Childhood infection and subsequent risk of psychotic disorders in adults: A systematic review and meta-analysis.

Abstract

The effects of childhood infection exposure on the risk of subsequent psychosis are unclear and no overview is available. We conducted a meta-analysis to assess the link between childhood infection and the risk of psychosis in later life. We performed systematic searches of the PubMed and Embase databases to identify relevant articles published up to March 1, 2020. Random-effects models were used to pool the odds ratios [OR] of childhood infection and later psychosis. Thirteen observational studies (seven on hospital exposure to infection and six on central nervous system (CNS) infection) were included in the meta-analysis. Hospital contact with any infection during childhood was associated with an increased risk of psychosis (OR, 1.27; 95 % confidence interval (CI), 1.13-1.44; p < 0.001; I2 = 84 %) or schizophrenia (OR, 1.44; 95 % CI, 1.19-1.73; p < 0.001; I2 = 54.2 %) later in life. In further analysis, the association also existed for children exposed to CNS infection (OR, 1.68; 95 % CI, 1.08-2.62; p = 0.021; I2 = 68.7 %). However, the risk was modulated by the timing and frequency of infection. Our results suggest an increased risk of psychosis later in life with infection exposure in childhood. However, non-causal explanations for the association cannot be ruled out.