Risk of anxiety, depression, and ADHD in pediatric patients with inflammatory bowel disease: A population-based cohort study.

ABSTRACT

INTRODUCTION: Inflammatory bowel disease (IBD) is associated with depression and anxiety in adults, but data is scarce on risk of psychiatric diseases in children with IBD. We aimed to estimate the risk of anxiety, depression, or attention-deficit/hyperactivity disorder in patients with pediatric-onset IBD. METHODS: We performed a nationwide, register-based cohort study including all patients with pediatric-onset IBD diagnosed in Denmark in the period 1998-2018, resulting in 3,559 patients matched 15 on age, sex, municipality of residence, and time period, resulting in 17,795 reference individuals. We used Cox regression to calculate hazard ratios for each outcome following a diagnosis with IBD. RESULTS: Patients with pediatric-onset IBD had an increased risk of depression (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.26-1.80) and of using antidepressants (HR 1.54, 95% CI 1.39-1.71), and surprisingly a reduced risk of using methylphenidate (HR 0.75, 95% CI 0.58-0.98). Patients with both IBD subtypes (Crohn's diseases [CD] and ulcerative colitis [UC]) had an increased risk of using antidepressants and developing depression, which was particularly high in patients with CD (HR 1.73, 95% CI 1.35-2.22). Patients with UC had reduced risk of using methylphenidate (HR 0.63, 95% CI 0.43-0.93) and a reduced - though not statistically significant - risk of being diagnosed with ADHD compared with the background population. DISCUSSION: Patients with pediatric-onset IBD have a 50% increased risk of developing depression, which is important for health care providers to be aware of and manage. Remarkably, we found a reduced risk of receiving methylphenidate and being diagnosed with ADHD, which merits further investigation.