Risk of Psychiatric Disorders following Irritable Bowel Syndrome: A Nationwide Population-Based Cohort Study

Abstract

BackgroundIrritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder observed in patients who visit general practitioners for GI-related complaints. A high prevalence of psychiatric comorbidities, particularly anxiety and depressive disorders, has been reported in patients with IBS. However, a clear temporal relationship between IBS and psychiatric disorders has not been well established.ObjectiveWe explored the relationship between IBS and the subsequent development of psychiatric disorders including schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and sleep disorder.MethodsWe selected patients who were diagnosed with IBS caused by gastroenteritis, according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort was formed of patients without IBS who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on psychiatrist diagnoses.ResultsThe IBS cohort consisted of 4689 patients, and the comparison cohort comprised 18756 matched control patients without IBS. The risks of depressive disorder (HR = 2.71, 95% confidence interval [CI] = 2.30–3.19), anxiety disorder (HR = 2.89, 95% CI = 2.42–3.46), sleep disorder (HR = 2.47, 95% CI = 2.02–3.02), and bipolar disorder (HR = 2.44, 95% CI = 1.34–4.46) were higher in the IBS cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive disorder, anxiety disorder, and sleep disorder remained significantly increased in all of the stratified follow-up durations (0–1, 1–5, ≥5 y).ConclusionsIBS may increase the risk of subsequent depressive disorder, anxiety disorder, sleep disorder, and bipolar disorder. The risk ratios are highest for these disorders within 1 year of IBS diagnosis, but the risk remains statistically significant for more than 5 years. Clinicians should pay particular attention to psychiatric comorbidities in IBS patients.

A meta-analysis and systematic review of the comorbidity between irritable bowel syndrome and bipolar disorder

“…Among 6 qualified included studies, our results are consistent with 3 large-scale trials, [12–14] but not with the other 3, [9–11] which may be due to differences in the study designs and number of cases. In addition, in one of the previous reports, immunity dysfunctions such as asthma and autoimmune diseases were found to be independent risk factors for the development of BD in patients with IBS.…”

“…Although there was no significant heterogeneity or publication bias detected in current meta-analysis, we found that the studies included in the current meta-analysis consisted of 2 types of study designs; one was derived from database research [12–14] and the other one was from primary research. [9–11] Therefore, we performed subgroup meta-analysis based on different study designs.…”

“…However, in the most recent 3 large-scale studies, the comorbidity rate of BD in patients with IBS was significantly higher than in healthy controls. [12–14] These inconsistent findings may be due to the different study designs (self-reported study vs a nationwide database search), [10,12] different sample sizes, [10,11,13] different diagnostic criteria, [10,12] or different regions of research. [9,13] To address the inconsistency, the current study aimed to summarize evidence on the comorbidity rates of IBS and BD and to examine possible associations between the comorbidity rates and clinical variables through a systematic review and meta-analysis.…”

Risk of uterine, ovarian and breast cancer following pelvic inflammatory disease: a nationwide population-based retrospective cohort study

“…Common co-morbidities including hypertension, diabetes mellitus, dyslipidemia, congestive heart failure, chronic pulmonary diseases, coronary artery diseases, and cerebrovascular diseases were also compared between PID and controls. The study design and the criteria had been used in similar studies [10–12]. …”

The current treatment landscape of irritable bowel syndrome in adults in Hong Kong: consensus statements

“…In a community-based survey in Hong Kong, the prevalence of generalised anxiety disorder was 16 13 In a cross-sectional study of 201 subjects with IBS, 67.2% were poor sleepers. 14 The correlation between sleep score and IBS severity was independent of anxiety and depression; nonetheless the prevalence of sleep disturbances was higher in patients with co-morbid anxiety and depression.…”