Thursday, August 22, 2019

Risk for Psychiatric Disorders, Suicide Higher in Children With IBD

Children with inflammatory bowel disease (IBD) may be at higher risk for psychiatric disorders and suicide attempt, according to a large, population-based study published in JAMA Pediatrics.

The risk for psychiatric disorders and suicide among children with IBD was greater when compared with siblings without IBD, indicating that the risk is likely related to IBD itself and not to genetic or environmental factors shared with siblings.

"Particularly concerning is the increased risk of suicide attempt," wrote Agnieszka Butwicka, M.D., Ph.D., of the Karolinska Institute in Sweden and colleagues. "Long-term psychological support should therefore be considered for patients with childhood-onset IBD."

The study included all children born in Sweden between 1973 and 2013. Researchers compared those who were diagnosed with ulcerative colitis (n=3,228), Crohn's disease (n=2,536), or IBD-unclassified (n=700) before age 18 with 323,200 matched controls and 6,999 siblings without IBD. The average age at diagnosis of IBD was 14.

The primary outcome was any psychiatric disorder and suicide attempt during a median follow up of nine years. Secondary outcomes were diagnoses of specific disorders including psychotic, mood, anxiety, eating, and personality disorders as well as substance use, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and intellectual disability.

The risk of any psychiatric disorder was increased in all IBD subgroups, with a hazard ratio (HR) of 1.6. This increased risk for any psychiatric disorder was especially high the first year after an IBD diagnosis (HR=3.5). While the risk for suicide was increased throughout the follow-up period (HR=1.4), the risk was significantly higher five or more years after an IBD diagnosis (HR=1.5).

IBD also was significantly associated with mood disorders, anxiety disorders, eating disorders, personality disorders, ADHD, and autism spectrum disorders.

“This high risk of psychiatric disorders was observed among individuals with very early onset IBD and those whose parents had a history of psychiatric disorders, suggesting that these groups may be particularly vulnerable,” the researchers wrote. "The highest risk of anxiety and mood disorders during the first year after a diagnosis of IBD suggests the need for psychological support for these patients.”

For related information, see the Psychiatric News article "Childhood Stomach Pains May Foretell Adult Psychiatric Disorders."

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