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Original research
Psychiatric disorders in paediatric-onset immune-mediated inflammatory diseases: a nationwide Danish study
  1. Sabine Jansson1,2,
  2. Mikkel Malham1,3,
  3. Katrine Carlsen3,4,
  4. Helene Ingels5,
  5. Marianne Hørby Jørgensen5,
  6. Lauri Juhani Virta6,
  7. Kaija-Leena Kolho7,
  8. Charlotte Ulrikka Rask2,8,
  9. Vibeke Wewer1,3
  1. 1 Department of Pediatric and Adolescent Medicine, Hvidovre Hospital, Copenhagen, Denmark
  2. 2 Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
  3. 3 Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescent and Adults, Hvidovre Hospital, Hvidovre, Denmark
  4. 4 Department of Pediatric and Adolescent Medicine, Hvidovre Hospital, Hvidovre, Denmark
  5. 5 Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
  6. 6 Research Department, The Social Insurance Institution of Finland, Helsinki, Finland
  7. 7 Department of Pediatrics, University of Helsinki Children's Hospital, Helsinki, Finland
  8. 8 Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Sabine Jansson, Department of Pediatric and Adolescent Medicine, Hvidovre Hospital, Copenhagen, Denmark; sabine.jansson{at}outlook.com

Abstract

Objectives To investigate the frequency of psychiatric disorders before and after onset of paediatric-onset immune-mediated inflammatory diseases (pIMID).

Study design In a nationwide study from 1996 to 2018, we investigated psychiatric disorders in patients with paediatric-onset inflammatory bowel diseases, autoimmune liver diseases and rheumatic diseases, using Danish national healthcare and population registers. Each case was matched with up to 10 controls from the background population. The cumulative incidence for psychiatric disorders prior to pIMID onset in patients was compared with controls. Cox proportional regression was used to estimate adjusted HRs (aHR) with a 95% CI between cases and controls after the index date.

Results We included 11 208 cases (57% female) and 98 387 controls. The median age at disease onset was 12.5 years (IQR 8–15) and follow-up time 9.8 years (IQR 5–15). We found an association between psychiatric disorders before index date and a diagnosis of subsequent pIMID (OR 1.3, 95% CI 1.2 to 1.4). Notably, after index date, cases also had an increased risk (aHR 1.6, 95% CI 1.5 to 1.7) of psychiatric disorders compared with controls. This risk was increased for all groups of psychiatric disorders. Female patients had an increased risk of suicide attempt after index date (aHR 1.4, 95% CI 1.1 to 1.8).

Conclusion Patients with pIMID are at increased risk for a broad spectrum of psychiatric disorders both before and after onset of pIMID. The results support the need for awareness of psychiatric morbidity in this young patient group and the need for coordinated healthcare for those with comorbid states.

  • mental health
  • paediatrics
  • gastroenterology
  • rheumatology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/archdischild-2023-325675

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @MikkelMalham, @Virta

    • Contributors SJ: contributed to the conceptualisation/design of the study, interpretation of data, carried out the analyses, drafted the initial manuscript, approved the manuscript and is responsible for the overall content as guarantor. MM: contributed to the conceptualisation/design of the study, interpretation of data, carried out the analyses, revised the initial manuscript, approved the manuscript and is responsible for reported research. KC: contributed to the conceptualisation/design of the study, interpretation of data, revised the initial manuscript, approved the manuscript and is responsible for reported research. MHJ: contributed to the conceptualisation/design of the study, interpretation of data, revised the initial manuscript, approved the manuscript and is responsible for reported research. HI: contributed to the conceptualisation/design of the study, interpretation of data, revised the initial manuscript, approved the manuscript and is responsible for reported research. LJV: contributed to the conceptualisation/design of the study, interpretation of data, revised the initial manuscript, approved the manuscript and is responsible for reported research. K-LK: contributed to the conceptualisation/design of the study, interpretation of data, revised the initial manuscript, approved the manuscript and is responsible for reported research. CUR: contributed to the conceptualisation/design of the study, interpretation of data, revised the initial manuscript, approved the manuscript and is responsible for reported research. VW: contributed to the conceptualisation/design of the study, interpretation of data, revised the initial manuscript, approved the manuscript and is responsible for reported research.

    • Funding This work was supported by the Lundbeck Foundation grant number (F-61171-19-27).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.