Mental Health Risks Higher Among Young People With IBD

COPENHAGEN — Children and young adults with inflammatory bowel disease (IBD) are about 2.5 times more likely to develop posttraumatic stress disorder (PTSD), almost twice as likely to report an eating disorder, and 1.5 times more likely to engage in self-harm, a new UK study suggests.

The retrospective, observational study of young people with IBD vs those without assessed the incidence of a wide range of mental health conditions in people aged 5-25 years.

“Anxiety and depression will not be a surprise to most of us. But, we also saw changes for eating disorders, PTSD, and sleep changes,” said Richard K. Russell, MD, a pediatric gastroenterologist at the Royal Hospital for Sick Children in Edinburgh, Scotland.

Russell presented the research at the European Crohn’s and Colitis Organisation (ECCO) 2023 Congress, held in Copenhagen, Denmark, and virtually.

Our findings indicate an unmet need for mental health care for young patients with IBD, he said. “All of us at ECCO need to address this gap.”

Key Findings

Russell and colleagues identified 3898 young people diagnosed with IBD in the 10-year period January 1, 2010 through January 1, 2020 using the Optimum Patient Care Research Database, which includes de-identified data from more than 1000 general practices across the UK. They used propensity score matching to create a control group of 15,571 people without IBD, controlling for age, sex, socioeconomic status, ethnicity, and health conditions other than IBD.

Median follow-up was about 3 years.

The cumulative lifetime risk for developing any mental health condition by age 25 was 31.1% in the IBD group vs 25.1% in controls, a statistically significant difference.

Compared with the control group, the people with incident IBD were significantly more likely to develop:

  • PTSD

  • Eating disorders

  • Self-harm

  • Sleep disturbance

  • Depression

  • Anxiety disorder

  • ‘Any mental health condition’

Those most are risk included males overall, and specifically boys aged 12-17 years. Those with Crohn’s disease vs other types of IBD were also most at risk.

In a subgroup analysis, presented as a poster at the meeting, Russell and colleagues also found that mental health comorbidity in children and young adults with IBD is associated with increased IBD symptoms and healthcare utilization, as well as time off work.

Children and young adults with both IBD and mental health conditions should be monitored and receive appropriate mental health support as part of their multidisciplinary care, Russell said.

Russell added that the study period ended a few months before the COVID-19 pandemic began, so the research does not reflect its impact on mental health in the study population.

“The number of children and young adults we’re seeing in our clinic with mental health issues has rocketed through the roof because of the pandemic,” he said.

Russell suggested that the organization create a psychology subgroup called Proactive Psychologists of ECCO, or Prosecco for short.

Clinical Implications

The study is important for highlighting the increased burden of mental health problems in young people with IBD, said session co-moderator Nick Kennedy, MD, a consultant gastroenterologist and chief research information officer with the Royal Devon University Healthcare NHS Foundation Trust in the UK.

Kennedy, who was not affiliated with the research, is also supportive of the idea of a psychological subgroup within ECCO.

The peak age for developing mental health disorders found by the study (12-17 years) “is a unique and very sensitive time,” said Sara Mesilhy, MBBS, a gastroenterologist with the Royal College of Physicians in the UK.

“These results highlight the need for development of early screening psychiatric programs starting from time of diagnosis and continuing on periodic intervals to offer the best management plan for IBD patients, especially those with childhood-onset IBD,” said Mesilhy, who was not affiliated with the research.

Such programs would “improve the patient’s quality of life, protecting them from a lot of suffering and preventing the bad sequalae for these disorders,” said Mesilhy. “Moreover, we still need further studies to identify the most efficient monitoring and treatment protocols.”

Kennedy applauded the researchers for conducting a population-based study because it ensured an adequate cohort size and maximized identification of mental health disorders.

“It was interesting to see that there were a range of conditions where risk was increased, and that males with IBD were at particularly increased risk,” he added.

Researchers’ use of coded primary care data was a study limitation, but it was “appropriately acknowledged by the presenter,” Kennedy said.

The study was supported by Pfizer. Russell disclosed he is a consultant and member of a speakers’ bureau for Pfizer outside the submitted work. Kennedy and Mesilhy report no relevant financial relationships.

European Crohn’s and Colitis Organisation (ECCO) 2023 Congress: Abstract OP28 and Poster P822. Presented March 3, 2023.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter: @MedReporter.

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