Kids with gut problems need mental health support
Childhood-onset IBD tends to have an even more severe disease course and longer duration than IBD diagnosed in adulthood.
We found that individuals with childhood-onset IBD were at increased risk of any psychiatric disorder and suicide attempt, including several categories of psychiatric disorders. Most of this association remained significant when comparing individuals with IBD with their siblings without IBD, thus accounting for environmental and genetic factors shared within siblings.
Our findings confirm and further support the results of 2 previous original studies on childhood-onset IBD (eTable 1 in the Supplement). The increased risk of mood and anxiety disorders seen in our study is consistent with findings from both America19 and Finland,20 as well as a recent meta-analysis by Stapersma et al.34 However, none of those studies included IBD-unclassified, had a follow-up longer than 5 years, or had a follow-up in adulthood. Those studies were unable to consider unmeasured familial confounding owing to a lack of genetically informative data.
In adult IBD, high rates of depressive and anxiety symptoms have previously been described.12 An increased risk of psychiatric diagnoses associated with IBD has been consistently reported for mood disorders,11,13,14 with ambiguous findings for anxiety disorders.11,13 A study by Bhandari et al35 recently found that patients with IBD with depressive symptoms reported suicidal ideation more often than did other patients with depressive symptoms (27% vs 12%), but this increase was not statically significant (P = .08). To our knowledge, the risk of suicide attempt has not been studied among patients with IBD, although some studies on mortality among patients with IBD have reported data on completed suicide,7,9,10,36,37 with 1 study demonstrating an association between IBD and suicide.7 However, meta-analyses have failed to confirm these findings,8,38 mostly because of insufficient statistical power. The Danish study by Gradus et al6 reported an association between completed suicide and both UC and CD in adults. We chose not to examine the risks for completed suicide owing to the low power for that measure (there were 14 suicide deaths in our cohort). However, the observed increased risk of suicide attempt in our study underlines the severity of psychiatric disorders in patients with IBD.
Studies on an association between eating disorders and IBD are scarce39 and mostly limited to case reports or general research on autoimmune disease in patients with eating disorders.40,41 Patients with IBD may experience abdominal pain and defecation with food intake, making them more likely to exclude certain food items from their diet. Therefore, various aspects of food intake may be associated with the symptoms of eating disorders in patients with IBD.
A Taiwanese study42 reported that adults with ADHD have a 2-fold increased risk for UC, but a previous study by Virta and Kolho20 on 248 children with IBD failed to find a statistically significant association between ADHD and childhood-onset IBD. Our study, using a much larger sample, found a 1.2-fold increased risk for ADHD with IBD. It has been speculated that some patients with ASD have alterations of the intestinal barrier43 and that this alteration might serve as a link to IBD. We found a 1.4-fold increased risk for ASD among individuals with IBD. This result is supported by a previous report by Kohane et al44 on a possible association between IBD and ASD, even though no supportive statistical measures were reported. In contrast with the previous report, we presented data from subgroups of patients with IBD and calculated IRs, along with the relative risks in comparison with reference individuals from the general population.
Consistent with a recent report on adult IBD by Bernstein et al,13 the results of our study indicate no increased risk of psychotic disorders associated with IBD. Although psychotic disorders are rare among children, follow-up through adulthood enabled us to evaluate this outcome among individuals with childhood-onset IBD. In our study, the median age at the end of follow-up was 23 years (IQR, 18-29 years), which was older than the median age of 20.1 years (IQR, 18.3-22.3 years) at the first diagnosis of schizophrenia observed in the Swedish-born population.45
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