Risk of Anxiety, Depression, and Attention-Deficit/Hyperactivity Disorder in Pediatric Patients With Inflammatory Bowel Disease: A Population-Based Cohort Study

Clin Transl Gastroenterol. 2024 Apr 1;15(4):e00657. doi: 10.14309/ctg.0000000000000657.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antidepressive Agents / therapeutic use
  • Anxiety / epidemiology
  • Attention Deficit Disorder with Hyperactivity* / epidemiology
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Colitis, Ulcerative* / complications
  • Colitis, Ulcerative* / diagnosis
  • Colitis, Ulcerative* / epidemiology
  • Colitis, Ulcerative* / psychology
  • Crohn Disease / complications
  • Crohn Disease / diagnosis
  • Crohn Disease / epidemiology
  • Crohn Disease / psychology
  • Denmark / epidemiology
  • Depression* / epidemiology
  • Female
  • Humans
  • Inflammatory Bowel Diseases / complications
  • Inflammatory Bowel Diseases / epidemiology
  • Inflammatory Bowel Diseases / psychology
  • Male
  • Methylphenidate / adverse effects
  • Methylphenidate / therapeutic use
  • Proportional Hazards Models
  • Registries* / statistics & numerical data
  • Risk Factors

Substances

  • Antidepressive Agents
  • Methylphenidate
  • Central Nervous System Stimulants