Celiac Disease Carries Persistent Risk for Psychological Disorders
By Van Waffle
Celiac disease increases risk for psychological disorders long after diagnosis and treatment. While the link is well-known, a new study from Columbia University is the first to follow the trail for many years and show that people diagnosed with celiac disease in childhood are more likely to experience psychological conditions well into adulthood.
The risk for a psychological disorder is 1.7 times higher for children with celiac disease than for those in the general population. This declines to 1.1 in adulthood. The findings suggest healthcare providers should monitor for psychological distress as part of standard follow-up in celiac patients.
"Certain psychiatric disorders are more common in people with celiac disease than in the general population," stated Benjamin Lebwohl, MD.
“While we’ve known for some time that certain psychiatric disorders are more common in people with celiac disease than in the general population, most of those studies either only looked at just one psychiatric disorder at a time, or looked only in the relatively short term among patients with recently diagnosed celiac disease,” says lead researcher Benjamin Lebwohl, MD, Director of Clinical Research, Celiac Disease Center at Columbia University, New York. This study is important because it considers, “a whole variety of different psychiatric disorders that might develop.”
Secondly, there are long-term implications of being diagnosed with celiac disease in childhood, and this study was able to quantify them, Lebwohl says.
“Specifically we found increased risks of mood and anxiety disorders, which is important, because those are the two most common psychiatric disorders: depression and anxiety. We also found an increased risk of eating disorders, and an increased risk of attention deficit hyperactivity disorder (ADHD),” Lebwohl explains. “In terms of long-term risks, the two that popped out, that appear to persist, are mood disorders such as depression, and ADHD. Both of those are diagnoses that are still increased in adults who have a remote childhood diagnosis of celiac disease.”
Shayna Coburn, Ph.D., psychologist in the Division of Gastroenterology, Hepatology and Nutrition at Children’s National Hospital, who did not work on this research, says the evidence found in this study is significant because it uses a large sample from a population database. A large database allowed the authors to “detect even small but reliable differences between groups of people and confidently draw conclusions.”
The data came from a Swedish nationwide cohort of 19,186 children diagnosed with celiac disease between 1973 and 2016. Over a median follow-up time of 12 years, 16.5 percent were also diagnosed with a psychiatric disorder, compared to 14.1 percent of children in the general population.
A weakness of the study is that it cannot rule out surveillance bias, meaning people being treated for one condition are more likely to receive an additional diagnosis. The greatest risk of psychiatric disorders tended to be in the near term, in the first year after diagnosis of celiac disease, Lebwohl says. This is likely the period of time when children are under most intensive investigation. However, surveillance bias is less likely to appear in long-term effects. The fact that adults with a childhood diagnosis of celiac still showed a signal of psychiatric disorders indicates the increased risk is real.
It is difficult to know whether the observed psychological conditions are entirely relevant to children diagnosed with celiac disease now.
Coburn points to a drawback in research spanning a long timeframe, because the experience of people with celiac disease may have changed over the duration of the study. Since 1973 the process of diagnosing both celiac disease and psychiatric disorders has shifted, awareness of both has increased, and availability of gluten-free foods has improved substantially. This makes it difficult to know whether the observed psychological conditions are entirely relevant to children diagnosed with celiac disease now.
However, Coburn says this study, “raises questions about whether the first year after diagnosis might be a particularly vulnerable time for a child’s well-being,” so future research should explore the mechanisms underlying these risks, “and design behavioral treatments to improve the mental health of children with celiac disease.”