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Risk of Anxiety, Depression, and Attention-Deficit/Hyperactivity Disorder in Pediatric Patients With Inflammatory
Rebecca Kristine Kappel1, Tania Hviid Bisgaard1, Gry Poulsen1
1Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
Insights
Children with inflammatory bowel disease (IBD) face a 50% higher risk of depression. However, they show a decreased likelihood of attention-deficit/hyperactivity disorder (ADHD) diagnosis and methylphenidate use, warranting further research.
Area of Science:
- Pediatric gastroenterology
- Child and adolescent psychiatry
- Epidemiology
Background:
- Inflammatory bowel disease (IBD) is linked to mental health issues in adults.
- Limited data exists on psychiatric disease risk in pediatric IBD patients.
Purpose of the Study:
- To assess the risk of anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) in children diagnosed with IBD.
Main Methods:
- Nationwide, register-based cohort study in Denmark (1998-2018).
- Included 3,559 pediatric IBD patients matched with 17,795 controls.
- Utilized Cox regression to calculate hazard ratios for psychiatric outcomes.
Main Results:
- Pediatric IBD patients had a 50% increased risk of depression (HR 1.50) and antidepressant use (HR 1.54).
- Crohn's disease patients showed a higher risk of depression and antidepressant use.
- A reduced risk of methylphenidate use (HR 0.75) and ADHD diagnosis was observed in pediatric IBD patients.
Conclusions:
- Pediatric IBD is associated with a significantly increased risk of depression.
- The reduced risk of ADHD diagnosis and methylphenidate use in pediatric IBD requires further investigation.
Introduction:
Inflammatory bowel disease (IBD) is associated with depression and anxiety in adults, but data are scarce on risk of psychiatric diseases in children with IBD. We aimed to estimate the risk of anxiety, depression, or attention-deficit/hyperactivity disorder (ADHD) in patients with pediatric-onset IBD.
Methods:
We performed a nationwide, register-based cohort study including all patients with pediatric-onset IBD diagnosed in Denmark during 1998-2018, resulting in 3,559 patients matched 1:5 on age, sex, municipality of residence, and time period, resulting in 17,795 reference individuals. We used Cox regression to calculate hazard ratios for each outcome after a diagnosis with IBD.
Results:
Patients with pediatric-onset IBD had an increased risk of depression (hazard ratio [HR] 1.50; 95% confidence interval [CI] 1.26-1.80) and of using antidepressants (HR, 1.54; 95% CI, 1.39-1.71) and, surprisingly, a reduced risk of using methylphenidate (HR, 0.75; 95% CI, 0.58-0.98). Patients with both IBD subtypes (Crohn's disease and ulcerative colitis) had an increased risk of using antidepressants and developing depression, which was particularly high in patients with Crohn's disease (HR, 1.73; 95% CI, 1.35-2.22). Patients with ulcerative colitis had reduced risk of using methylphenidate (HR, 0.63; 95% CI, 0.43-0.93) and a reduced-although not statistically significant-risk of being diagnosed with ADHD compared with the background population.
Discussion:
Patients with pediatric-onset IBD have a 50% increased risk of developing depression, which is important for healthcare providers to be aware of and manage. Remarkably, we found a reduced risk of receiving methylphenidate and being diagnosed with ADHD, which merits further investigation.
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