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Comment
, 1 (3), 107-114

Incidence of Suicide in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

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Incidence of Suicide in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Chaoran Zhang et al. J Can Assoc Gastroenterol.

Abstract

Background and aims: Patients with inflammatory bowel disease (IBD) have higher incidence of psychosocial disorders, including depression. As suicide is the most severe manifestation of depression, we sought to identify if patients with IBD have a higher incidence of suicide through a systematic review and meta-analysis.

Methods: Systematic literature searches for articles using EMBASE and MEDLINE using Ovid were conducted to identify studies investigating suicide in IBD. Reference harvesting of the bibliographies of key articles was also performed. We included studies reporting expected number of death or standardized mortality ratio (SMR) for suicide in IBD. Meta-analysis for each IBD condition (Crohn's disease [CD] and ulcerative colitis [UC]) was conducted separately, as well as combined.

Results: Seven cohort studies were identified through our search strategy and included in our systematic review and meta-analysis. In our analysis, the SMR for suicide in patients with IBD for all studies included was 1.20 (95% CI, 0.94-1.54). The overall pooled SMR for CD and UC were 1.36 (95% CI, 0.98-1.88) and 1.16 (95% CI, 0.8-1.69) respectively.

Conclusions: Patients with Crohn's disease and ulcerative colitis may have an increased risk of suicide. These results highlight the importance physicians must place on ensuring the mental health of patients with IBD is both assessed and treated appropriately.

Keywords: Inflammatory bowel disease; Meta-analysis; Suicide; Systematic review.

Figures

Figure 1.
Figure 1.
Flow diagram summarizing trial identification and selection.
Figure 2.
Figure 2.
Funnel plot of the studies included in this study. Studies with no events observed were excluded due to undefined standard error. The unshaded area represents the region within which 95% of studies are expected to lie in the absence of both biases and heterogeneity (fixed effect summary log odds ratio ± 1.96 *standard error of summary log odds ratio). The solid vertical line corresponds to the SMR from the random effects model (10).
Figure 3.
Figure 3.
SMR with 95% confidence intervals for all study population, together with the random effects pooled SMR. Heterogeneity testing (I2, P value from Cochrane’s Q) shown for each analysis.
Figure 4.
Figure 4.
Sensitivity analysis: SMR with 95% confidence intervals for all study population excluding studies with SMR of zero, together with the random effects pooled SMR. Heterogeneity testing (I2, P value from Cochrane’s Q) shown for each analysis.

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