TOPLINE

Among patients with inflammatory bowel disease (IBD), the risk for psychiatric disorders increased 2-3 years before diagnosis, peaked shortly after diagnosis, and remained elevated even at 10 years, according to a recent nationwide cohort study. The increased risk was mainly driven by major depressive disorder, anxiety disorders, and substance misuse.

METHODOLOGY

• Researchers conducted a nationwide cohort study in Sweden involving patients with IBD diagnosed between 2007 and 2023, comparing them with matched reference individuals from the general population.
• To examine risk in the years leading up to diagnosis, the study followed up 48,230 patients with IBD (excluding those with a psychiatric disorder diagnosed more than 5 years before their IBD diagnosis) and compared them with 210,582 reference individuals.
• To examine risk after diagnosis, 43,862 patients with IBD (mean age, 41.6 years; 47.3% women; 13,282 with Crohn’s disease, 25,714 with ulcerative colitis, and 4866 with IBD-unclassified) — excluding anyone with a psychiatric disorder at any point before diagnosis — were compared with 178,821 reference individuals.
• A sibling-controlled cohort additionally compared patients with IBD with 26,807 full siblings without IBD to assess the potential contribution of shared familial factors.
• The primary outcome was any psychiatric disorder; secondary outcomes included psychotic disorders, mood disorders, anxiety disorders, eating disorders, substance misuse disorders, personality disorders, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorders; the risk for psychiatric disorders was estimated from 5 years before to 10 years after IBD diagnosis.

TAKEAWAY

• The risk for any psychiatric disorder began increasing 2-3 years before IBD diagnosis (hazard ratio [HR], 1.15; 95% CI, 1.09-1.21 at 2 years before IBD diagnosis), peaked immediately after diagnosis (HR, 1.50; 95% CI, 1.41-1.59 at 0.5 years after IBD diagnosis), declined rapidly thereafter, and remained elevated even at 10 years after diagnosis (HR, 1.19; 95% CI, 1.13-1.24).
• The temporal pattern of the risk for psychiatric disorders associated with IBD was similar across IBD subtypes, but the association was generally stronger for Crohn’s disease and IBD-unclassified than for ulcerative colitis — for example, at 0.5 years after diagnosis, HRs were 1.69 (95% CI, 1.52-1.87) for Crohn’s disease, 1.55 (95% CI, 1.31-1.84) for IBD-unclassified, and 1.38 (95% CI, 1.28-1.50) for ulcerative colitis.
• The increased risk was primarily driven by major depressive disorder, anxiety disorders, and substance misuse, with no clear increase in risk observed for psychotic disorders, personality disorders, and ADHD.
• In the sibling-controlled cohort, researchers observed similar associations between IBD and any psychiatric disorder both before and after diagnosis, with HRs of 1.27 (95% CI, 1.15-1.41) at 0.5 years before IBD diagnosis, 1.47 (95% CI, 1.35-1.61) at 0.5 years after diagnosis, and 1.10 (95% CI, 1.03-1.18) at 10 years after diagnosis, suggesting that shared familial factors cannot fully explain the observed associations.

IN PRACTICE

“Health care providers (eg, gastroenterologists and general practitioners) should maintain vigilance for psychiatric symptoms in patients with IBD, particularly for major depressive disorder, anxiety disorders, and substance misuse,” wrote the authors of the study. “Despite having the greatest need and potential to benefit, patients with IBD may have limited access to timely and high-quality mental health care, and some of them with psychiatric disorders may even remain undiagnosed due to diagnostic overshadowing, inadequate evaluations, and stigma,” they added.

SOURCE

The study was led by Jiangwei Sun of the School of Public Health (Shenzhen), Sun Yat-Sen University in Shenzhen, China. It was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS

The study lacked primary care data, so some mild psychiatric disorders may have been missed. The study also lacked detailed information on lifestyle factors that may confound the association. Because the study was observational and conducted in Sweden, the findings may not apply to countries with different healthcare systems or rates of IBD and psychiatric disorders.

DISCLOSURES

The study was supported by the Swedish Society for Medical Research, the European Crohn’s and Colitis Organisation, the Swedish Society of Medicine, and other organizations. Several authors disclosed financial relationships with pharmaceutical companies — including grant funding, speaker or advisory board roles, lecture honoraria, and research collaborations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.