Childhood-Onset IBD Increases Risk for Psychiatric Disorders

Agnieszka Butwicka, MD, PhD

New data suggests that children with inflammatory bowel disease (IBD) should receive long-term psychological support because of a greater risk in developing a psychiatric disorder.

In a new population-based cohort study, a team led by Agnieszka Butwicka, MD, PhD, a researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, found that childhood-onset IBD is linked to an increase risk of various psychiatric disorders, as well as suicide attempts.

The investigators examined the data of 6464 individuals with a childhood-onset IBD diagnosis from the Swedish national health care and population registers for all children under the age of 18 between 1973-2013.

Of the patients in the study, 3228 were diagnosed with ulcerative colitis, 2536 with Crohn’s disease, and 700 with unclassified IBD. The patients were compared with 323,200 matched reference individuals from the general population and 6999 siblings of IBD patients. Also, the study population had a mean age of 13 at the time of diagnosis, with a median follow-up time of 9 years.

While the primary outcome was any psychiatric disorder and suicide attempt, secondary outcomes were specific psychiatric psychotic, mood, anxiety, eating, personality and behavioral disorders, substance misuse, attention-deficit/hyperactivity disorder, autism spectrum disorders, and intellectual disability.

The investigators found that 1117 individuals (17.3%) with IBD received a diagnosis of any psychiatric disorder, while 38,044 of 323,200 individuals (11.8%) in the general population received a diagnosis of any psychiatric disorder.

They also found a link between IBD and specific psychiatric disorders, as well as suicide attempts.

“Inflammatory bowel disease was significantly associated with suicide attempt (HR, 1.4; 95% CI, 1.2-1.7) as well as mood disorders (HR, 1.6; 95% CI, 1.4-1.7), anxiety disorders (HR, 1.9; 95% CI, 1.7-2.0) eating disorders (HR, 1.6; 95% CI, 1.3-2.0), personality disorders (HR, 1.4; 95% CI, 1.1-1.8), attention-deficit/hyperactivity disorder (HR, 1.2; 95% CI, 1.1-1.4), and autism spectrum disorders (HR, 1.4; 95% CI, 1.1-1.7),” the authors wrote.

The results were similar for males and females. Hazard ratios for any of the psychiatric disorders were highest in the first year of follow-up, but remained statistically significant after more than 5 years of follow-up.

“Results were largely confirmed by sibling comparison, with similar estimates noted for any psychiatric disorder (HR, 1.6; 95% CI, 1.5-1.8), and suicide attempt (HR, 1.7; 95% CI, 1.2-2.3),” the authors wrote.

In a recent study, investigators linked depression rates with patients with severe IBD symptoms.

A team led by Ben Wilkinson, Mental Health Research Group, College of Medicine and Health, University of Exeter, conducted a cross-sectional study examining the role of emotional processing biases in contributing to depression for IBD patients in 120 patients.

Of the 120 study participants, 104 volunteers completed a questionnaire that included inquiries on age, sex, social support, socioeconomic status, anxiety, and depression, while 112 underwent assessments of biases in emotional recognition, emotional memory, and reinforcement learning and had recorded from clinical records the type of IBD, duration of the disease, and IBD activity.

Also, 99 participants provided blood for high-sensitivity C-reactive protein levels.

The investigators found that 68 participants had Crohn’s disease and 49 had ulcerative colitis. Of these patients, 35 had active disease and 26 had depression.

The study, “Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt,” was published online in JAMA Pediatrics.