Swedish Population Study Links Celiac Disease With Higher Risk of Psychiatric Disorders

Researchers in Sweden have found that children diagnosed with celiac disease have a 19% higher risk of receiving a psychiatric diagnosis as adults, especially for eating and mood disorders, attention-deficit hyperactivity disorder (ADHD), and autism.

Findings appeared this week in the journal Clinical Gastroenterology and Hepatology.

The new study used data from the ESPRESSO cohort, a database of health records from more than 19,000 children in Sweden created from 2015 to 2017 to study gastrointestinal illnesses. Data from 1973 through 2016 was culled from 28 sites, and researchers matched each patient with up to five reference controls.

Over a median follow-up time of 12.3 years, 3174 children (16.5%) who had celiac disease were diagnosed with a psychiatric disorder, compared with 14.1% of the patients in the control group. Corresponding incidence rates of psychiatric disorders were also higher among the children with celiac disease.

A person with celiac disease has an immune reaction to eating gluten, a common protein found in wheat, barley, and rye. Gluten triggers inflammation in the small intestine lining, causing bloating, gas, fatigue, and diarrhea; over time, the person is unable to absorb nutrients, and some may experience osteoporosis. Dietary changes to avoid gluten are recommended.

The greatest risk of a psychiatric diagnosis appeared in the first year after celiac diagnosis (HR, 1.70; 95% CI, 1.41-2.05). But the risk remained as children reached adulthood, and the authors reported the celiac patients were at particularly high risk of certain disorders:

• Mood disorders (hazard ratio [HR],1.20; 95% CI, 1.12-1.28)
• Eating disorders (HR, 1.34; 95% CI, 1.18-1.51)
• ADHD (HR, 1.29; 95% CI, 1.20-1.39)
• Autism spectrum disorder (HR, 1.47; 95% CI, 1.32-1.64)

There was significant link between celiac disease and psychotic disorders, personality disorders, behavioral disorders, or suicide. Researchers did find that childhood celiac disease was associated with a greater likelihood to use psychiatric drugs in adulthood.

Researchers evaluated records to study only children with celiac disease who also had siblings, and the siblings without celiac disease had no higher risk of psychiatric disorders than the general population. Also, the team evaluated children diagnosed with a psychiatric disorder before the diagnosis with celiac disease; they concluded that while the stress of following a gluten-free diet might account for some level of depression or anxiety, it did not fully account for their findings.

This is consistent with a smaller study published in May found increased levels of depression and anxiety among 50 children newly diagnosed with celiac disease—as well as their parents—compared with a control group.

Due to their findings, authors of the Swedish study wrote, “Mental health surveillance should be integral in the care of celiac disease.”