Mental health support needed in young-onset IBD

IBD

By Mardi Chapman

22 Aug 2019

Childhood-onset IBD is associated with psychiatric morbidity including mood and eating disorders and suicide attempts, new research shows.

The findings support a similar association recognised in adult-onset IBD and point to the need for long-term psychological support for patients.

The Swedish study comprised more than 6,000 people with childhood-onset IBD followed for a median of 9 years and compared to both a general population cohort and siblings without IBD.

It found 17.1% of people with childhood-onset IBD received a diagnosis of any psychiatric disorder compared to 11.2% of the matched general population and 10.4% of siblings.

The hazard ratio for any psychiatric disorder in the IBD group compared to both the general population and siblings was 1.6.

The risk was particularly high in the first year after an IBD diagnosis (HR 3.5) and remained high for five or more years.

Young onset of IBD before six years of age (HR 2.4), extraintestinal manifestations of IBD (HR 2.0) or bowel or perianal surgery (HR 1.9-2.0) also increased the risk.

Mood disorders (HR 1.6), anxiety disorders (HR 1.9) eating disorders (HR 1.6-2.1), personality disorders (HR 1.4-1.9) and suicide attempts (HR 1.4-1.7) were some of the more common and concerning diagnoses in IBD patients.

ADHD (HR 1.2) and autistic spectrum disorders (HR 1.4) were also more likely with IBD however there was no increased risk of psychotic disorders.

“To our knowledge, this is the first study on the risk of suicide attempt and psychiatric disorders among individuals with childhood-onset IBD that uses a sibling comparison approach,” the study said.

“By reducing familial confounding, we have been able to show that familial factors do not seem to explain the increased risk of psychiatric outcomes, suggesting an association between IBD and those psychiatric disorders.”

Associate Professor Antonina Mikocka-Walus, a psychologist at Deakin University who specialises in psychogastroenterology, said it was very powerful study.

“What is quite important about this study is not comparing to the general population but comparing to siblings because that shows you that it is not something to do with the family. There is something about IBD that makes people more anxious or depressed.”

She told the limbic that previous studies, largely in adults, have shown that rates of anxiety can be as high as 69% and depression around 30% during flares of IBD and then drop during remission.

“So as long as they have IBD, they will have periods of anxiety and depression and it will come back or become more severe.”

She said one-off interventions and quick fixes were therefore futile.

“It requires more ongoing care and that’s why we have been recommending, in my studies and many others, that chronic illness care with multidisciplinary teams are available.”

“My recommendations for practice would be to screen anyone who is new to IBD… and check whenever you see the patient again, whether this is annually or biannually, if they are feeling okay, if their mental health is fine as well.”

She said incorporating mental health practitioners into IBD services was not common yet research had shown it was more effective for patients than referring them externally for psychological help.

An editorial in JAMA Pediatrics said the rigorous study “represents the best data we currently have on the intersection of pediatric IBD and mental health”.

“Their study highlights a substantial risk in a vulnerable population and should trigger revision of guidelines and allocation of resources to support widespread screening and treatment for these dangerous conditions.”

It said there was a strong precedent for integrating ancillary health services such as nutrition support into IBD care and with improved outcomes.

Yet there remained consistently inadequate access to mental health services in the general pediatric population as well as in specific populations such as patients with IBD.

The editorial called for regular screening for mental health disorders, especially depression and suicidal ideation, in all children with IBD as a priority.

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