title: Psychological outcome, fatigue, and quality of life after infection with shiga toxin-producing Escherichia coli O104.
abstract: OBJECTIVE
  From May through July 2011 in northern Germany, there was a large outbreak of hemolytic uremic syndrome and bloody diarrhea, which was related to infections from Shiga toxin-producing Escherichia coli O104 (STEC). We investigated the depression, posttraumatic symptoms, fatigue, and health-related quality of life among patients within the first 6 months after STEC infection and aimed to identify factors associated with poor outcome.
  
  
  METHODS
  In a cohort study, we performed baseline assessments of 389 patients (69% female) 3 months after STEC infection (82 ± 36 days) and follow-up assessments of 308 of the patients 6 months afterward (199 ± 17 days). Data were collected at 13 hospitals in northern Germany. Patients completed validated self-report scales and a diagnostic interview.
  
  
  RESULTS
  At baseline, hemolytic uremic syndrome was diagnosed in 31% of the patients. Six months after the infection, mean self-reported severity of depression and posttraumatic symptoms and fatigue were significantly greater than in the general population, and the mean score from the mental component of health-related quality of life survey was significantly lower than average. Posttraumatic stress disorder had recently developed in 3% of patients (95% confidence interval, 1%-5%), and 43% of patients had clinically relevant fatigue (95% confidence interval, 41%-45%). The most important baseline factors associated with poor psychological health 6 months after STEC infection were previous traumatic events, neuroticism, and low social support (all P < .05).
  
  
  CONCLUSIONS
  Six months after the major outbreak of STEC infection in northern Germany, a substantial number of patients had poor psychological health, persistent fatigue, and impaired quality of life. For future outbreaks, patients' premorbid risk factors should be considered, which might minimize the long-term effects of infections on mental health.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany. Electronic address: b.loewe@uke.uni-hamburg.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Löwe
authors.affiliation: Israelitisches Krankenhaus, Hamburg, Germany.
authors.forename: Viola
authors.initials: V
authors.lastname: Andresen
authors.affiliation: Department of Gastroenterology and Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Fraedrich
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
authors.forename: Kerrin
authors.initials: K
authors.lastname: Gappmayer
authors.affiliation: Department of Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Department of Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: András
authors.initials: A
authors.lastname: Treszl
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Riegel
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Charité University Medical Center, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.affiliation: Department of Gastroenterology and Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Broicher
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D004196:Disease Outbreaks; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D054323:Shiga-Toxigenic Escherichia coli / Q000302:isolation & purification*; D016896:Treatment Outcome
keywords: Chronic Fatigue Syndrome; HrQoL; Mental Disorders; PTSD; Posttraumatic Stress Disorder