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Primavera A Spagnolo, MD, PhD

Pronouns:

She/Her/Hers

Rank:

Instructor

Institution:

Connors Center For Women's Health and Gender Biology and Department of Psychiatry/ Brigham and Women's Hospital

Department:

Psychiatry

Authors:

Primavera A Spagnolo,* Anna P Joseph,* Ancella Roy,* Jessica Harder,* Hadine Joffe

Principal Investigator:

Primavera A Spagnolo

Comorbidity of PTSD, Depression, and Immune System Dysfunction in a Large Cohort of Men and Women

PTSD and autoimmune and inflammatory diseases (AIID) are female-prevalent conditions and both pose an high individual and societal burden. Recently, a link between PTSD and AIID has emerged, although the majority of research in this area has not considered differences among sexes.

This study is aimed at filling this gap and also provides insight into the compounding effect that depression may exert on the relationship between PTSD and AIID, since depression is also associated with an increased inflammatory state and is more prevalent in women compared to men.

Overview

Growing evidence indicates a reciprocal relationship between systemic inflammation and stress exposure, as indicated by high rates of co-morbidity between PTSD and several autoimmune and inflammatory disorders (AIID). The prevalence of both conditions is higher in women than men, however few studies have assessed sex-differences in the prevalence of AIID in individuals with PTSD.

 

Objectives

Here, we examined the prevalence of AIID in a large cohort of men and women with PTSD and in a subgroup of individuals with comorbid depression, given that this disorder is also associated with a pro-inflammatory state.

 

Methods

We conducted a retrospective cohort study of 5,765 patients diagnosed with PTSD  enrolled in the MGB Biobank between 2010 and 2021. Of those, patients aged 18-49, with no lifetime diagnosis of bipolar disorder and schizophrenia were included in the analysis. Chi-square tests were used to test differences in the prevalence of comorbid AIID among men and women with PTSD (n= 957). Analyses were repeated in the subgroup of individuals with comorbid depression.

 

Results

Compared to an overall prevalence between 5-9% in the general population, the prevalence of AIID in our study sample was approximately 57% (60% in women vs 50% in men). Women with PTSD were more likely to have an AIID than men with PTSD (p= 0.003). Similar results were obtained when considering exclusively systemic autoimmune disorders (p= 0.0001) and in the subgroup of individuals (n=493 female; n=178 male) with comorbid depression (p= 0.006). Finally, women with comorbid depression showed higher rates of AIID than women with PTSD only (68% vs 60%).

 

Conclusions

Our study extends prior research on the link between PTSD and AIID. We showed that the magnitude of this association was greater in women compared to men and was further exacerbated by comorbid depression, suggesting a common ethiopathogenetic mechanism among these disorders