Psychiatric Disorders in Patients With a Diagnosis of Celiac Disease During Childhood From 1973 to 2016
Authors: Benjamin Lebwohl, Linnea Haggård, Louise Emilsson, Jonas Söderling, Bjorn Roelstraete, Agnieszka Butwicka, Peter H.R. Green, Jonas F. Ludvigsson
Journal: Clinical Gastroenterology and Hepatology (2020)

Background & AimsFew studies have explored the link between childhood celiac disease and long-term psychiatric comorbidities. We performed a population-based cohort study of associations between childhood celiac disease and psychiatric disorders and investigated whether risk persists into adulthood.MethodsWe performed a nationwide study in Sweden using data from the Epidemiology Strengthened by histoPathology Reports in Sweden cohort. In this cohort, 19,186 children with a diagnosis of biopsy-verified celiac disease from 1973 through 2016 were identified from Sweden's 28 pathology departments. Each patient was matched with as many as 5 reference children (controls, n = 94,249). Data on psychiatric disorders were obtained from the patient register. We used Cox proportional modeling to estimate hazard ratios (HRs).ResultsDuring a median follow-up period of 12.3 years, 3174 children (16.5%) with celiac disease received a new diagnosis of a psychiatric disorder, compared with 13,286 controls (14.1%). Corresponding incidence rates were 12.2 per 1000 person-years (95% CI, 11.8–12.7) vs 10.3 per 1000 person-years (95% Cl, 10.2–10.5). Childhood celiac disease was associated with a 19% increase in risk of any psychiatric disorder (95% CI, 1.14–1.23); the increase in risk was observed in all childhood age groups. The highest HRs were seen in the first year after celiac diagnosis (HR, 1.70; 95% CI, 1.41–2.05). The risk increase persisted into adulthood (age, >18 y: HR, 1.11; 95% CI, 1.04–1.17). We found increased risks of mood disorders (HR, 1.20; 95% CI, 1.12–1.28), anxiety disorders (HR, 1.12; 95% CI, 1.06–1.19), eating disorders (HR, 1.34; 95% CI, 1.18–1.51), attention deficit hyperactivity disorder (HR, 1.29; 95% CI, 1.20–1.39), and autism spectrum disorder (HR, 1.47; 95% CI, 1.32–1.64). We found no statistically significant risk increase for psychotic disorders, psychoactive substance misuse, behavioral disorders, personality disorders, suicide attempt, or suicide. Celiac disease also was linked to an increased use of psychiatric drugs (HR, 1.34; 95% CI, 1.24–1.43). A conditional logistic regression found that psychiatric disorders also were more common before a diagnosis of celiac disease (odds ratio, 1.56; 95% CI, 1.39–1.76).ConclusionsChildhood celiac disease is associated with an increased risk of subsequent psychiatric disorders, which persists into adulthood. Mental health surveillance should be integral in the care of celiac disease. Few studies have explored the link between childhood celiac disease and long-term psychiatric comorbidities. We performed a population-based cohort study of associations between childhood celiac disease and psychiatric disorders and investigated whether risk persists into adulthood. We performed a nationwide study in Sweden using data from the Epidemiology Strengthened by histoPathology Reports in Sweden cohort. In this cohort, 19,186 children with a diagnosis of biopsy-verified celiac disease from 1973 through 2016 were identified from Sweden's 28 pathology departments. Each patient was matched with as many as 5 reference children (controls, n = 94,249). Data on psychiatric disorders were obtained from the patient register. We used Cox proportional modeling to estimate hazard ratios (HRs). During a median follow-up period of 12.3 years, 3174 children (16.5%) with celiac disease received a new diagnosis of a psychiatric disorder, compared with 13,286 controls (14.1%). Corresponding incidence rates were 12.2 per 1000 person-years (95% CI, 11.8–12.7) vs 10.3 per 1000 person-years (95% Cl, 10.2–10.5). Childhood celiac disease was associated with a 19% increase in risk of any psychiatric disorder (95% CI, 1.14–1.23); the increase in risk was observed in all childhood age groups. The highest HRs were seen in the first year after celiac diagnosis (HR, 1.70; 95% CI, 1.41–2.05). The risk increase persisted into adulthood (age, >18 y: HR, 1.11; 95% CI, 1.04–1.17). We found increased risks of mood disorders (HR, 1.20; 95% CI, 1.12–1.28), anxiety disorders (HR, 1.12; 95% CI, 1.06–1.19), eating disorders (HR, 1.34; 95% CI, 1.18–1.51), attention deficit hyperactivity disorder (HR, 1.29; 95% CI, 1.20–1.39), and autism spectrum disorder (HR, 1.47; 95% CI, 1.32–1.64). We found no statistically significant risk increase for psychotic disorders, psychoactive substance misuse, behavioral disorders, personality disorders, suicide attempt, or suicide. Celiac disease also was linked to an increased use of psychiatric drugs (HR, 1.34; 95% CI, 1.24–1.43). A conditional logistic regression found that psychiatric disorders also were more common before a diagnosis of celiac disease (odds ratio, 1.56; 95% CI, 1.39–1.76). Childhood celiac disease is associated with an increased risk of subsequent psychiatric disorders, which persists into adulthood. Mental health surveillance should be integral in the care of celiac disease.