A Swedish study found that the surgical removal of the tonsils or adenoids may be associated with a higher risk of stress-related disorders, including post-traumatic stress disorder.

In the nationwide study, published in JAMA Network Open, investigators included more than 1 million children and young adults, with 83,957 patients who underwent tonsillectomy or adenoidectomy and 839,570 matched controls. The investigators found a 43% increased risk of developing stress-related disorders in those who had the surgery compared with controls (hazard ratio [HR] = 1.43, 95% CI = 1.38–1.48). Post-traumatic stress disorder (PTSD) showed the highest associated risk (HR = 1.55, 95% CI = 1.43–1.69).

A separate sibling analysis of 51,601 patients and 75,159 unexposed siblings confirmed the findings, showing a 34% increased risk (HR = 1.34, 95% CI = 1.25–1.44).

The risk remained consistent across sex, parental education, family history, and time since surgery, though it increased with age at the time of the procedure. Patients aged 26 years or older showed the highest risk (HR = 1.76, 95% CI = 1.43–2.15). Risk was greatest in the first decade postsurgery (HR = 1.55, 95% CI = 1.47–1.63) but persisted beyond 20 years of follow-up.

Limitations included the lack of access to detailed medical records and a focus on cases treated in specialist care, which may not fully capture stress-related disorders treated in primary care settings.

The research was funded by the National Natural Science Foundation of China and the Medical Excellence Award from the First Affiliated Hospital of Guangxi Medical University. Full disclosures are available in the study.