Increased Risk of Psychiatric Disorders in IBD Patients
A Swedish cohort study found that patients with inflammatory bowel disease (IBD) are at increased risk for several psychiatric disorders both before and after diagnosis.
Patients with inflammatory bowel disease (IBD) are at increased risk for several psychiatric disorders both before and after diagnosis, according to a Swedish cohort study.
The study, conducted by researchers at the Karolinska Institutet in Stockholm, found that the relative rate of any psychiatric disorder started to increase 2-3 years before IBD diagnosis, and peaked immediately after IBD diagnosis.
The increased risk was mainly driven by major depressive disorders, anxiety disorders, and substance misuse. In contrast, no increase was observed for psychotic disorders, personality disorders, and attention deficit-hyperactivity disorder.
IBD patients were more likely to have autism spectrum disorders shortly after diagnosis, and eating disorders 5 or more years onwards.
The researchers suggested that the clearly elevated risks observed in the pre-diagnostic period may reflect the impact of subclinical inflammation, gastrointestinal symptoms, and psychological stress experienced years before IBD diagnosis and during diagnostic workup.
The study's findings highlight the importance of integrating psychological care into IBD routine practice and including mental illness assessment and management in IBD guidelines.
The researchers included 48,230 patients with IBD and 210,582 matched reference individuals in their pre-diagnostic analysis. During a median follow-up of 5 years, 8.6% of IBD patients were diagnosed with any psychiatric disorder before IBD diagnosis compared with 6.8% of reference individuals.
After excluding those with any psychiatric disorder before the index date, the post-diagnostic analysis included 43,862 IBD patients and 178,821 matched reference individuals. Mean age at IBD diagnosis was 41.6 years, 47.3% were female, and 11.3% had childhood-onset IBD.
IBD patients tended to have more healthcare visits and more often a record of parental psychiatric history versus their matched counterparts (4.4% vs 3.1%).
During a median follow-up of 7.4 years, 16.5% of IBD patients were diagnosed with any psychiatric disorder after IBD diagnosis versus 12.8% of reference individuals. Major depressive disorders (4.6% vs 3.2%), anxiety disorders (7.3% vs 5.3%), and substance misuse (3.3% vs 2.7%) were most common.
The cumulative incidence of any psychiatric disorder was consistently higher in IBD patients, irrespective of IBD subtypes, with 10-year cumulative incidence differences of 3.21% in IBD, 4.23% in Crohn's disease, 2.43% in ulcerative colitis, and 4.69% in patients with IBD-unclassified.
This corresponded to one extra psychiatric disorder per 31 IBD patients, 24 Crohn's patients, 41 ulcerative colitis patients, and 21 IBD-unclassified patients during a 10-year period.
The researchers also conducted a sibling comparison analysis that suggested that shared familial factors do not fully explain the associations between IBD and psychiatric disorders.
In the sibling-controlled cohort, 26,807 IBD patients with at least one IBD-free full sibling were identified. Although IBD patients were younger than their matched siblings, more of them developed a psychiatric disorder after IBD diagnosis (15.6% vs 12.6%).
Significant pre- and post-diagnostic associations between IBD and any psychiatric disorder were observed, although hazard ratios were somewhat lower than those from the population-based comparison analysis.
The cumulative incidence of any psychiatric disorder was also consistently higher in IBD patients versus their siblings, irrespective of IBD subtypes.
The researchers pointed out that due to a lack of primary care data, their analyses may have missed some individuals with mild psychiatric symptoms or those not seeking healthcare, "which would underestimate the true absolute risk of psychiatric disorders in patients with IBD."
"As a result, our findings should only be interpreted in context of cases that require specialist care," they wrote.
## Increased Risk of Psychiatric Disorders in IBD Patients
The study's findings highlight the importance of integrating psychological care into IBD routine practice and including mental illness assessment and management in IBD guidelines.
## Cumulative Incidence of Any Psychiatric Disorder
| IBD Subtype | 10-Year Cumulative Incidence Difference | | --- | --- | | IBD | 3.21% | | Crohn's disease | 4.23% | | Ulcerative colitis | 2.43% | | IBD-unclassified | 4.69% |
This table shows the 10-year cumulative incidence differences of any psychiatric disorder in IBD patients, by IBD subtype.
## Sibling Comparison Analysis
The researchers also conducted a sibling comparison analysis that suggested that shared familial factors do not fully explain the associations between IBD and psychiatric disorders.
In the sibling-controlled cohort, 26,807 IBD patients with at least one IBD-free full sibling were identified. Although IBD patients were younger than their matched siblings, more of them developed a psychiatric disorder after IBD diagnosis (15.6% vs 12.6%).
Significant pre- and post-diagnostic associations between IBD and any psychiatric disorder were observed, although hazard ratios were somewhat lower than those from the population-based comparison analysis.
The cumulative incidence of any psychiatric disorder was also consistently higher in IBD patients versus their siblings, irrespective of IBD subtypes.
## Limitations of the Study
The researchers pointed out that due to a lack of primary care data, their analyses may have missed some individuals with mild psychiatric symptoms or those not seeking healthcare, "which would underestimate the true absolute risk of psychiatric disorders in patients with IBD."
"As a result, our findings should only be interpreted in context of cases that require specialist care," they wrote.
