Lyme Disease Heightens Risk of Mental Disorders, Suicidality, Study Finds

People in Denmark diagnosed with Lyme disease in a hospital went on to have 28% higher rates of mental disorders and were twice as likely to have attempted suicide, compared with those without the diagnosis, according to a study published Wednesday in AJP in Advance. Having more than one episode of Lyme disease was associated with a higher rate of mental disorders, affective disorders, and suicide attempts.

According to the CDC, nearly half a million people a year in the United States are treated for Lyme disease (also known as Lyme borreliosis), the most common vector-borne disease, and the areas where Lyme disease is common are expanding. Several studies have pointed to a connection between Lyme disease and psychiatric manifestations in people with untreated infection as well as months to years after antibiotic therapy, wrote Brian A. Fallon, M.D., M.P.H., of Columbia University and New York State Psychiatric Institute and colleagues. The current study is believed to be the first large population-based study examining the relationship between Lyme disease and psychiatric outcomes.

The researchers analyzed patient medical records for the nearly 7 million people living in Denmark and compared individuals diagnosed with Lyme disease in a hospital setting (n=12,616) with those without this diagnosis. Specifically, they examined cases of various mental disorders and suicidality among all individuals and adjusted the results based on known risk factors for mental illness such as sex, age, education level, socioeconomic status, and comorbidities. Patients who had a history of mental disorder or suicidality prior to the Lyme disease diagnosis were excluded from the analysis.

The analysis revealed that in addition to patients with Lyme disease being at greater risk of mental disorders and suicide attempts compared with those without this disease, they also had a 42% higher rate of affective disorders and a 75% higher rate of death by suicide. “Notably, the rate for affective disorders was highest during the first year after diagnosis and highest for completed suicide during the first 3 years after diagnosis,” Fallon and colleagues wrote.

“Our study focused on those whose Lyme disease was severe enough to require hospital contact,” Fallon told Psychiatric News. “Our results are therefore not surprising, given that individuals with hospital-based diagnoses of serious infections are known to have an increased risk of subsequent affective disorders and suicide.” The study results may not be generalizable to potentially less severe cases of Lyme disease that were handled outside the hospital.

Despite the findings, hospital-diagnosed cases of Lyme disease were not a major contributor to the overall rate of mental disorders or suicide in the general population, the authors noted. For example, the absolute rate for suicide of patients who were diagnosed with Lyme disease in the hospital was low, accounting for 25 fatalities over a 22-year period, representing 0.2% of all suicides during that time.

“Although the absolute population risk is low, clinicians should be aware of the potential psychiatric sequelae of this global disease,” Fallon and colleagues concluded.

For more on this topic, see the chapter on infectious diseases in The American Psychiatric Association Publishing Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry from APA Publishing.

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Prenatal Choline Supplements May Protect Offspring if Mother Contracts Viral Infection

Taking choline supplements during pregnancy may reduce the negative impact of viral respiratory infections on offspring, according to a study published in the Journal of Psychiatric Research.

“The new analysis may provide information relevant to potential COVID-19 effects on fetal brain development and their interaction with higher prenatal maternal choline levels,” wrote Robert Freedman, M.D., of the University of Colorado School of Medicine and colleagues.

Previous studies showed that infection in pregnant women can affect fetal brain development and may increase the risk of attention-deficit/hyperactivity disorder, autism spectrum disorder, and schizophrenia in offspring. Freedman and others have also found evidence to suggest higher levels of maternal choline—a vitamin B nutrient found in various foods and dietary supplements—may help mitigate these risks to infants.

It is recommended that pregnant women get 500 mg of choline daily, according to Freedman and colleagues. For the current study, the researchers compared choline levels measured at 16 weeks’ gestation in 36 pregnant women who had developed moderate to severe respiratory infections by week 16 with 53 mothers who reported no inflections. When the infants reached three months of age, the mothers completed the Infant Behavior Questionnaire-Revised Short Form (IBQ-R). The questionnaire asks parents to rate infants on measures of attention and engagement with parents, fearfulness and sadness, activity, and more.

Mothers with viral respiratory infections in early gestation were younger and more likely to be depressed and anxious, the researchers reported. Infants of mothers who had contracted a viral respiratory infection and had higher gestational choline serum levels (defined as ≥7.5 mM) scored higher in their ability to maintain attention and bond with parents compared with infants whose mothers had contracted an infection but had lower choline levels (< 7.5 mM). The increased maternal anxiety and depression in the mothers with respiratory viral infections did not appear to be associated with their infants’ ability to maintain attention and bond with parents, Freedman and colleagues wrote.

The authors noted that the effects of choline on infant development following COVID-19 infection “are as yet unknown, and no mother in this study had an infection requiring intensive care medical support for COIVD-19.” However, they concluded, “phosphatidylcholine or choline supplements along with other prenatal vitamins may help buffer the fetal brain from the possible detrimental impact of the current pandemic and decrease the risk of the children’s future mental illness.”

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Increased Risk of Mental Illness in Youth Linked to Infection

Children and adolescents with infections appear to be at a heightened risk of mental disorders, suggests a report published Wednesday in JAMA Psychiatry.

“This study found associations between any treated infection and increased risks of all treated childhood and adolescent mental disorders, with the risks differing among specific mental disorders,” wrote Ole Köhler-Forsberg, M.D., of Aarhus University Hospital in Denmark and colleagues.

For the study, Köhler-Forsberg and colleagues analyzed information contained in the Danish nationwide registers on more than one million children and adolescents born in Denmark between January 1, 1995, and June 30, 2012. The researchers focused their analysis on records of infections requiring hospitalizations and less severe infections treated with only anti-infective medications such as antibiotics and antivirals in outpatient settings. They also examined mental health diagnoses made in a hospital and filled prescriptions for psychotropic medications.

The authors found that children who had been hospitalized with a severe infection were 84% more likely to be subsequently diagnosed with a mental disorder than children who had not been hospitalized with a severe infection. Children treated for less severe infections with anti-infective medications were 40% more likely to be subsequently diagnosed with a mental disorder compared with children who had not taken these medications. The disorders associated with the highest risks after infection were autistic spectrum disorder, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, oppositional defiant disorder, conduct disorder, personality and behavior disorders, schizophrenia spectrum disorders, and tic disorders, Köhler-Forsberg and colleagues noted.

Because this was an observational study, Forsberg and colleagues noted that “the results cannot prove causality.” Nonetheless, “these findings provide evidence for the involvement of infections and the immune system in the etiology of a wide range of mental disorders in children and adolescents,” they added.

“These results bring a sense of urgency to detailing the underlying mechanisms of this association, in particular because of the possibility that these severe and occasionally permanent neuropsychiatric conditions might be rapidly recognized and treated by pharmacological compounds already in clinical use,” Viviane Labrie, Ph.D., and Lena Brundin, M.D., Ph.D., of Van Andel Research Institute, wrote in an accompanying editorial. In the piece, Labrie and Brundin described several mechanisms by which exposure to infections may increase risk of mental illness.

For related information, see the Psychiatric News article “Can Childhood Infections Trigger Mental Disorders?”

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