People with childhood-onset IBD more likely to attempt suicide: JAMA

Sweden: Patients with childhood-onset inflammatory bowel disease (IBD) are more likely to get psychiatric morbidity as confirmed by between-sibling results, finds a recent study. What is more concerning is the increased suicide attempt among such patients.

The study, published in the journal JAMA Pediatrics suggests that long-term psychological support should be considered for patients with childhood-onset IBD.

Previous studies have shown an association between IBD and psychiatric morbidity in adults, not accounting for familial confounding. Despite IBD being of more severe course in children, the association between childhood-onset IBD and psychiatry morbidity still remains unclear.

Agnieszka Butwicka, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden, and colleagues conducted this population-based cohort study to examine the risk of psychiatric morbidity in individuals with childhood-onset IBD, controlling for potential confounding shared between siblings.

For the purpose, the researchers recruited data from the Swedish national health care and population registers of all children younger than 18 years born from 1973 to 2013. The study involved 6464 individuals (2831 girls and 3633 boys; mean [SD] age at diagnosis of IBD, 13 [4] years) with a diagnosis of childhood-onset IBD (3228 with ulcerative colitis, 2536 with Crohn disease, and 700 with IBD unclassified). They were then compared with 323 200 matched reference individuals from the general population and 6999 siblings of patients with IBD.

The primary outcome was any psychiatric disorder and suicide attempt. Secondary outcomes were the following specific psychiatric disorders: psychotic, mood, anxiety, eating, personality, and behavioural disorders; substance misuse; attention-deficit/hyperactivity disorder; autism spectrum disorders; and intellectual disability.

Also Read: Higher sun exposure (vitamin D) linked to lower risk of IBD in children

Key findings include:

• During a median follow-up time of 9 years, 1117 individuals with IBD (17.3%) received a diagnosis of any psychiatric disorder (incidence rate, 17.1 per 1000 person-years), compared with 38 044 of 323 200 individuals (11.8%) in the general population (incidence rate, 11.2 per 1000 person-years), corresponding to an HR of 1.6, equaling 1 extra case of any psychiatric disorder per 170 person-years.


• Inflammatory bowel disease was significantly associated with suicide attempt as well as mood disorders, anxiety disorders, eating disorders, personality disorders, attention-deficit/hyperactivity disorder, and autism spectrum disorders.


• Results were similar for boys and girls.


• Hazard ratios for any psychiatric disorder were highest in the first year of follow-up but remained statistically significant after more than 5 years.


• Psychiatric disorders were particularly common for patients with very early-onset IBD (<6 years) and for patients with a parental psychiatric history.


• Results were largely confirmed by sibling comparison, with similar estimates noted for any psychiatric disorder and suicide attempt.

Also Read: Women with IBD at higher risk of Postpartum mental Illness: BMJ

"Their study highlights a substantial risk in a vulnerable population and should trigger a revision of guidelines and allocation of resources to support widespread screening and treatment for these dangerous conditions," William E. Bennett and Marian D. Pfefferkorn from Indiana University School of Medicine, Indianapolis, write in an accompanying editorial.

To read the complete study log on to doi:10.1001/jamapediatrics.2019.2662