Use of Antibiotics and Risk of Psychiatric Disorders in Newly Diagnosed Cancer Patients: A Population-Based Cohort Study in Sweden

• Published in: Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2022-03, Vol.31 (3), p.528-535
• Main Authors: Hu, Kejia, Smedby, Karin E, Sjölander, Arvid, Montgomery, Scott, Valdimarsdóttir, Unnur, Engstrand, Lars, Fang, Fang, Fall, Katja
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - adverse effects; Cohort Studies; Dysbiosis; Humans; Mental Disorders - epidemiology; Neoplasms - drug therapy; Neoplasms - epidemiology; Proportional Hazards Models; Registries; Risk Factors; Sweden - epidemiology
• ISSN: 1055-9965; 1538-7755; 1538-7755
• DOI: 10.1158/1055-9965.EPI-21-1095

Antibiotic-induced dysbiosis is associated with an increased risk of depression and anxiety in the general population. A diagnosis of cancer is associated with an immediately and dramatically elevated risk of psychiatric disorders, but the potential influence of prediagnostic antibiotic-induced dysbiosis is unknown. Based on a national cohort of cancer patients in Sweden, we included 309,419 patients who were diagnosed with a first primary malignancy between July 2006 and December 2013. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of first-onset psychosis, depression, anxiety, or stress-related disorders during the first year after cancer diagnosis for antibiotic use during the year before cancer diagnosis. Compared with no antibiotic use, use of antibiotics was associated with a higher rate of the aforementioned psychiatric disorders (HR, 1.23; 95% CI, 1.16-1.30) after adjustment for sociodemographic factors, comorbidity, potential indications for antibiotics, and cancer stage and type. The magnitude of the association was higher for broad-spectrum antibiotics (HR, 1.27; 95% CI, 1.18-1.37), higher doses (HR, 1.32; 95% CI, 1.22-1.44), more frequent use (HR, 1.33; 95% CI, 1.21-1.46), and recent use (HR, 1.26; 95% CI, 1.17-1.35). Use of antibiotics, especially of broad-spectrum type, of high dose and frequency, with recent use, was associated with an aggravated risk of psychiatric disorders, compared with no antibiotic use. A better understanding of the microbiota-gut-brain axis may open up a wide avenue for the prevention and treatment of psychiatric disorders in cancer patients.