title: Hospital admission with infection during childhood and risk for psychotic illness--a population-based cohort study.
abstract: A growing body of literature suggests that exposure to infections, particularly maternal infections, during pregnancy confers risk for later development of psychotic disorder. Though brain development proceeds throughout childhood and adolescence, the influence of infections during these ages on subsequent psychosis risk is insufficiently examined. The aim of this study was to investigate the potential association between infections during childhood and nonaffective psychoses in a large population-based birth cohort with follow up long enough to include peak incidence of nonaffective psychosis. We included all individuals born in Sweden between 1973 and 1985, (N = 1172879), with follow up on first time inpatient care with nonaffective psychosis from age 14 years until 2006, (N = 4638). Following adjustment for differences in sex, socioeconomic status, family history of psychosis, and hospital admissions involving noninfectious, nonpsychiatric care, we observed a small but statistically significant association between hospital admissions for infections, in general, throughout childhood (0-13 years) and a later diagnosis of nonaffective psychosis, hazard ratio (HR) = 1.10 (95% CI 1.03-1.18), and this association seemed to be driven by bacterial infection, HR = 1.23 (95% CI 1.08-1.40). Bacterial infections and central nervous system infections during preadolescence (10-13 years) conferred the strongest risk, HR 1.57 (95% CI 1.21-2.05) and HR 1.96 (95% CI 1.05-3.62), respectively. Although preadolescence appeared to be a vulnerable age period, and bacterial infection the most severe in relation to psychosis development, the present findings can also indicate an increased susceptibility to hospital admission for infections among children who will later develop nonaffective psychosis due to social or familial/genetic factors.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; asa.blomstrom@ki.se.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Blomström
authors.affiliation: Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Håkan
authors.initials: H
authors.lastname: Karlsson
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Anna
authors.initials: A
authors.lastname: Svensson
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Thomas
authors.initials: T
authors.lastname: Frisell
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Henrik
authors.initials: H
authors.lastname: Dal
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Cecilia
authors.initials: C
authors.lastname: Magnusson
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden;
authors.forename: Christina
authors.initials: C
authors.lastname: Dalman
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology*; D002494:Central Nervous System Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000209:etiology; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: cohort study; epidemiology; prenatal; psychosis; schizophrenia