Early Onset Active Inflammatory Bowel Disease Is Associated With Psychiatric Comorbidities: A Multi-Network Propensity-Matched Cohort Study

Background: Psychiatric disease burden in patients with Inflammatory bowel disease (IBD) has risen substantially over the past few decades. However, there is limited data on the relationship between IBD disease activity and the incidence of psychiatric comorbidities. We sought to conduct a population-based study to investigate the impact of early onset disease activity in newly diagnosed IBD patients on psychiatric disease diagnoses and medication usage.

Methods: We performed a retrospective cohort study using the TriNetX database. We identified all adult patients diagnosed with IBD and documented IBD-specific medication use. We stratified these IBD patients into 2 cohorts based on IBD Disease Activity, occurring 6 months to 1 year after initial IBD diagnosis. Active IBD was defined as the utilization of steroids and/or elevated fecal calprotectin [≥200 µg/g] occurring 6 months to 1 year after initial IBD diagnosis. We examined the outcomes of psychiatric disease diagnoses and psychotropic medication prescriptions occurring 1 year after the initial diagnosis.

Results: Out of 69 105 patients with an IBD diagnosis during the study period, after propensity score matching, 16 922 IBD patients each were included in the 2 cohorts based on disease activity. Patients with active IBD had significantly higher odds of developing major depressive disorder, anxiety disorder, bipolar disorder, alcohol use disorder, opiate use disorder, attention deficit hyperactivity disorder, and obsessive-compulsive disorder. Additionally, patients with active IBD also had significantly higher odds of using all studied psychotropic medications, including antidepressants, antipsychotic medications, anxiolytics, sedatives, hypnotic medications, mood stabilizers, stimulant medications, and medications used for substance use disorders (including alcohol, opioid, and tobacco use).

Conclusions: Active IBD shortly after the IBD diagnosis is associated with a higher incidence of psychiatric comorbidities. Awareness of behavioral health in IBD is important, and proper treatment is necessary.