In the Journals

Kids with IBD at increased risk for later psychiatric disorders, study finds

Kids diagnosed with inflammatory bowel disease, or IBD, are at increased risk for psychiatric disorders later in life, especially those who were diagnosed before age 6 years, according to findings published in JAMA Pediatrics.

“The study shows that children with IBD and their parents are in need of psychological support and longer follow-up,” Agnieszka Butwicka, MD, PhD, assistant professor in the department of medical epidemiology and biostatistics at the Karolinska Institute in Sweden, said in a news release. “Special help could be offered to children who become ill at a young age and to children of parents with mental health problems.”

Butwicka and colleagues conducted a population-based cohort study that included all children aged 0 to 18 years born in Sweden between 1973 and 2013. The researchers assessed more than 6,000 people with childhood-onset IBD, such as ulcerative colitis (n = 3,228), Crohn’s disease (n = 2,536) and unclassified IBD (n = 700).

The researchers then examined patient outcomes after a median of 9 years and compared them with the outcomes of nearly 7,000 of the patients’ siblings without IBD and more than 320,000 controls.

Upset teen receives counseling from provider 
Source: Shutterstock

During the follow-up period, 17.3% of patients with IBD were diagnosed with a psychiatric disorder (incidence rate [IR] = 17.1 per 1,000 person-years) compared with 11.8% of controls (IR = 11.2 per 1,000 person-years; HR = 1.6; 95% CI, 1.5-1.7).

Specifically, suicide attempts were more common among those with IBD (HR = 1.4; 95% CI, 1.2-1.7). Those with IBD were also more likely to have mood disorders (HR = 1.6; 95% CI, 1.4-1.7), anxiety disorders (HR = 1.9; 95% CI, 1.7-2), eating disorders (HR = 1.6; 95% CI, 1.3-2), personality disorders (HR = 1.4; 95% CI, 1.1-1.8), ADHD (HR = 1.2; 95% CI, 1.1-1.4) and autism spectrum disorders (HR = 1.4; 95% CI, 1.1-1.7). Boys and girls had similar risk for these conditions.

According to the researchers, those with IBD were at highest risk for psychiatric diagnoses in the first year of follow-up. However, the risk for psychiatric conditions was statistically significant for more than 5 years after diagnosis. Those with IBD beginning before age 6 years and those whose parents had psychiatric diagnoses were at greatest risk for any disorder. The increased risk for diagnoses and suicide attempts remained after comparison with siblings.

“Because the risk for these children is higher compared with their own siblings, it is likely that it is IBD affecting their mental health rather than other factors such as socioeconomics, lifestyle or hereditary in the family,” Jonas F. Ludvigsson, MD, PhD, professor in the department of medical epidemiology and biostatistics at the Karolinska Institute, said in the release.

In a related editorial, William E. Bennett Jr., MD, MS, and Marian D. Pfefferkorn, MD, from the Indiana University School of Medicine, suggested that patients with IBD may not be at increased risk for psychiatric disorders but that patients with chronic illness may be more likely to be diagnosed with psychiatric disorders. However, they noted that these findings “indicate a need for more focused intervention during adolescents, when patients appear even more vulnerable.”

“Because suicide is the third leading cause of death in teenagers, and depression is the leading cause of morbidity, careful attention to these disorders in patients with IBD is paramount,” they wrote. “An integrated mental health and digestive health model is the simplest, and best, solution.” – by Katherine Bortz

References:

Bennett Jr. WE, Pfefferkorn MD. JAMA Pediatr. 019;doi:10.1001/jamapediatrics.2019.2669.

Butwicka A, et al. JAMA Pediatr. 2019;doi:10.1001/jamapediatrics.2019.2662.

Disclosures: Bennett, Butwicka and Pfefferkorn report no relevant financial disclosures. Ludvigsson reports coordinating a study on behalf of the Swedish IBD quality register that received funding from Janssen Corporation. Please see the study for all other relevant financial disclosures.

