New-onset autoimmunity in people living with post-traumatic stress disorder

Background Prior observational studies suggested an association between post-traumatic stress disorder (PTSD) and autoimmune disorders; however, a comprehensive evaluation of this relationship remains limited. Methods In this retrospective cohort study, using the TriNetX global network, individuals newly diagnosed with chronic PTSD without autoimmune disease at baseline were propensity-score-matched to individuals without PTSD (2005–2025). Matching included age, sex, race, ethnicity, obesity, smoking, and psychiatric comorbidities variables. Cox models estimated the risk of 32 new-onset autoimmune disorders during a 5-year follow-up period, overall and by organ class. Analyses were repeated across subgroups defined by sex, age, race, ethnicity, and the presence or absence of depression and/or anxiety. Results The matched cohort included 316,482 individuals (mean age, 38.5 ± 16.6 years; 64.1% women). Over 1,054,536 person-years of follow-up, new autoimmune disorders occurred in 12,845 (8.4%) individuals with PTSD and 9,988 (6.5%) individuals without PTSD (hazard ratio [HR], 1.34 [95% CI 1.30–1.37]; absolute risk difference calculated over 4 years was 2.9% [2.7–3.1]). PTSD was associated with higher risks of rheumatologic (HR, 1.33 [1.26–1.41]), gastrointestinal (1.25 [1.15–1.36]), hematologic (1.59 [1.39–1.81]), endocrine (1.40 [1.35–1.45]), and neurologic autoimmune disorders (1.53 [1.31–1.78]). The increased risk remained consistent in sex-stratified analyses, with HRs of 1.20 [1.15–1.25] in men and 1.32 [1.29–1.36] in women, and across all ages, racial, and ethnic subgroups and in subjects with or without comorbid depression or anxiety. Conclusions PTSD is associated with an increased risk of subsequent development of autoimmune disorders.