title: Sexually transmitted infections after bereavement - a population-based cohort study.
abstract: Loss of a loved one has consistently been associated with various health risks. Little is however known about its relation to sexually transmitted infections (STIs).
  
  
  
  We conducted a population-based cohort study during 1987-2012 using the Swedish Multi-Generation Register, including 3,002,209 women aged 10-44 years. Bereavement was defined as death of a child, parent, sibling or spouse (N = 979,579, 33 %). STIs were defined as hospital visits with an STI as main or secondary diagnosis. Poisson regression and negative binomial regression were used to estimate incidence rate ratios (IRRs) and 95 % confidence intervals (CIs) of STIs, comparing incidence rates of women who had experienced loss to those who had not.
  
  
  
  Bereaved women were at significantly higher risk of nearly all STIs studied. The relative risk of any STI was highest during the first year after loss (IRR: 1.45, 95 % CI: 1.27-1.65) and predominantly among women with subsequent onset of psychiatric disorders after bereavement (IRR: 2.61, 95 % CI: 2.00-3.34). Notably, a consistent excess risk, persisting for over five years, was observed for acute salpingitis (IRR: 1.28, 95 % CI: 1.13-1.44), a severe complication of bacterial STIs.
  
  
  
  These data suggest that women who have experienced bereavement are at increased risk of STIs.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden. emily.bond@ki.se.
authors.forename: Emily
authors.identifier: 0000-0001-5374-7085
authors.initials: E
authors.lastname: Bond
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden. donghao.lu@ki.se.
authors.forename: Donghao
authors.initials: D
authors.lastname: Lu
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Herweijer
authors.affiliation: Department of Laboratory Medicine, Karolinska Institutet, H5, Division of Pathology, Karolinska Universitetssjukhuset Huddinge, Stockholm, 14186, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Sundström
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden.|Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Stapi v/Hringbraut, 101, Reykjavik, Iceland.|Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Unnur
authors.initials: U
authors.lastname: Valdimarsdóttir
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden.|Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Katja
authors.initials: K
authors.lastname: Fall
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden.
authors.forename: Lisen
authors.initials: L
authors.lastname: Arnheim-Dahlström
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Sparén
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Box 281, Stockholm, 17177, Sweden.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001601:Bereavement; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology; D012042:Registries; D012306:Risk; D012488:Salpingitis / Q000175:diagnosis; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Bereavement; Condyloma; HPV vaccination; Psychological stress; Salpingitis; Sexually transmitted infections