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Rising incidence of psychiatric disorders before diagnosis of immune-mediated inflammatory disease

  • R. A. Marrie (a1) (a2), R. Walld (a3), J. M. Bolton (a4), J. Sareen (a4), J. R. Walker (a5), S. B. Patten (a6), A. Singer (a7), L. M. Lix (a2), C. A. Hitchon (a1), R. El-Gabalawy (a5) (a8), A. Katz (a2) (a3) (a7), J. D. Fisk (a9), C. N. Bernstein (a1) and for the CIHR Team in Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease (a1) (a2) (a3) (a4) (a5) (a6) (a7) (a8) (a9)...

Abstract

Aims.

After the diagnosis of immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA), the incidence of psychiatric comorbidity is increased relative to the general population. We aimed to determine whether the incidence of psychiatric disorders is increased in the 5 years before the diagnosis of IMID as compared with the general population.

Methods.

Using population-based administrative health data from the Canadian province of Manitoba, we identified all persons with incident IBD, MS and RA between 1989 and 2012, and cohorts from the general population matched 5 : 1 on year of birth, sex and region to each disease cohort. We identified members of these groups with at least 5 years of residency before and after the IMID diagnosis date. We applied validated algorithms for depression, anxiety disorders, bipolar disorder, schizophrenia, and any psychiatric disorder to determine the annual incidence of these conditions in the 5-year periods before and after the diagnosis year.

Results.

We identified 12 141 incident cases of IMID (3766 IBD, 2190 MS, 6350 RA) and 65 424 matched individuals. As early as 5 years before diagnosis, the incidence of depression [incidence rate ratio (IRR) 1.54; 95% CI 1.30–1.84) and anxiety disorders (IRR 1.30; 95% CI 1.12–1.51) were elevated in the IMID cohort as compared with the matched cohort. Similar results were obtained for each of the IBD, MS and RA cohorts. The incidence of bipolar disorder was elevated beginning 3 years before IMID diagnosis (IRR 1.63; 95% CI 1.10–2.40).

Conclusion.

The incidence of psychiatric comorbidity is elevated in the IMID population as compared with a matched population as early as 5 years before diagnosis. Future studies should elucidate whether this reflects shared risk factors for psychiatric disorders and IMID, a shared final common inflammatory pathway or other aetiology.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Address for correspondence: R. A. Marrie, Health Sciences Center, GF-543, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada. (Email: rmarrie@hsc.mb.ca)

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Rising incidence of psychiatric disorders before diagnosis of immune-mediated inflammatory disease

  • R. A. Marrie (a1) (a2), R. Walld (a3), J. M. Bolton (a4), J. Sareen (a4), J. R. Walker (a5), S. B. Patten (a6), A. Singer (a7), L. M. Lix (a2), C. A. Hitchon (a1), R. El-Gabalawy (a5) (a8), A. Katz (a2) (a3) (a7), J. D. Fisk (a9), C. N. Bernstein (a1) and for the CIHR Team in Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immunoinflammatory Disease (a1) (a2) (a3) (a4) (a5) (a6) (a7) (a8) (a9)...

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