Summary: Children with inflammatory bowel disease (IBD) are at increased risk of being diagnosed with a mental health problem. The risk of being diagnosed with a psychiatric condition is 1.6 times higher for those with IBD than the general population. IBD is associated with an increased risk of eating disorders, anxiety, depression, personality disorders, and ASD diagnosis. Researchers report there is also an increased risk of suicidal thoughts when the child reaches adulthood. The risk of being diagnosed with a psychiatric disorder was highest during the first year of IBD diagnosis, especially in children diagnosed with the condition before the age of 6.
Source: Karolinska Institute
Children with Inflammatory Bowel Disease (IBD) run a greater risk of psychiatric disorders, according to a new study from Karolinska Institutet in Sweden published in JAMA Pediatrics. The researchers claim that more psychological support and longer follow-up is needed for the children affected and their parents.
It is already known that adults with IBD (Ulcerative Colitis or Crohn’s Disease) run an increased risk of psychiatric disorders. Now a new study shows that children with IBD also run a higher risk of mental health problems.
More than 6,400 children with IBD, born between 1973 and 2013, were included in the study. Using population registers, the researchers compared the risk of psychiatric disorders later on in life with both healthy children from the general population and with the patients’ own siblings. By comparing the patients with their siblings, it was possible to take a large number of so-called confounders, such as socioeconomics, lifestyle and heredity into account, factors that are known to affect the risk of psychiatric disorders in children.
During an average follow-up period of 9 years, approximately 17 percent of the children with IBD were given a psychiatric diagnosis compared with just under 12 percent of the healthy children and about 10 percent of the siblings. This means that the risk of psychiatric disorders was 1.6 times higher in children with IBD compared to Swedish children from the general population. Likewise, the risk for the children with IBD was greater than for their siblings.
The higher risk applied to a number of psychiatric diagnoses such as depression, anxiety, eating disorders, personality disorders, ADHD and autism spectrum disorder. There was also a higher risk of suicide attempt after reaching adulthood.
“The study shows that children with IBD and their parents are in need of psychological support and longer follow-up,” says Agnieszka Butwicka, a researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
“Special help could be offered to children who become ill at a young age and to children of parents with mental health problems.”
The risk of mental health problems was greatest during the first year with IBD. The risk was particularly high for children who were diagnosed with IBD before the age of 6 years and for children of parents with psychiatric disorders.
The study is an observational study that cannot identify causality with certainty. However, according to the researchers, the results do indicate that IBD contributes to mental health problems.
“Because the risk for these children is higher compared with their own siblings, it is likely that it is IBD affecting their mental health rather than other factors such as socioeconomics, lifestyle or heredity in the family,” says Jonas F. Ludvigsson, professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
Funding: The research was conducted with funding from Fredrik och Ingrid Thurings Stiftelse, Mag-Tarmfonden, the Mjölkdroppen foundation, the Jane and Dan Olsson foundation, the Swedish Cancer Society, the Swedish Foundation for Strategic Research, the Swedish medical association, the Strategic Research Programme in Neuroscience (StratNeuro) at Karolinska Institutet, the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM), the Swedish Research Council, and Stockholm County Council.
Co-author Henrik Larsson has served as a speaker for Eli Lilly and Shire and has received research grants from Shire; all outside the submitted work. Jonas Halfvarson received consulting/lecture fees from Abbvie, Celgene, Ferring, Hospira, Janssen, Medivir, MSD, Pfizer, Prometheus, Renapharma Vifor, Sandoz, Shire, Takeda, and Tillotts Pharma and research grants from Janssen, MSD and Takeda. Ola Olén has been principal investigator for projects at Karolinska Institutet partly financed by investigator-initiated grants from Janssen and Pfizer and has received fees for lectures and participation on advisory boards from Janssen, Ferring and Takeda. Jonas F. Ludvigsson coordinates a study on behalf of the Swedish IBD quality register (SWIBREG), which has received funding from Janssen Corporation.
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Original Research: Closed access
“Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt”. Agnieszka Butwicka et al.
JAMA Pediatrics. doi:10.1001/jamapediatrics.2019.2662
Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt
Inflammatory bowel disease (IBD) has been associated with psychiatric morbidity in adults, although previous studies have not accounted for familial confounding. In children, IBD has an even more severe course, but the association between childhood-onset IBD and psychiatric morbidity remains unclear.
To examine the risk of psychiatric morbidity in individuals with childhood-onset IBD, controlling for potential confounding shared between siblings.
Design, Setting, and Participants
A population-based cohort study was conducted using data from the Swedish national health care and population registers of all children younger than 18 years born from 1973 to 2013. The study included 6464 individuals with a diagnosis of childhood-onset IBD (3228 with ulcerative colitis, 2536 with Crohn disease, and 700 with IBD unclassified) who were compared with 323 200 matched reference individuals from the general population and 6999 siblings of patients with IBD. Cox proportional hazards regression was used to estimate hazard ratios (HRs) with 95% CIs. Statistical analysis was performed from January 1, 1973, to December 1, 2013.
Main Outcomes and Measures
The primary outcome was any psychiatric disorder and suicide attempt. Secondary outcomes were the following specific psychiatric disorders: psychotic, mood, anxiety, eating, personality, and behavioral disorders; substance misuse; attention-deficit/hyperactivity disorder; autism spectrum disorders; and intellectual disability.
The study included 6464 individuals with a diagnosis of childhood-onset IBD (2831 girls and 3633 boys; mean [SD] age at diagnosis of IBD, 13  years). During a median follow-up time of 9 years, 1117 individuals with IBD (17.3%) received a diagnosis of any psychiatric disorder (incidence rate, 17.1 per 1000 person-years), compared with 38 044 of 323 200 individuals (11.8%) in the general population (incidence rate, 11.2 per 1000 person-years), corresponding to an HR of 1.6 (95% CI, 1.5-1.7), equaling 1 extra case of any psychiatric disorder per 170 person-years. 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) Results were similar for boys and girls. Hazard ratios for any psychiatric disorder were highest in the first year of follow-up but remained statistically significant after more than 5 years. Psychiatric disorders were particularly common for patients with very early-onset IBD (<6 years) and for patients with a parental psychiatric history. 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).Conclusions and Relevance
Overall, childhood-onset IBD was associated with psychiatric morbidity, confirmed by between-sibling results. Particularly concerning is the increased risk of suicide attempt, suggesting that long-term psychological support be considered for patients with childhood-onset IBD.