Most of us have had clients who have been sick while attempting to undergo therapy. When client’s have a diagnosis of PTSD the research supports that it is the PTSD that is associated with immune system problems. Two large studies that have been published in 2019 highlight this.
In their 2019 study Huan Song and her associates examined 144 919 individuals from the Swedish population, with stress related disorders (PTSD, acute stress reaction, adjustment disorder, and other stress reactions) for subsequent risk of life threatening infections, such as sepsis, endocarditis, and meningitis. They controlled for familial background, physical and or psychiatric comorbidities. They concluded that in their population, stress related disorders were associated with a subsequent risk of life-threatening infections.
Similarly, in 2019 Jiang and her associates published a nationwide cohort study of all residents of Denmark who received a PTSD diagnosis between 1995 and 2011. They suggested that PTSD diagnosis is a risk factor for numerous infection types and that the associations between PTSD diagnosis and infections are modified by sex.
In another study in 2018 by Huan Song and her team they examined data from 106 464 patients with stress-related disorders, 1 064 640 matched unexposed individuals, and 126 652 full siblings. They concluded that in their cohort, exposure to a stress-related disorder was significantly associated with increased risk of subsequent autoimmune disease, compared with matched unexposed individuals and with full siblings.
Furthermore Passos and colleagues in 2015 published a systematic review, meta-analysis, and meta-regression of the inflammatory markers in post-traumatic stress disorder. They found that PTSD was associated with increased interleukin 6, interleukin 1β, TNFα, and interferon γ levels. Essentially the body is experiencing chronic low-grade inflammation when someone has PTSD. This was also supported by Speer et al. 2018 review and by Hori and Kim’s 2019 review.
If PTSD is making people sick by affecting their immune system, does treating the PTSD change immune system factors?
So far only Huan Song et al 2019 has found that the relative risk of life-threatening infections appeared to be attenuated with use of selective serotonin reuptake inhibitors in the treatment of PTSD and other stress related disorder. They cautioned that their findings need replication. Speer et al 2018 recommended treatment of both the psychological symptoms and physical co-morbidities to address the chronically inflamed state.
Behavioural interventions such as Cognitive Processing Therapy treat PTSD effectively, it would be interesting to know if this effect is also associated with immune system changes.
References
Hori, H., & Kim, Y. (2019). Inflammation and post-traumatic stress disorder. Psychiatry and clinical neurosciences, 73(4), 143–153. https://doi.org/10.1111/pcn.12820
Jiang, T., Farkas, D. K., Ahern, T. P., Lash, T. L., Sørensen, H. T., & Gradus, J. L. (2019). Posttraumatic Stress Disorder and Incident Infections: A Nationwide Cohort Study. Epidemiology (Cambridge, Mass.), 30(6), 911–917. https://doi.org/10.1097/EDE.0000000000001071
Passos, I. C., Vasconcelos-Moreno, M. P., Costa, L. G., Kunz, M., Brietzke, E., Quevedo, J., Salum, G., Magalhães, P. V., Kapczinski, F., & Kauer-Sant’Anna, M. (2015). Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. The lancet. Psychiatry, 2(11), 1002–1012. https://doi.org/10.1016/S2215-0366(15)00309-0
Song, H., Fall, K., Fang, F., Erlendsdóttir, H., Lu, D., Mataix-Cols, D., Fernández de la Cruz, L., D’Onofrio, B. M., Lichtenstein, P., Gottfreðsson, M., Almqvist, C., & Valdimarsdóttir, U. A. (2019). Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study. BMJ (Clinical research ed.), 367, l5784. https://doi.org/10.1136/bmj.l5784
Song, H., Fang, F., Tomasson, G., Arnberg, F. K., Mataix-Cols, D., Fernández de la Cruz, L., Almqvist, C., Fall, K., & Valdimarsdóttir, U. A. (2018). Association of Stress-Related Disorders With Subsequent Autoimmune Disease. JAMA, 319(23), 2388–2400. https://doi.org/10.1001/jama.2018.7028
Speer, K., Upton, D., Semple, S., & McKune, A. (2018). Systemic low-grade inflammation in post-traumatic stress disorder: a systematic review. Journal of inflammation research, 11, 111–121. https://doi.org/10.2147/JIR.S155903
