Anxiety after coeliac disease diagnosis predicts mucosal healing: a population‐based study

Abstract

Summary Background Coeliac disease has been linked to anxiety and depression. However, their association with mucosal healing is unknown. Aim To examine the relationship between anxiety, depression and mucosal healing in coeliac disease. Methods Between 1969 and 2008, we collected data on all small intestinal biopsies with villous atrophy from Sweden's 28 pathology departments. We restricted our cohort to individuals with data on follow‐up biopsy (either persistent villous atrophy [n = 3317] or mucosal healing [n = 4331]). Through Cox regression, we estimated hazard ratios (HRs) for anxiety or depression. Results During follow‐up, 123 (2.8/1000 person‐years) individuals with mucosal healing had developed anxiety, compared to 94 (2.1/1000 person‐years) with persistent villous atrophy. Mucosal healing was hence associated with a higher risk of future anxiety (HR = 1.49; 95% CI = 1.12‐1.96). Similarly, 167 (3.8/1000 person‐years) individuals with mucosal healing developed depression, compared to 148 (3.3/1000 person‐years) with persistent villous atrophy, corresponding to a HR of 1.25 (95% CI = 0.99‐1.59). Mucosal healing was more common in individuals with prior diagnoses of anxiety or depression before follow‐up biopsy. Anxiety diagnosed between diagnostic and follow‐up biopsy for coeliac disease was associated with an almost nine‐fold increased chance of mucosal healing (odds ratio = 8.94; 95%CI = 2.03‐39.27). Conclusion Anxiety and depression are more common in coeliac disease patients with mucosal healing, both before and after follow‐up biopsy, an association potentially mediated through more vigilant compliance with a gluten‐free diet. This finding raises concern that achieving the goal of mucosal healing may come at a cost of an increased risk of mood disorders.

Diminished quality of life among adolescents with coeliac disease using maladaptive eating behaviours to manage a gluten‐free diet: a cross‐sectional, mixed‐methods study

“…Adherence and self-advocacy are particularly problematic for adolescents as they venture outside of the home and become more independent (13,14) . The focus on food and eating behaviours, and possibly even adherence to a GFD, may be associated with an increased risk of psychosocial problems and disordered eating patterns and behaviours in adolescents with CD (15)(16)(17)(18)(19)(20)(21) .…”

Letter: anxiety after coeliac disease diagnosis predicts mucosal healing—a population‐based study

“…

EDITORS,We read with interest the recent study by Ludvigsson et al 1 Authors performed a nationwide population-based cohort study in patients diagnosed with coeliac disease (CD) between 1969 and 2008. 1 The authors stated that anxiety and depression are more common in coeliac disease patients with mucosal healing, both before and after follow-up biopsy. After reviewing the research, we have several concerns about the design and results of the study.In this study authors performed regression analysis to evaluate the impact of various factors on anxiety and depression including age at follow-up biopsy, gender, duration of coeliac disease at the time of follow-up biopsy, calendar period of first biopsy and educational attainment.

…”

Editorial: anxiety and depression associated with mucosal healing in coeliac disease

“…However, while maintaining a GFD is ideal for disease management, it is also recognised to be challenging both practically and emotionally . The study conducted by Ludvigsson et al provides a valuable exploration of the relationship between psychological comorbidity and mucosal healing associated with maintaining a GFD.…”

“…In a nationwide longitudinal population‐based cohort study involving 7648 individuals, Ludvigsson et al explored the association between diagnosis of anxiety or depression and its relationship to mucosal healing. The authors found that the risk of developing anxiety was 2.8 per 1000 person‐years of follow‐up in the mucosal healing group (n = 4331) vs 2.1 per 1000 in the group identified with persistent villous atrophy (n = 3317).…”

“…Nevertheless, Ludvigsson et al provide important evidence for the interplay between mucosal healing and psychological comorbidity, and the significant psychological costs associated with maintaining a GFD. Given this, along with utilising a GFD as directed by dieticians and gastroenterologists, it seems that the integration of mental health professionals to identify and address psychological comorbidities is not only warranted but also likely to lead to improved physical and psychological health.…”