O33 The association between IBD and mental ill health: a retrospective primary care cohort study

Abstract

<h3>Introduction</h3> Patients with active inflammatory bowel disease (IBD) and psychological comorbidity experience worse IBD outcomes. This study describes the incidence of a wide range of mental illnesses including severe mental illness and deliberate self harm in patients with IBD. <h3>Methods</h3> A population based retrospective open cohort study was undertaken using IQVIA medical research data between 1995 and 2021. Patients with incident IBD were 4:1 matched by demographics and primary care practice to unexposed controls. Following exclusion of those with mental ill health at study entry, the risk of developing the outcomes of interest (deliberate self harm, depression, anxiety, insomnia) were calculated using Cox proportional hazards model after adjustment for key covariates. <h3>Results</h3> We identified 48,799 incident IBD patients, of which 28,352 (58.1%) had UC and 20,447 (41.9%) had Crohn’s disease. Median age was 41.5 (IQR 29.6–57.5) years, with an equal proportion of males and females with IBD (51.7% vs 48.3%). The incidence rate ratios of mental illnesses were higher in IBD patients than controls (all p&lt;0.001): deliberate self-harm 1.31 (95%CI 1.16–1.47); anxiety 1.17 (1.11–1.24); depression 1.36 (1.31–1.42); and insomnia 1.62 (1.54–1.69). Patients with Crohn’s disease were more likely to develop deliberate self-harm adj HR 1.51 (95%CI 1.28–1.78), anxiety 1.38 (1.16–1.65), depression 1.36 (1.26–1.47) and insomnia 1.74 (1.62–1.86). The incidence rate ratios of mental illnesses were particularly high during first year following IBD diagnosis: anxiety 1.28 (1.13–1.46); depression 1.62 (1.48–1.77); insomnia 1.99 (1.78–2.21). Associations of deliberate self-harm included: IBD (adj HR 1.20 (95%CI 1.07–1.35), female sex (1.06 (1.35–1.60), age quintile compared to &gt;61.3 years (&lt;27.4 years (4.48 (3.95–5.93)), anxiety (1.57 (1.35–1.82), depression (5.97 (5.33–6.69), insomnia (2.32 (2.02–2.66), and severe mental illness (5.74 (4.56–7.22). <h3>Conclusions</h3> There is a significant burden of mental illness in patients following an IBD diagnosis. The incidence of deliberate self harm, depression, anxiety, insomnia was higher than in healthy controls. Patients are at higher risk of mental illness during the first year following IBD diagnosis.