Association between Inflammatory Bowel Disease and Psychiatric Morbidity and Suicide: A Swedish Nationwide Population-Based Cohort Study with Sibling Comparisons

Abstract

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: We used a 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 7465 [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 [HR 1.3-1.5]. An increased risk of suicide attempts was observed among all IBD types [HR=1.2-1.4], 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 be within the first year after IBD diagnosis.