Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Jan 4;12(1):142.
doi: 10.3390/nu12010142.

Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis

Emma Clappison  1 , Marios Hadjivassiliou  2 , Panagiotis Zis  2
Affiliations
Meta-Analysis

Psychiatric Manifestations of Coeliac Disease, a Systematic Review and Meta-Analysis

Emma Clappison et al. Nutrients. .

Abstract

Background: Coeliac disease (CD) is increasingly prevalent and is associated with both gastrointestinal (GI) and extra-intestinal manifestations. Psychiatric disorders are amongst extra-intestinal manifestations proposed. The relationship between CD and such psychiatric disorders is not well recognised or understood.

Aim: The aim of this systematic review and meta-analysis was to provide a greater understanding of the existing evidence and theories surrounding psychiatric manifestations of CD.

Methodology: An online literature search using PubMed was conducted, the prevalence data for both CD and psychiatric disorders was extracted from eligible articles. Meta analyses on odds ratios were also performed.

Results: A total of 37 articles were included in this review. A significant increase in risk was detected for autistic spectrum disorder (OR 1.53, 95% CI 1.24-1.88, p < 0.0001), attention deficit hyperactivity disorder (OR 1.39, 95% CI 1.18-1.63, p < 0.0001), depression (OR 2.17, 95% CI 2.17-11.15, p < 0.0001), anxiety (OR 6.03, 95% CI 2.22-16.35, p < 0.0001), and eating disorders (OR 1.62, 95% CI 1.37-1.91, p < 0.00001) amongst the CD population compared to healthy controls. No significant differences were found for bipolar disorder (OR 2.35, 95% CI 2.29-19.21, p = 0.43) or schizophrenia (OR 0.46, 95% CI 0.02-10.18, p = 0.62).

Conclusion: CD is associated with an increased risk of depression, anxiety, eating disorders as well as ASD and ADHD. More research is required to investigate specific biological explanations as well as any effect of gluten free diet.

Keywords: anxiety; attention deficit hyperactivity disorder; autistic spectrum disorder; bipolar disorder; coeliac disease; depression; eating disorders; gluten free diet; psychiatric manifestations; schizophrenia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart displaying this selection process.
Figure 2
Figure 2
(a) Forest plot of pooled prevalence of ASD in CD. (b) Funnel plot investigating distribution in ASD studies.
Figure 3
Figure 3
(a) Forest plot of pooled prevalence of ADHD in CD. (b) Funnel plot investigating distribution in ADHD studies.
Figure 4
Figure 4
(a) Forest plot of pooled prevalence of depression in CD. (b) Funnel plot investigating distribution in depression studies.
Figure 5
Figure 5
(a) Forest plot of pooled prevalence of anxiety in CD. (b) Funnel plot investigating distribution in anxiety studies.
Figure 6
Figure 6
(a) Forest plot of pooled prevalence of bipolar disorder in CD. (b) Funnel plot investigating distribution in bipolar disorder studies.
Figure 7
Figure 7
(a) Forest plot of pooled prevalence of schizophrenia and other psychotic disorders in CD. (b) Funnel plot investigating distribution in schizophrenia and other psychotic disorders studies.
Figure 8
Figure 8
(a) Forest plot of pooled prevalence of eating disorders in CD. (b) Funnel plot investigating distribution in eating disorder studies.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Cossu G., Carta M.G., Contu F., Mela Q., Demelia L., Elli L., Dell’Osso B. Coeliac disease and psychiatric comorbidity: Epidemiology, pathophysiological mechanisms, quality-of-life, and gluten-free diet effects. Int. Rev. Psychiatry. 2017;29:489–503. doi: 10.1080/09540261.2017.1314952. - DOI - PubMed
    1. Zysk W., Głąbska D., Guzek D. Social and Emotional Fears and Worries Influencing the Quality of Life of Female Celiac Disease Patients Following a Gluten-Free Diet. Nutrients. 2018;10:1414. doi: 10.3390/nu10101414. - DOI - PMC - PubMed
    1. Wolf R.L., Lebwohl B., Lee A.R., Zybert P., Reilly N.R., Cadenhead J., Amengual C., Green P.H. Hypervigilance to a gluten-free diet and decreased quality of life in teenagers and adults with celiac disease. Dig. Dis. Sci. 2018;63:1438–1448. doi: 10.1007/s10620-018-4936-4. - DOI - PubMed
    1. Leffler D.A., Acaster S., Gallop K., Dennis M., Kelly C.P., Adelman D.C. A novel patient-derived conceptual model of the impact of celiac disease in adults: Implications for patient-reported outcome and health-related quality-of-life instrument development. Value Health. 2017;20:637–643. doi: 10.1016/j.jval.2016.12.016. - DOI - PubMed
    1. Singh P., Arora A., Strand T.A., Leffler D.A., Catassi C., Green P.H., Kelly C.P., Ahuja V., Makharia G.K. Global prevalence of celiac disease: Systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 2018;16:823–836. doi: 10.1016/j.cgh.2017.06.037. - DOI - PubMed