A cohort study of Swedish patients with inflammatory bowel disease (IBD) found an increased risk of any psychiatric disorder from 2 to 3 years before diagnosis through 10 years after.
There is evidence to suggest that patients with IBD are more susceptible to psychiatric disorders than the general population, but it is still unclear whether psychiatric morbidity can occur before IBD onset or is a consequence of IBD diagnosis. There is also a lack of evidence overall when considering psychiatric disorders outside of anxiety and depressive symptoms, which are the most prevalent psychiatric comorbidities for patients with IBD.
Jiangwei Sun, MD, from Sun Yat-Sen University in Guangdong, China, and colleagues conducted a nationwide cohort study of patients with a confirmed diagnosis of IBD to evaluate the “temporal pattern of any and specific psychiatric disorders” occurring from 5 years before to 10 years after IBD diagnosis. Patients with IBD were compared to the general population and full siblings of patients with IBD, who did not have IBD, to consider the potential influence of genetic and early-life environmental factors.
This study included 43,862 patients with IBD diagnosed from 2007 to 2023 compared with 178,821 reference individuals in a matched population-based cohort. There were 26,807 patients with IBD who were identified to have at least one full sibling confirmed to be IBD-free. The primary outcome was any psychiatric disorder, with secondary outcomes including psychotic disorders, mood disorders, anxiety disorders, eating disorders, substance misuse, personality disorders, attention-deficit/hyperactivity disorder, and autism spectrum disorders.
There was an increase in the hazard ratio of any psychiatric disorder beginning from 2 to 3 years before IBD diagnosis, a peak in hazard ratio directly following the IBD diagnosis, and then a rapid decrease of hazard ratio that remained increased at 10 years after diagnosis. This increase was largely due to major depressive disorder, anxiety disorders, and substance misuse. These patterns of increase were observed regardless of IBD subtype, sex, age, and calendar period of IBD diagnosis. There was no increase in hazard ratio observed for psychotic disorders, personality disorders, and attention-deficit/hyperactivity disorder. There was an increased risk for autism spectrum disorder following diagnosis and eating disorders from 5 or more years after diagnosis.
The hazard ratios in the sibling comparison were slightly lower than those from the population-based comparison but still represented both pre- and post-diagnostic associations between IBD and psychiatric disorder. This suggests that “shared familial factors cannot fully explain the observed associations between IBD and psychiatric disorders,” as Dr. Sun and colleagues explained.
Dr. Sun and colleagues concluded, “patients with IBD experience increased risks of major depressive disorders, anxiety disorder, and substance misuse both before and after diagnosis with risks persisting up to 10 years after diagnosis.” They went on to comment that their findings “support raising mental health awareness and integrating psychological care into inflammatory bowel disease management, with extended attention starting from inflammatory bowel disease diagnostic workup.”