Childhood-onset inflammatory bowel disease (IBD) typically has a more severe course than adult-onset IBD, and has been found to be associated with psychiatric morbidity in previous studies. However, these studies have failed to account for familial confounding. In this population-based cohort study, 6,464 patients with childhood-onset IBD were compared with 323,200 matched controls and 6,999 siblings of patients with IBD to examine the risk of psychiatric morbidity, including any psychiatric disorder and suicide attempt. At baseline, 3,228 patients had ulcerative colitis, 2,536 had Crohn’s disease, and 700 had IBD-unclassified. Patients were followed for a median of 9 years (IQR 4 to 15 years), and the median age at the end of follow-up was 23 years (IQR 18 to 29 years). Researchers found that, during the follow-up period, more patients with childhood-onset IBD received a diagnosis of any psychiatric disorder (incidence rate (IR) 17.1 per 1,000 person-years) than matched controls (IR 11.2 per 1,000 person-years, HR 1.6, 95% CI 1.5 to 1.7). Moreover, more patients with childhood-onset IBD attempted suicide (IR 1.6 per 1,000 person-years) than matched controls (IR 1.2 per 1,000 person years, HR 1.4, 95% CI 1.2 to 1.7). Childhood-onset IBD was also associated with mood disorders (HR 1.6, 95% CI 1.4 to 1.7), anxiety disorders (HR 1.9, 95% CI 1.7 to 2.0), eating disorders (HR 1.6, 95% CI 1.3 to 2.0), personality disorders (HR 1.4, 95% CI 1.1 to 1.8), attention-deficit/hyperactivity disorder (HR 1.2, 95% CI 1.1 to 1.4), and autism spectrum disorders (HR 1.4, 95% CI 1.1 to 1.7). The sibling comparison confirmed the observed associations, and results were similar between girls and boys. The risk of any psychiatric disorder was tripled in the first year after IBD diagnosis (HR 3.5, 95% CI 3.0 to 4.0) and remained statistically significant after 5 or more years of follow-up (HR 1.3, 95% CI 1.2 to 1.5). Finally, there was a particularly increased risk of any psychiatric disorder among patients with very early-onset IBD (<6 years of age, HR 2.4, 95% CI 1.9 to 3.1), as well as those with extra-intestinal manifestations (HR 2.0, 95% CI 1.7 to 2.4), bowel surgery (HR 1.9, 95% CI 1.6 to 2.2), perianal surgery (HR 2.0, 95% CI 1.7 to 2.4), and parental psychiatric history (HR 3.4, 95% CI 1.7 to 6.7) as compared to matched controls. This study was limited by a lack direct measurement of IBD severity. In summary, this study emphasizes the increased risk of psychiatric morbidity in patients with childhood-onset IBD, and thus, the critical importance of mental health surveillance in this patient group.
Click to read the study JAMA Pediatrics
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