Infections and post-traumatic stress disorder: a population-based matched cohort study
Abstract
Background: At some point in their lives 1 in 10 people in the UK are expected to experience posttraumatic stress disorder (PTSD). Critical illness and intensive care unit treatment have been associated with risk of PTSD. The relationship between acute infections and PTSD is not clear.
Methods: Using data from the Clinical Practice Research Datalink Aurum (01/01/2007-31/03/2023), we conducted six matched cohort studies. Adults with lower respiratory tract (LRTI), urinary tract (UTI) and skin/soft tissue (SSTI) infections, gastroenteritis (GE), sepsis, and meningitis/encephalitis (positive control) were matched on sex, age, general practice, and calendar period with up to five adults without infection. Using Cox regression, stratified by matched set, and adjusting for Charlson comorbidity index, harmful alcohol use, smoking, and obesity we estimated hazard ratios (HRs) for incident PTSD among adults with infection relative to those without.
Results: The smallest cohort consisted of 18,101 individuals with meningitis/encephalitis matched to 90,021 without, and the largest of 396,812 individuals with SSTI matched to 1,734,615 without. Median follow-up was shortest in the sepsis cohort (2.4 years) and longest in the GE cohort (4.2 years). Median age ranged from 43 to 72 years; 49-57% of all cohorts were women, except in the UTI cohort (80%). After adjustment, each infection was associated with an increased PTSD hazards: UTI: HR 1.56 (95%CI 1.38,1.75), LRTI: 1.64 (1.50, 1.78), SSTI: 1.64 (1.51,1.78), GE: 1.89 (1.74, 2.07), sepsis: 2.25 (1.89, 2.69), and meningitis/encephalitis: 2.43 (1.82, 3.25).
Conclusions: Our findings suggest that acute infections among adults may increase PTSD risk. Evidence was stronger for more severe infections, e.g. sepsis. Further research is needed to understand pathways between infections and PTSD.
Key messages: • A large electronic health records study among adults in the UK links acute infections to PTSD, particularly severe infections such as sepsis and meningitis/encephalitis.
• Mental health monitoring and interventions following severe infections may identify and support incident PTSD cases. Further research is needed to understand pathways between infections and PTSD.
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BibTeX
@article{gorelangton2026infections,
title = {{Infections and post-traumatic stress disorder: a population-based matched cohort study}},
author = {GR Gore-Langton and SL Cadogan and JF Iglesias and KE Mansfield and IJ Douglas and S Fazel and J Tazare and C Morton and N Mukadam and C Warren-Gash},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.940},
url = {https://doi.org/10.1093/eurpub/ckag169.940},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Infections and post-traumatic stress disorder: a population-based matched cohort study
AU - GR Gore-Langton
AU - SL Cadogan
AU - JF Iglesias
AU - KE Mansfield
AU - IJ Douglas
AU - S Fazel
AU - J Tazare
AU - C Morton
AU - N Mukadam
AU - C Warren-Gash
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.940
UR - https://doi.org/10.1093/eurpub/ckag169.940
AB - Background: At some point in their lives 1 in 10 people in the UK are expected to experience posttraumatic stress disorder (PTSD). Critical illness and intensive care unit treatment have been associated with risk of PTSD. The relationship between acute infections and PTSD is not clear. Methods: Using data from the Clinical Practice Research Datalink Aurum (01/01/2007-31/03/2023), we conducted six matched cohort studies. Adults with lower respiratory tract (LRTI), urinary tract (UTI) and skin/soft tissue (SSTI) infections, gastroenteritis (GE), sepsis, and meningitis/encephalitis (positive control) were matched on sex, age, general practice, and calendar period with up to five adults without infection. Using Cox regression, stratified by matched set, and adjusting for Charlson comorbidity index, harmful alcohol use, smoking, and obesity we estimated hazard ratios (HRs) for incident PTSD among adults with infection relative to those without. Results: The smallest cohort consisted of 18,101 individuals with meningitis/encephalitis matched to 90,021 without, and the largest of 396,812 individuals with SSTI matched to 1,734,615 without. Median follow-up was shortest in the sepsis cohort (2.4 years) and longest in the GE cohort (4.2 years). Median age ranged from 43 to 72 years; 49-57% of all cohorts were women, except in the UTI cohort (80%). After adjustment, each infection was associated with an increased PTSD hazards: UTI: HR 1.56 (95%CI 1.38,1.75), LRTI: 1.64 (1.50, 1.78), SSTI: 1.64 (1.51,1.78), GE: 1.89 (1.74, 2.07), sepsis: 2.25 (1.89, 2.69), and meningitis/encephalitis: 2.43 (1.82, 3.25). Conclusions: Our findings suggest that acute infections among adults may increase PTSD risk. Evidence was stronger for more severe infections, e.g. sepsis. Further research is needed to understand pathways between infections and PTSD. Key messages: • A large electronic health records study among adults in the UK links acute infections to PTSD, particularly severe infections such as sepsis and meningitis/encephalitis. • Mental health monitoring and interventions following severe infections may identify and support incident PTSD cases. Further research is needed to understand pathways between infections and PTSD.
SN - 1101-1262
SN - 1464-360X
ER -