title: Psychosocial stress as a risk factor for sepsis: a population-based cohort study.
abstract: OBJECTIVE
  To characterize the relationship between stress and future risk of sepsis. We also evaluated the role of depression in this relationship.
  
  
  METHODS
  We used population-based data on 30,183 participants in the Reasons for Geographic and Racial Differences in Stroke cohort, characterizing stress using the Perceived Stress Scale (PSS) and depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). We identified incident sepsis events as hospitalizations for a serious infection with the presence of at least two systemic inflammatory response syndrome criteria. We assessed associations between PSS and incidence of sepsis for 1 and 10 years of follow-up, adjusting for demographics and chronic medical conditions and assessing the role of health behaviors and CES-D in these relationships.
  
  
  RESULTS
  In 2003 to 2012, 1500 participants experienced an episode of sepsis. Mean PSS and CES-D scores were 3.2 (2.9) and 1.2 (2.1). PSS was associated with increased 1-year adjusted incidence of sepsis (hazard ratio [HR] = 1.21 per PSS standard deviation, 95% confidence interval = 1.06-1.38); multivariable adjustment for health behaviors and CES-D did not change this association (1.20, 1.03-1.39). PSS was also associated with increased 10-year adjusted incidence of sepsis (HR = 1.07 per PSS standard deviation; 95% confidence interval = 1.02-1.13). Multivariable adjustment showed that health behaviors did not affect this long-term association, whereas the addition of CES-D reduced the association between PSS and sepsis during 10-year follow-up (HR = 1.04, 0.98-1.11).
  
  
  CONCLUSIONS
  Increased stress was associated with higher 1-year adjusted incidence of sepsis, even after accounting for depressive symptoms. The association between stress and 10-year adjusted incidence of sepsis was also significant, but this association was reduced when adjusting for depressive symptoms. Reduction of stress may limit short-term sepsis risk.
authors.affiliation: From the Departments of Emergency Medicine (H.E.W, J.P.D.), Epidemiology (J.P.D.), Medicine, and Emergency Medicine (H.E.W.), and Division of Preventive Medicine (M.M.S., J.P.D.), University of Alabama School of Medicine (C.O.), Birmingham, Alabama; and Department of Epidemiology (R.G.), University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Connor
authors.initials: C
authors.lastname: Ojard
authors.forename: John P
authors.initials: JP
authors.lastname: Donnelly
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Russell
authors.initials: R
authors.lastname: Griffin
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D013315:Stress, Psychological / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology