. Limitations: Unspecified stress reaction has less precise criteria than other stress-related diagnoses, and we could not adjust for some potential confounders. Conclusions: Our results augment literature on stress disorders and cardiovascular disease by highlighting the additional importance of unspecified stress disorders. Further research on this diagnostic category, which may represent subsyndromal psychopathology, is warranted. These findings support considering persons with non-specific stress-related psychopathology in treatment and tertiary prevention activities.",
keywords = "Cardiovascular, Epidemiology, Stress disorders, Subsyndromal psychiatric disorders, Unspecified reaction to severe stress, Unspecified stress disorders",
author = "Smith, {Meghan L.} and Farkas, {D{\'o}ra K{\"o}rmendin{\'e}} and Sumner, {Jennifer A.} and Unnur Valdimarsd{\'o}ttir and Lash, {Timothy L.} and S{\o}rensen, {Henrik Toft} and Gradus, {Jaimie L.}",
note = "Funding Information: This work was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation (grant number R248-2017-521 ), and the National Institute of Mental Health (grant numbers 1R01MH110453-01A1 and 1R21MH094551-01A1 to JLG). Publisher Copyright: {\textcopyright} 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = mar,
doi = "10.1016/j.jad.2020.12.180",
language = "English",
volume = "282",
pages = "712--716",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier BV",

}

RIS

TY - JOUR

T1 - Unspecified stress disorders and risk of arterial and venous thromboembolic disease in the Danish population

AU - Smith, Meghan L.

AU - Farkas, Dóra Körmendiné

AU - Sumner, Jennifer A.

AU - Valdimarsdóttir, Unnur

AU - Lash, Timothy L.

AU - Sørensen, Henrik Toft

AU - Gradus, Jaimie L.

N1 - Funding Information: This work was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation (grant number R248-2017-521 ), and the National Institute of Mental Health (grant numbers 1R01MH110453-01A1 and 1R21MH094551-01A1 to JLG). Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/3

Y1 - 2021/3

N2 - Background: Posttraumatic stress disorder is a well-documented risk factor for cardiovascular disease. Whether non-specific stress-related psychopathology also increases risk is less well known. Methods: In a cohort of adult Danish-born residents of Denmark with an incident diagnosis of unspecified reaction to severe stress (“unspecified stress reaction”) between 1995 and 2011 (N = 24,534), we assessed incidence of seven arterial and venous cardiovascular events/conditions between 1996 and 2013. We calculated standardized incidence ratios (SIRs) comparing incidence of each outcome among the cohort to expected incidence based on sex-, age-, and calendar-time-specific national rates. We conducted stratified analyses by demographic characteristics, comorbidities, and length of follow-up time. Results: Incidence over the study period ranged from 1.1% for provoked VTE to 5.7% for stroke, adjusting for competing risk of death. Unspecified stress reaction was associated with all outcomes (SIRs ranging from 1.3, 95% confidence interval (CI): 1.1–1.4 for atrial fibrillation/flutter to 1.9, 95% CI: 1.7–2.2 for unprovoked VTE and 1.9, 95% CI: 1.6–2.3 for provoked VTE). Associations persisted, but were attenuated, when restricting to persons without alcohol use disorder and to persons without physical health comorbidities. Limitations: Unspecified stress reaction has less precise criteria than other stress-related diagnoses, and we could not adjust for some potential confounders. Conclusions: Our results augment literature on stress disorders and cardiovascular disease by highlighting the additional importance of unspecified stress disorders. Further research on this diagnostic category, which may represent subsyndromal psychopathology, is warranted. These findings support considering persons with non-specific stress-related psychopathology in treatment and tertiary prevention activities.

AB - Background: Posttraumatic stress disorder is a well-documented risk factor for cardiovascular disease. Whether non-specific stress-related psychopathology also increases risk is less well known. Methods: In a cohort of adult Danish-born residents of Denmark with an incident diagnosis of unspecified reaction to severe stress (“unspecified stress reaction”) between 1995 and 2011 (N = 24,534), we assessed incidence of seven arterial and venous cardiovascular events/conditions between 1996 and 2013. We calculated standardized incidence ratios (SIRs) comparing incidence of each outcome among the cohort to expected incidence based on sex-, age-, and calendar-time-specific national rates. We conducted stratified analyses by demographic characteristics, comorbidities, and length of follow-up time. Results: Incidence over the study period ranged from 1.1% for provoked VTE to 5.7% for stroke, adjusting for competing risk of death. Unspecified stress reaction was associated with all outcomes (SIRs ranging from 1.3, 95% confidence interval (CI): 1.1–1.4 for atrial fibrillation/flutter to 1.9, 95% CI: 1.7–2.2 for unprovoked VTE and 1.9, 95% CI: 1.6–2.3 for provoked VTE). Associations persisted, but were attenuated, when restricting to persons without alcohol use disorder and to persons without physical health comorbidities. Limitations: Unspecified stress reaction has less precise criteria than other stress-related diagnoses, and we could not adjust for some potential confounders. Conclusions: Our results augment literature on stress disorders and cardiovascular disease by highlighting the additional importance of unspecified stress disorders. Further research on this diagnostic category, which may represent subsyndromal psychopathology, is warranted. These findings support considering persons with non-specific stress-related psychopathology in treatment and tertiary prevention activities.

KW - Cardiovascular

KW - Epidemiology

KW - Stress disorders

KW - Subsyndromal psychiatric disorders

KW - Unspecified reaction to severe stress

KW - Unspecified stress disorders

UR - http://www.scopus.com/inward/record.url?scp=85099201255&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2020.12.180

DO - 10.1016/j.jad.2020.12.180

M3 - Letter

C2 - 33445098

AN - SCOPUS:85099201255

VL - 282

SP - 712

EP - 716

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -