Suicidal Behavior Among Hospitalized Adults With Inflammatory Bowel Disease: A United States Nationwide Analysis

Inflamm Bowel Dis. 2017 Dec 19;24(1):25-34. doi: 10.1093/ibd/izx005.

Abstract

Background: Suicidal behavior in inflammatory bowel disease (IBD) has been minimally explored. We aimed to determine United States (US) nationally representative prevalence estimates of suicidal ideation (SI) and suicide/self-inflicted injury (S/SII) among hospitalized adults with IBD and to examine trends in suicidal behavior over time.

Methods: A retrospective cross-sectional study using National (Nationwide) Inpatient Sample data (2006-2011) identified adults with Crohn's disease (CD) or ulcerative colitis (UC), SI or S/SII, and multiple comorbid risk factors for suicidal behavior.

Results: We identified 331,777 (estimated 1.64 million) IBD-related hospitalizations (64% CD, 36% UC) and 39,787,239 (estimated 196.08 million) hospitalizations among the general US population. Among IBD-related hospitalizations, 2502 discharges were associated with SI (prevalence 0.76%) and 1104 with S/SII (prevalence 0.33%). Both were significantly greater in CD versus UC (P < 0.001). Relative to the general US population, IBD patients were significantly less likely to demonstrate suicidal behavior: (SI:0.33% versus 0.59%, P < 0.001) (S/SII:0.75% versus 1.04%, P < 0.001). Multivariable logistic regression revealed that IBD was associated with decreased odds of SI (adjusted odds ratio [aOR] 0.62, 95%CI 0.60-0.65) and S/SII (aOR 0.43, 95%CI 0.40-0.45) relative to the general population, and suicidal behavior was lower in IBD compared to disease-related controls with rheumatoid arthritis and systemic lupus erythematosus. Similar increasing trends in suicidal behavior were observed in IBD and non-IBD populations (2006-2011).

Conclusion: In this large US database, SI or S/SII occurred in over 1% of the IBD population and was increased in CD versus UC.

Keywords: inflammatory bowel diseases/psychology; mental health; self-inflicted injury; suicide.

MeSH terms

  • Adolescent
  • Adult
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / epidemiology
  • Arthritis, Rheumatoid / psychology*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / epidemiology
  • Inflammatory Bowel Diseases / psychology*
  • Lupus Erythematosus, Systemic / complications
  • Lupus Erythematosus, Systemic / epidemiology
  • Lupus Erythematosus, Systemic / psychology*
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Suicidal Ideation*
  • Suicide / psychology
  • Suicide / statistics & numerical data*
  • United States / epidemiology
  • Young Adult