Suicide Attempts, Schizophrenia, and Depression Among Inflammatory Bowel Disease Patients: Data From a Large Database

Psychiatric disorders are more common in inflammatory bowel disease (IBD) patients compared with the general population. We aimed to investigate the prevalence and risk factors of depression, schizophrenia, and suicide attempts among IBD patients in Israel.

Data on IBD patients over 25 years (1999 to 2024) was extracted from the Clalit Health Maintenance Organization. Possible risk factors were investigated via multivariate analyses. A matched case-control analysis was performed of attempted suicide cases.

A total of 3,262,623 adults were analyzed. The frequency rate of suicide attempts was 1.5%, schizophrenia 1.3%, and depression 25.7% among 19,100 Crohn's disease (CD) patients compared with 1.1%, 1.4%, and 23.0% among 17,731 ulcerative colitis (UC) patients. In a multivariate analysis, female gender (OR 1.284, P <0.001), smoking (OR 1.479, P <0.001), CD (OR 1.274, P <0.010), schizophrenia (OR 7.69, P <0.001), and depression (OR 6.284, P <0.001) were found to be predictors of suicide attempts. Case-control analysis of 490 patients with a prior suicide attempt revealed significantly higher rates of schizophrenia (13.1% vs. 1.2%, P <0.001) and depression (70.0% vs. 19.6%, P <0.001) among the suicide group. In a multivariate analysis, schizophrenia (OR 9.873, P <0.001) and depression (OR 8.964, P <0.001) were significant risk factors for suicide attempts. The mortality rate among those with a suicide attempt (98/490, 20%) was significantly higher compared with those without a suicide attempt (5301/36,341, 14.6%, P <0.001).

The main risk factor for suicide attempts among IBD patients is comorbid psychiatric disease. Proactive mental health care by gastroenterologists and integrated psychology services is highly recommended.