Increased Burden of Psychiatric Disorders in Inflammatory Bowel Disease

Bernstein CN1, Hitchon CA1, Walld R2, Bolton JM3, Sareen J3, Walker JR4, Graff LA4, Patten SB5, Singer A6, Lix LM2,7, El-Gabalawy R8,5, Katz A2,6,7, Fisk JD8,9, Marrie RA1,6; CIHR Team in Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease. Inflamm Bowel Dis. 2018 Jul 7. doi: 10.1093/ibd/izy235. [Epub ahead of print]

Author information

1 Department of Internal Medicine, MB, Canada.

2 Manitoba Centre for Health Policy, MB, Canada.

3 Department of Psychiatry, MB, Canada.

4 Department of Clinical Health Psychology, MB, Canada.

5 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

6 Department of Family Medicine, MB, Canada.

7 Department of Community Health Sciences, MB, Canada.

8 Department of Anesthesia and Perioperative Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

9 Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada.


BACKGROUND: Psychiatric comorbidity in inflammatory bowel disease (IBD) is well known; however, data from a truly representative sample are sparse. We aimed to estimate the incidence and prevalence of psychiatric disorders in an IBD cohort compared with a matched cohort without IBD.

METHODS: Using population-based administrative health data from Manitoba, Canada, we identified all persons with incident IBD from 1989 to 2012 and a general population matched cohort (5:1). We applied validated algorithms for IBD, depression, anxiety disorders, bipolar disorder, and schizophrenia to determine the annual incidence of these conditions post-IBD diagnosis and their lifetime and current prevalence.

RESULTS: There were 6119 incident cases of IBD and 30,573 matched individuals. After adjustment for age, sex, socioeconomic status, region of residence, and year, there was a higher incidence in the IBD cohort compared with controls for depression (incidence rate ratio [IRR], 1.58; 95% confidence interval [CI], 1.41-1.76), anxiety disorder (IRR, 1.39; 95% CI, 1.26-1.53), bipolar disorder (IRR, 1.82; 95% CI, 1.44-2.30), and schizophrenia (IRR, 1.64; 95% CI, 0.95-2.84). Incidence rate ratios were similar for Crohn's disease and ulcerative colitis between males and females and were stable over time. However, within the IBD cohort, the incidence rates of depression, anxiety, and bipolar disorders were higher among females, those aged 18-24 years vs those older than 44 years, urbanites, and those of lower socioeconomic status. The lifetime and current prevalence rates of psychiatric disorders were also higher in the IBD than the matched cohort.

CONCLUSIONS: The incidence and prevalence of psychiatric disorders are elevated in the IBD population.

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