To Örebro University

BACKGROUND AND AIMS: Inflammatory bowel disease (IBD) is linked to psychiatric morbidity, but few studies have assessed general population comparators. We aimed to investigate the risk of psychiatric morbidity and suicide in adult-onset IBD patients.

METHODS: Nationwide population-based cohort study in Sweden (1973-2013). We studied the risk of psychiatric disorders and suicide in 69,865 adult-onset IBD patients (ulcerative colitis, UC: n=43,557; Crohn's disease, CD: n=21,245; and IBD-unclassified: n=5063) compared to 3,472,913 general population references and 66,292 siblings.

RESULTS: During a median follow-up of 11 years, we found 7,465 (10.7%) first psychiatric disorders in IBD (incidence rate, IR/1000 person-years 8.4) and 306,911 (9.9%) in the general population (IR 6.6), resulting in 1.8 extra psychiatric morbidity per 100 patients followed-up for 10 years and a hazard ratio (HR) of 1.3 (95% confidence interval, 95%CI=1.2-1.3). The highest risk of overall psychiatric morbidity was seen in the first year after IBD diagnosis (HR=1.4, 95%CI=1.2-1.6) and in patients with extraintestinal manifestations (HR=1.6, 95%CI=1.5-1.7). Psychiatric morbidity was more common in all IBD subtypes (HRs 1.3 to 1.5). An increased risk of suicide attempts was observed among all IBD types (HRs=1.2 to 1.4), whereas completed suicide was explicitly associated with CD (HR=1.5) and elderly-onset (diagnosed at the age of >60 years) IBD (HR=1.7).

CONCLUSION: Adult-onset IBD was associated with an increased risk of psychiatric disorders and suicide attempts. Psychological follow-up should be provided to patients with IBD, especially those with extraintestinal manifestations and elderly-onset IBD. This follow-up should transpire within the first year after IBD diagnosis.