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Psychiatric Disorders Among 5,800 Patients With Microscopic Colitis: A Nationwide Population-Based Matched Cohort
David Bergman1, Bjorn Roelstraete1, Jiangwei Sun1
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Introduction:
Microscopic colitis (MC) is an inflammatory condition of the large intestine. Primarily diagnosed in middle-aged and older adults, the incidence of the disease has increased markedly during the past few decades. While MC is associated with a reduced quality of life, large-scale studies on the association with future psychiatric disorders are lacking.
Methods:
We conducted a nationwide matched cohort study in Sweden from 2006 to 2021. Through a nationwide histopathology database (the Epidemiology Strengthened by histoPathology Reports in Sweden study), we identified 5,816 patients with a colorectal biopsy consistent with MC. These patients were matched with 21,509 reference individuals from the general population all of whom with no previous record of psychiatric disorders.
Results:
From 2006 to 2021, 519 patients with MC (median age 64.4 years [interquartile range = 49.5-73.3]) and 1,313 reference individuals were diagnosed with psychiatric disorders (9.9 vs 6.5 events per 1,000 person-years), corresponding to 1 extra case of psychiatric disorder in 29 patients with MC over 10 years. After adjustments, the hazard ratio for psychiatric disorders was 1.57 (95% confidence interval = 1.42-1.74). We found significantly elevated estimates up to 10 years after MC diagnosis and a trend toward higher risk with increasing age. Specifically, we observed increased risks for unipolar depression, anxiety disorders, stress-related disorders, substance abuse, and suicide attempts. In sibling-controlled analysis, the adjusted hazard ratio was 1.76 (95% confidence interval = 1.44-2.15).
Discussion:
Patients with MC are at increased risk of incident psychiatric disorders compared with the general population.
Insights
Microscopic colitis (MC) patients face a higher risk of developing psychiatric disorders. This nationwide study found a 57% increased hazard ratio for conditions like depression and anxiety following an MC diagnosis.
Area of Science:
- Gastroenterology
- Psychiatry
- Epidemiology
Background:
- Microscopic colitis (MC) is an inflammatory bowel disease affecting the large intestine, primarily diagnosed in older adults.
- While MC impacts quality of life, large-scale data on its link to future psychiatric disorders is limited.
Purpose of the Study:
- To investigate the association between microscopic colitis and the risk of developing psychiatric disorders.
- To quantify the magnitude and duration of this association.
Main Methods:
- A nationwide matched cohort study in Sweden (2006-2021) involving 5,816 MC patients and 21,509 matched controls.
- Utilized a national histopathology database and linked psychiatric diagnoses, controlling for prior psychiatric conditions.
Main Results:
- MC patients showed a 57% increased hazard ratio (HR=1.57) for psychiatric disorders compared to controls.
- Elevated risks were observed up to 10 years post-diagnosis, including unipolar depression, anxiety, stress-related disorders, substance abuse, and suicide attempts.
- Sibling-controlled analysis further supported the association with an adjusted HR of 1.76.
Conclusions:
- Patients diagnosed with microscopic colitis have a significantly increased risk of developing psychiatric disorders.
- The findings highlight the need for integrated care and monitoring of mental health in MC patients.
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