Kids diagnosed with inflammatory bowel disease, or IBD, are at increased risk for psychiatric disorders later in life, especially those who were diagnosed before age 6 years, according to findings published in JAMA Pediatrics.

“The study shows that children with IBD and their parents are in need of psychological support and longer follow-up,” Agnieszka Butwicka, MD, PhD, assistant professor in the department of medical epidemiology and biostatistics at the Karolinska Institute in Sweden, said in a news release. “Special help could be offered to children who become ill at a young age and to children of parents with mental health problems.”

Butwicka and colleagues conducted a population-based cohort study that included all children aged 0 to 18 years born in Sweden between 1973 and 2013. The researchers assessed more than 6,000 people with childhood-onset IBD, such as ulcerative colitis (n = 3,228), Crohn’s disease (n = 2,536) and unclassified IBD (n = 700).

The researchers then examined patient outcomes after a median of 9 years and compared them with the outcomes of nearly 7,000 of the patients’ siblings without IBD and more than 320,000 controls.

Upset teen receives counseling from provider 
Source: Shutterstock

During the follow-up period, 17.3% of patients with IBD were diagnosed with a psychiatric disorder (incidence rate [IR] = 17.1 per 1,000 person-years) compared with 11.8% of controls (IR = 11.2 per 1,000 person-years; HR = 1.6; 95% CI, 1.5-1.7).

Specifically, suicide attempts were more common among those with IBD (HR = 1.4; 95% CI, 1.2-1.7). Those with IBD were also more likely to have mood disorders (HR = 1.6; 95% CI, 1.4-1.7), anxiety disorders (HR = 1.9; 95% CI, 1.7-2), eating disorders (HR = 1.6; 95% CI, 1.3-2), personality disorders (HR = 1.4; 95% CI, 1.1-1.8), ADHD (HR = 1.2; 95% CI, 1.1-1.4) and autism spectrum disorders (HR = 1.4; 95% CI, 1.1-1.7). Boys and girls had similar risk for these conditions.

According to the researchers, those with IBD were at highest risk for psychiatric diagnoses in the first year of follow-up. However, the risk for psychiatric conditions was statistically significant for more than 5 years after diagnosis. Those with IBD beginning before age 6 years and those whose parents had psychiatric diagnoses were at greatest risk for any disorder. The increased risk for diagnoses and suicide attempts remained after comparison with siblings.

“Because the risk for these children is higher compared with their own siblings, it is likely that it is IBD affecting their mental health rather than other factors such as socioeconomics, lifestyle or hereditary in the family,” Jonas F. Ludvigsson, MD, PhD, professor in the department of medical epidemiology and biostatistics at the Karolinska Institute, said in the release.

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In a related editorial, William E. Bennett Jr., MD, MS, and Marian D. Pfefferkorn, MD, from the Indiana University School of Medicine, suggested that patients with IBD may not be at increased risk for psychiatric disorders but that patients with chronic illness may be more likely to be diagnosed with psychiatric disorders. However, they noted that these findings “indicate a need for more focused intervention during adolescents, when patients appear even more vulnerable.”

“Because suicide is the third leading cause of death in teenagers, and depression is the leading cause of morbidity, careful attention to these disorders in patients with IBD is paramount,” they wrote. “An integrated mental health and digestive health model is the simplest, and best, solution.” – by Katherine Bortz

References:

Bennett Jr. WE, Pfefferkorn MD. JAMA Pediatr. 019;doi:10.1001/jamapediatrics.2019.2669.

Butwicka A, et al. JAMA Pediatr. 2019;doi:10.1001/jamapediatrics.2019.2662.

Disclosures: Bennett, Butwicka and Pfefferkorn report no relevant financial disclosures. Ludvigsson reports coordinating a study on behalf of the Swedish IBD quality register that received funding from Janssen Corporation. Please see the study for all other relevant financial disclosures.