Early Onset Active IBD Linked to Higher Rates of Psychiatric Disorders, Medication Use

Early onset inflammatory bowel disease (IBD) activity post-diagnosis is associated with a higher incidence of psychiatric diagnoses and psychotropic medication usage, according to a study published in Crohn’s & Colitis 360.¹

Patients with IBD exhibit a higher prevalence of comorbid conditions, with concurrent psychiatric disease diagnoses contributing to a substantial part of their disability, particularly in those with poorly controlled disease. Previous research has shown that patients with IBD and comorbid psychiatric disease experience substantially higher utilization of inpatient, emergency, and surgical services compared with those without a concurrent psychiatric comorbid condition.²

Additionally, prior studies have highlighted a bidirectional relationship between psychiatric comorbid conditions and IBD³; psychiatric diseases can influence the IBD disease course and impact the utilization of therapeutics. To further explore this connection, the researchers conducted a study to evaluate the impact of early onset IBD disease activity on concurrent psychiatric diagnoses and psychotropic medication use.¹

Early onset active inflammatory bowel disease (IBD) is associated with significantly higher rates of psychiatric disorders and increased use of psychotropic medications. | Image Credit: Nadzeya - stock.adobe.com

More specifically, they performed a retrospective cohort study, using the TriNetX Research Network, a large de-identified national database with 80 contributing health care organizations (HCOs), including over 113 million patients. From this database, the researchers identified all adult patients newly diagnosed with IBD and who had documented IBD-specific medication use (adalimumab, certolizumab pegol, golimumab, infliximab, vedolizumab, ustekinumab, tofacitinib, azathioprine, mercaptopurine, or methotrexate) on or after January 1, 2023.

They stratified patients into 2 cohorts based on IBD disease activity 6 to 12 months post-diagnosis: active IBD and nonactive IBD. The researchers defined active IBD as steroid use (hydrocortisone, prednisone, methylprednisolone, or budesonide) and/or elevated fecal calprotectin (FC) (≥200 µg/g) occurring 6 to 12 months post-diagnosis. Conversely, they defined nonactive IBD as those who did not use steroids and did not have elevated FC 6 to 12 months post-diagnosis.

Using the patients in these cohorts, the researchers examined the outcomes of psychiatric disease diagnosis and psychotropic medication prescriptions based on the International Classification of Diseases, 10^th Revision (ICD-10) codes, and RxNorm codes, respectively.

Within TriNetX, they identified 69,105 patients diagnosed with IBD between 2013 and 2023, 16,961 (24.5%) of whom had an IBD exacerbation 6 to 12 months after their initial diagnosis. After propensity score matching, the researchers identified 16,922 patients with IBD who experienced disease exacerbation and 16,922 patients with IBD who did not experience any disease exacerbation. The mean (standard deviation [SD]) age of the active IBD cohort was 43.69 (17.55), and 70.2% were White.

The researchers found that patients with active IBD had significantly higher odds of having a subsequent psychiatric diagnosis across all psychiatric diseases than those without active IBD. More specifically, they had higher odds of developing major depressive disorder (12.2% vs 5.7%; adjusted odds ratio [aOR], 2.32; 95% CI, 2.14-2.51), anxiety disorder (15.3% vs 7.2%; aOR, 2.31; 95% CI, 2.15-2.48), bipolar disorder (1.0% vs 0.7%; aOR, 1.56; 95% CI, 1.23-1.99), and alcohol use disorder (3.5% vs 1.2%; aOR, 3.0; 95% CI, 2.55-3.53).

Patients with active IBD were also more likely to develop opiate use disorder (1.4% vs 0.3%; aOR, 4.72; 95% CI, 3.48-6.39), attention-deficit/hyperactivity disorder (1.3% vs 1.0%; aOR, 1.34; 95% CI, 1.09-1.64), and obsessive-compulsive disorder (0.4% vs 0.2%; aOR, 2.0; 95% CI, 1.36-2.96).

Additionally, patients with active IBD had significantly higher odds of using all analyzed psychotropic medications than those without active IBD. Therefore, patients with active IBD had higher utilization of antidepressants (22.8% vs 9.5%; aOR, 2.81; 95% CI, 2.64-2.99), antipsychotic medications (7.5% vs 1.7%; aOR, 4.79; 95% CI, 4.20-5.46), and anxiolytics/sedatives/hypnotic mediations (35.0% vs 11.9%; aOR, 3.99; 95% CI, 3.78-4.22).

The researchers found that those with active IBD were also more likely to have been prescribed mood stabilizers (2.5% vs 1.2%; aOR, 2.06; 95% CI, 1.74-2.44), stimulant medications (1.6% vs 1.2%; aOR, 1.34; 95% CI, 1.12-1.61), and medications used for substance use disorders, including alcohol, opioid, and tobacco use (16.5% vs 4.4%; aOR, 4.27; 95% CI, 3.93-4.64).

“Given the findings of our study, it is imperative to start routine screening for psychiatric comorbidities early in the IBD course, with shorter intervals of screening for those with increased disease activity,” the authors wrote.

The researchers acknowledged their study’s limitations, including the inability to detect psychiatric comorbidities if patients received care from HCOs not covered by TriNetX. They noted that this limitation may have led them to underestimate the burden of psychiatric comorbidity. However, the researchers suggested areas for further research based on their findings.

“This underscores the importance of behavioral and psychosocial health in IBD and calls for early and routine assessment of comorbid psychiatric disease in patients with active IBD,” the authors concluded. “Further studies are needed to understand the impact of IBD disease activity on comorbid psychiatric disease, optimal screening strategies, and prognosis.”

References

1. Nadeem A, Donohue S, Shah FZ, et al. Early Onset Active Inflammatory Bowel Disease Is Associated With Psychiatric Comorbidities: A Multi-Network Propensity-Matched Cohort Study. Crohns Colitis 360. 2024;7(1):otae066. doi:10.1093/crocol/otae066
2. Szigethy E, Murphy SM, Ehrlich OG, et al. Mental health costs of inflammatory bowel diseases. Inflamm Bowel Dis. 2021;27(1):40-48. doi:10.1093/ibd/izaa030
3. Andrews H, Barczak P, Allan RN. Psychiatric illness in patients with inflammatory bowel disease. Gut. 1987;28(12):1600-1604. doi:10.1136/gut.28.12.1600