P822 The negative impact of mental health comorbidity in children and young adults with inflammatory bowel disease: a UK population-based cohort study
Cooney , R.(1);Barrett, K.(2);Russell, R.K.(3)*;
(1)University Hospitals Birmingham NHS Foundation Trust, GI Medicine, Birmingham, United Kingdom;(2)New Road Surgery, 166 New Road- Croxley Green-, Rickmansworth, United Kingdom;(3)Royal Hospital for Children & Young People, Department of Paediatrics and Gastroenterology, Edinburgh, United Kingdom;
Background
Whilst the high burden of mental health comorbidity in people with inflammatory bowel disease (IBD) is now being recognised, less is known about the additional impacts of having concurrent IBD and a mental health condition, especially in children and young adults.
Methods
We conducted a retrospective, observational study using a large UK primary care dataset (Optimum Patient Care Research Database). Children and young adults (aged 5-25 years) diagnosed with IBD prior to 2015 were identified and grouped into those with and without prevalent mental health conditions (any of depression, anxiety, eating disorders, body image disorder, attention-deficit disorder, behavioural disorders, adjustment disorder, acute stress disorder, schizophrenia, bipolar disorder or post-traumatic stress disorder). The following outcomes were compared over 5 years in the two groups; quality-of-life indicators (bowel symptoms [abdominal pain, discomfort or bloating, diarrhoea], systemic symptoms [fatigue, sleep problems, weight-loss, underweight, growth retardation], emotional function [low mood, substance abuse, deliberate self-harm, suicidal attempt or parasuicide] and social function [absence from school, absence from work, unemployment]), IBD-specific therapy interventions (diet [nutritional supplements], medications [oral and rectal 5-aminosalicylic acid and steroids, antimetabolites and tumour necrosis factor inhibitors] and surgery [abdominal and stoma formation]), and healthcare utilisation (primary care interactions and hospital admissions). Adjustment for confounders was performed using Cox regression for non-recurring outcomes (e.g. stoma formation), and negative binomial or Poisson regression for outcomes with recurring events (e.g. primary care interactions).
Results
1,943 individuals with IBD were identified. 295 of these had a prevalent mental health condition. Mental health comorbidity was associated with increased bowel symptoms (adjusted Incident Rate Ratio [aIRR] 1.82; 95% Confidence Interval [CI] 1.33, 2.52), sleep disturbance (adjusted Hazard Ratio [aHR] 1.63; 95% CI 1.02, 2.62), substance abuse (aHR 3.63; 95% CI 1.69, 7.78), primary care interactions (aIRR 1.33; 95% CI 1.12, 1.58) and hospital admissions (aIRR 1.87; 95% CI 1.29, 2.75) (Figure 1). In those >18 years old, mental health comorbidity was associated with increased time off work (aHR 1.55; 95% CI 1.21, 1.99) (Figure 1).
Conclusion
Mental health comorbidity in children and young adults with IBD is associated with increased IBD symptoms, healthcare utilisation and time off work. Given the impact of mental health comorbidity, it is crucial those affected are monitored and receive appropriate mental health support as part of their multidisciplinary care.