Posttraumatic stress disorder and risk of selected autoimmune diseases among US military personnel

Abstract

Background: Increasing evidence suggests a link between posttraumatic stress disorder (PTSD) and physical health. Stress disorders may lead to impairment of the immune system and subsequent autoimmune disease. This study investigated the association between PTSD and risk of selected autoimmune diseases (i.e. rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel diseases, and multiple sclerosis) among US active duty service members. Methods: Using data from the Millennium Cohort Study, incident autoimmune cases between study initiation and September 2015 were identified from medical encounter records in the Military Health System Data Repository (MDR). Participants were classified as having a history of PTSD if they self-reported receiving a health care provider's diagnosis of PTSD or if they screened positive using the PTSD Checklist−Civilian Version. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression models adjusted for demographics and history of another mental health condition. Results: Among 120,572 participants followed for a mean of 5.2 years, risk of any of the selected autoimmune diseases was 58% higher for those with a history of PTSD (HR = 1.58, 95% CI: 1.25, 2.01) compared with no history of PTSD. Further adjustment for BMI, smoking status, and alcohol use had little impact on the effect estimates, and results were not appreciably different according to combat experience and history of physical or sexual trauma. Conclusions: Active duty military personnel with PTSD may have an elevated risk of a range of autoimmune diseases, regardless of combat experience or prior trauma. Future research is needed to understand potential mechanisms which may inform future mitigative strategies in reducing extra-neuropsychiatric health problems among those with PTSD.

Gene Expression Analysis in Three Posttraumatic Stress Disorder Cohorts Implicates Inflammation and Innate Immunity Pathways and Uncovers Shared Genetic Risk With Major Depressive Disorder

“…The most significant differentially expressed gene was interleukin-1ß ( IL1B ), a pro-inflammatory cytokine that is associated with innate immunity and has been extensively studied for its role in autoinflammatory diseases ( Dinarello, 2011 ). Indeed, those with PTSD are at increased risk for autoimmune disorders including rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel diseases, and multiple sclerosis ( Ali et al, 2014 ; O’Donovan et al, 2015 ; Song et al, 2018 ; Bookwalter et al, 2020 ), and display elevated levels of pro-inflammatory cytokines, including interleukin-1ß ( Spivak et al, 1997 ; Tursich et al, 2014 ; Passos et al, 2015 ). Moreover, inflammation and dysregulation of the immune system has been associated with other psychiatric disorders that frequently co-occur with PTSD such as MDD ( Howren et al, 2009 ; Dowlati et al, 2010 ), schizophrenia ( Miller et al, 2011 ), and alcohol use disorder ( Crews et al, 2017 ; Patel et al, 2019 ).…”

Depression and Subsequent Risk for Incident Rheumatoid Arthritis Among Women

“…A previous study using the NHSII found that an increasing number of symptoms of posttraumatic stress disorder (PTSD) increased RA risk (41). Among military members, PTSD was associated with a 58% increased risk for any incident autoimmune disease, the most common being RA (42). A twin study also suggested that PTSD was significantly associated with increased RA risk (43).…”

Retrospective Observational Study of Daytime Add-On Administration of Zopiclone to Difficult-to-Treat Psychiatric Inpatients With Unpredictable Aggressive Behavior, With or Without EEG Dysrhythmia

“…In a recent systematic review, studies provided varying levels of evidence that Autism Spectrum Disorder children displayed higher levels of antibodies reactive to folate receptor α, MAG, MBP, ribosome P, endothelial cell, and ANA, as compared to healthy controls (31). Autoimmunity has also been invoked to explain the pathophysiology of subgroups of patients with schizophrenia spectrum and other psychotic disorders (32,33), mood disorders (34,35), PTSD (36)(37)(38), neurocognitive disorders (39,40), including those secondary to traumatic brain injury (41,42).…”