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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Infectious, atopic and inflammatory diseases, childhood adversities and familial aggregation are independently associated with the risk for mental disorders: Results from a large Swiss epidemiological study
Vladeta Ajdacic-Gross, Aleksandra Aleksandrowicz, Stephanie Rodgers, Margot Mutsch, Anja Tesic, Mario Müller, Wolfram Kawohl, Wulf Rössler, Erich Seifritz, Enrique Castelao, Marie-Pierre F Strippoli, Caroline Vandeleur, Roland von Känel, Rosa Paolicelli, Markus A Landolt, Cornelia Witthauer, Roselind Lieb, Martin Preisig
Vladeta Ajdacic-Gross, Aleksandra Aleksandrowicz, Stephanie Rodgers, Anja Tesic, Mario Müller, Wolfram Kawohl, Wulf Rössler, Erich Seifritz, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8021 Zurich, Switzerland
Margot Mutsch, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
Enrique Castelao, Marie-Pierre F Strippoli, Caroline Vandeleur, Martin Preisig, Department of Psychiatry, University Hospital of Lausanne, 1011 Lausanne, Switzerland
Roland von Känel, Department of Neurology, Bern University Hospital, 3010 Bern, Switzerland
Roland von Känel, Clinic Barmelweid, 5017 Barmelweid, Switzerland
Rosa Paolicelli, Division of Psychiatry Research, University of Zurich, 8032 Zurich, Switzerland
Markus A Landolt, University Children’s Hospital Zurich and Children’s Research Center and Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8032 Zurich, Switzerland
Cornelia Witthauer, Roselind Lieb, Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, 4055 Basel, Switzerland
Author contributions: Preisig M, Castelao E, Strippoli MPF and Vandeleur C designed the PsyCoLaus study and acquired the data; Ajdacic-Gross V, Aleksandrowicz A, Rodgers S and Müller M carried out the analysis; all authors contributed to the interpretation of the results and to the critical revision of the manuscript; Ajdacic-Gross V and Aleksandrowicz A wrote the paper; all authors contributed critical revisions of the text.
Supported by Research grants from GlaxoSmithKline; the Faculty of Biology and Medicine of Lausanne; and the Swiss National Science Foundation, Nos. 3200B0-105993, 3200B0-118308, 33CSCO-122661, 33CS30-139468 and 33CS30-148401.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the University of Lausanne.
Informed consent statement: All participants gave their written informed consent at enrollment into the study.
Conflict-of-interest statement: All authors: None.
Data sharing statement: The participants gave informed consent for data sharing within CoLaus and PsyCoLaus. No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vladeta Ajdacic-Gross, PhD, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 2019, 8021 Zurich, Switzerland. vajdacic@dgsp.uzh.ch
Telephone: +41-44-2967433 Fax: +41-44-2967449
Received: June 28, 2016
Peer-review started: July 1, 2016
First decision: August 5, 2016
Revised: September 12, 2016
Accepted: October 5, 2016
Article in press: October 9, 2016
Published online: December 22, 2016
AIM
To examine the associations between mental disorders and infectious, atopic, inflammatory diseases while adjusting for other risk factors.
METHODS
We used data from PsyCoLaus, a large Swiss Population Cohort Study (n = 3720; age range 35-66). Lifetime diagnoses of mental disorders were grouped into the following categories: Neurodevelopmental, anxiety (early and late onset), mood and substance disorders. They were regressed on infectious, atopic and other inflammatory diseases adjusting for sex, educational level, familial aggregation, childhood adversities and traumatic experiences in childhood. A multivariate logistic regression was applied to each group of disorders. In a complementary analysis interactions with sex were introduced via nested effects.
RESULTS
Associations with infectious, atopic and other chronic inflammatory diseases were observable together with consistent effects of childhood adversities and familial aggregation, and less consistent effects of trauma in each group of mental disorders. Streptococcal infections were associated with neurodevelopmental disorders (men), and measles/mumps/rubella-infections with early and late anxiety disorders (women). Gastric inflammatory diseases took effect in mood disorders (both sexes) and in early disorders (men). Similarly, irritable bowel syndrome was prominent in a sex-specific way in mood disorders in women, and, moreover, was associated with early and late anxiety disorders. Atopic diseases were associated with late anxiety disorders. Acne (associations with mood disorders in men) and psoriasis (associations with early anxiety disorders in men and mood disorders in women) contributed sex-specific results. Urinary tract infections were associated with mood disorders and, in addition, in a sex-specific way with late anxiety disorders (men), and neurodevelopmental and early anxiety disorders (women).
CONCLUSION
Infectious, atopic and inflammatory diseases are important risk factors for all groups of mental disorders. The sexual dimorphism of the associations is pronounced.
Core tip: This study adds to the evidence that infectious, atopic and inflammatory diseases make up an important group of risk factors for neurodevelopmental and common mental disorders. They contribute independently of further major risk factors such as childhood adversities, traumatic experiences and familial aggregation. Each group of mental disorders (neurodevelopmental, early and late anxiety, mood, substance) attracts different combinations of risk factors. The sexual dimorphism of the associations is pronounced. The hypothesized biological mechanism that acts as a common denominator in this group of risk factors involves imbalances, e.g., within the development of the immune system interfering with critical stages of brain development.
