Impact of mental health comorbidity in children and young adults with inflammatory bowel disease: a UK population-based cohort study

Abstract

Objective: To evaluate the impact of mental health comorbidity in children and young adults with inflammatory bowel disease (IBD).

Design: Retrospective observational study.

Setting: Representative population, routinely collected primary care data from the UK Optimum Patient Care Research Database (2015-2019).

Participants: Patients with IBD aged 5-25 years with mental health conditions were compared with patients with IBD of the same age without mental health conditions.

Primary and secondary outcome measures: Outcomes comprised quality-of-life indicators (low mood, self-harm, parasuicide, bowel symptoms, absence from school or work, unemployment, substance use and sleep disturbance), IBD interventions (medication, abdominal surgery, stoma formation and nutritional supplements) and healthcare utilisation (primary care interactions and hospital admissions).

Results: Of 1943 individuals aged 5-25 years with IBD, 295 (15%) had a mental health comorbidity. Mental health comorbidity was associated with increased bowel symptoms (adjusted incident rate ratio (aIRR) 1.82; 95% CI 1.33 to 2.52), sleep disturbance (adjusted HR (aHR) 1.63; 95% CI 1.02 to 2.62), substance use (aHR 3.63; 95% CI 1.69 to 7.78), primary care interactions (aIRR 1.33; 95% CI 1.12 to 1.58) and hospital admissions (aIRR 1.87; 95%CI 1.29 to 2.75). In individuals ≥18 years old, mental health comorbidity was associated with increased time off work (aHR 1.55; 95% CI 1.21 to 1.99).

Conclusions: Mental health comorbidity in children and young adults with IBD is associated with poorer quality of life, higher healthcare utilisation and more time off work. It is imperative that affected young patients with IBD are monitored and receive early mental health support as part of their multidisciplinary care.

Trial registration number: The study protocol was specified and registered a priori (ClinicalTrials.gov study identifier: NCT05206734).

Keywords: Inflammatory bowel disease; MENTAL HEALTH; Paediatric gastroenterology; Quality of Life.