Children with inflammatory bowel disease (IBD) aren't just dealing with its physiological effects that include persistent diarrhea, abdominal pain, weight loss, and fatigue. New research published in JAMA Pediatrics found that children with IBD also have a greater risk of developing a number of psychiatric disorders, including attempted suicide.
The study recommends long-term psychological support for children with IBD, and for their parents, too. "In children, IBD has an even more severe course," the researchers wrote. This IBD-mental disorders connection isn't news for adults, as reported previously in the medical literature.
Study Followed Crohn's Disease and Ulcerative Colitis
The research team at Karolinska Institutet in Stockholm followed 6,464 children with IBD who were born between 1973 and 2013. Since IBD is a term for two conditions—Crohn's disease and ulcerative colitis—the total participant group included 2,536 with Crohn's disease and 3,228 with ulcerative colitis, and 700 children were "unclassified" in terms of their disease. The disease, according to the Centers for Disease Control and Prevention, is probably caused by a defective immune system, but could also include a genetic component, when someone else in the family also has IBD.
As the medical university team explained in a statement, they compared the risk of kids with IBD developing psychiatric disorders later in life with that of both healthy children from the general population and the patients' siblings. That close look at siblings enabled a more precise examination of "confounders," the authors said, listing socioeconomics, lifestyle, and heredity that have previously proven to influence risk of mental disorders in kids. The researchers said it's likely that IBD affects children's mental health instead of those confounding factors.
First Year With IBD Is Critical
The first year with IBD for a child was the time they'd most likely develop a mental health problem, the authors said, especially if their diagnosis occurred before they turned 6 years old. Having a parent with a psychiatric disorder also increased risk.
The follow-up period was nine years for this observational study, meaning participants were observed or certain outcomes were measured without an attempt to affect that outcome. At that time, approximately 17% of IBD children received a psychiatric diagnosis, while less than 12% of healthy kids and approximately 10% of siblings received the same diagnosis. The authors said that higher risk group at 17% had psychiatric diagnoses like depression, anxiety, eating disorders and personality disorders, ADHD, and autism spectrum disorder. Suicide risk increased after adulthood.
Authors of the editorial comment cited the "rigorous design" of the study, and called the statistical analysis "stellar." They said this is the "best data" available on the intersection of pediatric IBD and mental health. In terms of what's next, they also suggested a revision of guidelines and allocation of resources for widespread screening and treatment.
IBD Increasing in Kids
An earlier 2016 report, also in JAMA Pediatrics, said incidences of pediatric IBD are approximately 10 per 100,000 children in the United States and Canada—with numbers on the upswing.
As the Nemours Children's Health System explains, kids don't outgrow IBD, but they can sometimes go without symptoms for years during periods of remission. Symptoms can often return as a flare or relapse. When they do have symptoms or have to go to medical appointments, they can miss school, also missing valuable social interactions and extracurricular activities they enjoy.
More recent research and the earlier JAMA report say growth failure is the most common "external" manifestation of IBD in kids, especially with Crohn's disease. As to why it occurs, reasons include inflammation, reduced nutrient intake and the inability to absorb and digest important nutrients, use of glucocorticoid medications to stop that inflammation, delayed puberty, and decreased physical activity.
That 2016 JAMA paper concludes that with good, commonsense recommendations, treatment goals for children should eliminate symptoms, restore normal growth, and ultimately prevent any surgical complications down the line.
What You Can Do to Help on the Mental Health Side
The Centers for Disease Control and Prevention says that ADHD, behavior problems, anxiety, and depression are the most common mental disorders in kids. If you suspect your child is having mental health problems, your intuition is probably right. The National Institute of Mental Health recommends taking these initial steps:
- Talk to your child's teacher and ask for reports of the child's behavior in different situations.
- Talk to your child's pediatrician and explain what you know and what others may have shared with you.
- Ask for a referral to a mental health professional who works with children.
Your child's treatment options might include:
- Psychotherapy or talk therapy which might include your participation as a parent
- Medications, which might be used alone or with psychotherapy
- Family counseling that includes other family members who weigh in on the best ways to help
- Parental support, when you meet with a therapist and other parents who also want to help their children
A user-friendly, comprehensive list of other support resources especially for parents is available from the Crohn's & Colitis Foundation.