The association between inflammatory bowel disease and mental ill health: a retrospective cohort study using data from UK primary care

Abstract

Summary Background Patients with active inflammatory bowel disease (IBD) and mental illnesses experience worse IBD outcomes. Aim To describe the incidence of mental illnesses, including deliberate self‐harm, in IBD patients. Methods A population‐based retrospective cohort study using IQVIA medical research data of a primary care database covering the whole UK, between January 1995 and January 2021. IBD patients of all ages were matched 4:1 by demographics and primary care practice to unexposed controls. Following exclusion of patients with mental ill health at study entry, adjusted hazard ratios (HR) of developing depression, anxiety, deliberate self‐harm, severe mental illness and insomnia were calculated using a Cox proportional hazards model. Results We included 48,799 incident IBD patients: 28,352 with ulcerative colitis and 20,447 with Crohn's disease. Incidence rate ratios of mental illness were higher in IBD patients than controls (all p < 0.001): deliberate self‐harm 1.31 (95% CI 1.16–1.47), anxiety 1.17 (1.11–1.24), depression 1.36 (1.31–1.42) and insomnia 1.62 (1.54–1.69). Patients with Crohn's disease were more likely to develop deliberate self‐harm HR 1.51 (95% CI 1.28–1.78), anxiety 1.38 (1.16–1.65), depression 1.36 (1.26–1.47) and insomnia 1.74 (1.62–1.86). Patients with IBD are at increased risk of deliberate self‐harm (HR 1.20 [1.07–1.35]). The incidence rate ratios of mental illnesses were particularly high during the first year following IBD diagnosis: anxiety 1.28 (1.13–1.46), depression 1.62 (1.48–1.77) and insomnia 1.99 (1.78–2.21). Conclusion Deliberate self‐harm, depression, anxiety and insomnia were more frequent among patients with IBD. IBD is independently associated with an increased risk of deliberate self‐harm.

Geographic differences in psychological symptoms, sleep quality, and quality of life in patients with inflammatory bowel disease: A multicenter study in China

“…In terms of psychological symptoms, we found that patients with IBD across different geographical regions of China's mainland commonly experienced anxiety and depression. This is consistent with previous studies, indicating that psychological health issues among patients with IBD are prevalent worldwide, 5,6 and that these psychological pressures can worsen the condition of these patients. 20 However, we also observed geographical differences.…”

“…4,5 Patients with IBD have been reported to be more prone to mental distress. 6 These psychological symptoms impair patient's QoL, and impact their attitudes and behaviors toward disease management and recovery, significantly contributing to an unfavorable prognosis of patients with IBD. 4,7 Furthermore, the onset of IBD is closely related to genetic background, environmental factors, dietary habits, and lifestyle.…”

“…Psychological manifestations are among the common issues faced by patients with IBD, including anxiety and depression 4,5 . Patients with IBD have been reported to be more prone to mental distress 6 . These psychological symptoms impair patient's QoL, and impact their attitudes and behaviors toward disease management and recovery, significantly contributing to an unfavorable prognosis of patients with IBD 4,7 .…”

Low Adherence is Associated with Chronic Active Disease in Ulcerative Colitis: A Retrospective Study from a Single Referral Center

“…10 A systematic review showed that in young IBD patients the presence of psychological morbidity decreased treatment adherence by 12%. 30 Anxiety, depression, stress, stigmatization leading to isolation, [31][32][33] are all problems investigated in UC patients. Addressing mental health problems in patients with IBD can improve their adherence to treatment and the somatic disease course and, consequently, reduce morbidity.…”

Risk of Attempted Suicide Among Patients with Inflammatory Bowel Disease: A Nationwide Longitudinal Follow-Up Study

“…Third, depressive disorder was identified and matched in the current study because depression is the most important risk factor for suicide-related symptoms, such as suicidal attempt and thought, and has been reported to be commonly comorbid with IBD. 34 Whether other minor psychiatric symptoms, such as anxiety and insomnia, may be associated with the risk of suicidal attempt among patients with IBD would need further investigation. In addition, the disease severity of depressive disorder was not available in the database and was difficultly matched between groups.…”