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. 2019 Oct 1;173(10):969-978.
doi: 10.1001/jamapediatrics.2019.2662.

Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt

Agnieszka Butwicka  1   2   3 , Ola Olén  4   5   6   7 , Henrik Larsson  1   8 , Jonas Halfvarson  9 , Catarina Almqvist  1   10 , Paul Lichtenstein  1 , Eva Serlachius  3   11 , Louise Frisén  3   11 , Jonas F Ludvigsson  1   12   13   14
Affiliations

Association of Childhood-Onset Inflammatory Bowel Disease With Risk of Psychiatric Disorders and Suicide Attempt

Agnieszka Butwicka et al. JAMA Pediatr. .

Abstract

Importance: 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.

Objective: 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.

Results: 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 [4] 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Olén reported being principal investigator for projects at Karolinska Institutet partly financed by investigator-initiated grants from Janssen and Pfizer and receiving fees for lectures and participation on advisory boards from Janssen, Ferring, and Takeda. Dr Larsson reported serving as a speaker for Eli Lilly and Shire and receiving research grants from Shire and personal fees from Evolan outside the submitted work. Dr Halfvarson reported receiving consulting and lecture fees from AbbVie, Celgene, Celltrion, Ferring, Hospira, Janssen, Medivir, MSD, Pfizer, Prometheus, RenapharmaVifor, Sandoz, Shire, Takeda, Tillotts Pharma, and Vifor Pharma and research grants from Janssen, MSD, and Takeda. Dr Almqvist reported receiving grants from the Swedish Research Council during the conduct of the study. Dr Ludvigsson reported coordinating a study on behalf of the Swedish IBD quality register that received funding from Janssen Corporation. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram for Patient Inclusion, Comparison Cohorts, and Follow-up
Figure 2.
Figure 2.. Hazard Ratios for Psychiatric Outcomes in Patients With Childhood-Onset Inflammatory Bowel Disease Compared With the General Population and Siblings
Bars indicate 95% CIs. ADHD indicates attention-deficit/hyperactivity disorder.
See this image and copyright information in PMC

Comment in

  • doi: 10.1001/jamapediatrics.2019.2669

References

    1. Everhov AH, Halfvarson J, Myrelid P, et al. . Incidence and treatment of patients diagnosed with inflammatory bowel diseases at 60 years or older in Sweden. Gastroenterology. 2018;154(3):518-528.e15. doi:10.1053/j.gastro.2017.10.034 - DOI - PubMed
    1. Büsch K, da Silva SA, Holton M, Rabacow FM, Khalili H, Ludvigsson JF. Sick leave and disability pension in inflammatory bowel disease: a systematic review. J Crohns Colitis. 2014;8(11):1362-1377. doi:10.1016/j.crohns.2014.06.006 - DOI - PubMed
    1. Wada K, Yamada N, Sato T, et al. . Corticosteroid-induced psychotic and mood disorders: diagnosis defined by DSM-IV and clinical pictures. Psychosomatics. 2001;42(6):461-466. doi:10.1176/appi.psy.42.6.461 - DOI - PubMed
    1. Anglin RE, Samaan Z, Walter SD, McDonald SD. Vitamin D deficiency and depression in adults: systematic review and meta-analysis. Br J Psychiatry. 2013;202:100-107. doi:10.1192/bjp.bp.111.106666 - DOI - PubMed
    1. Maldonado-Bouchard S, Peters K, Woller SA, et al. . Inflammation is increased with anxiety- and depression-like signs in a rat model of spinal cord injury. Brain Behav Immun. 2016;51:176-195. doi:10.1016/j.bbi.2015.08.009 - DOI - PMC - PubMed