Elsevier

The Journal of Pediatrics

Volume 184, May 2017, Pages 87-93.e1
The Journal of Pediatrics

Original Articles
Celiac Disease Is Associated with Childhood Psychiatric Disorders: A Population-Based Study

https://doi.org/10.1016/j.jpeds.2017.01.043Get rights and content

Objectives

To determine the risk of future childhood psychiatric disorders in celiac disease, assess the association between previous psychiatric disorders and celiac disease in children, and investigate the risk of childhood psychiatric disorders in siblings of celiac disease probands.

Study design

This was a nationwide registry-based matched cohort study in Sweden with 10 903 children (aged <18 years) with celiac disease and 12 710 of their siblings. We assessed the risk of childhood psychiatric disorders (any psychiatric disorder, psychotic disorder, mood disorder, anxiety disorder, eating disorder, psychoactive substance misuse, behavioral disorder, attention-deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], and intellectual disability). HRs of future psychiatric disorders in children with celiac disease and their siblings was estimated by Cox regression. The association between previous diagnosis of a psychiatric disorder and current celiac disease was assessed using logistic regression.

Results

Compared with the general population, children with celiac disease had a 1.4-fold greater risk of future psychiatric disorders. Childhood celiac disease was identified as a risk factor for mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD, and intellectual disability. In addition, a previous diagnosis of a mood, eating, or behavioral disorder was more common before the diagnosis of celiac disease. In contrast, siblings of celiac disease probands were at no increased risk of any of the investigated psychiatric disorders.

Conclusions

Children with celiac disease are at increased risk for most psychiatric disorders, apparently owing to the biological and/or psychological effects of celiac disease.

Section snippets

Methods

Between 2006 and 2008, we contacted Sweden's 28 pathology departments and obtained histological data on individuals who exhibited villous atrophy (Marsh stage 3) in small intestine biopsy specimens analyzed between 1969 and 2008.17 In this study, we equated villous atrophy with celiac disease. Although we did not have data on celiac serology in all individuals with villous atrophy, a review of patient charts revealed that in a random sample of 81 individuals with available serologic data, 71

Results

We identified 10 903 children with celiac disease and 12 710 siblings without celiac disease. The median age at the time of biopsy was 3.0 years (IQR, 1.3-8.9 years), and almost two-thirds of the patients were females. Descriptive variables differed slightly between the groups, with the most marked differences in parental age and country of birth (Table III). The median duration of follow-up was 9.6 years (IQR, 5.3-15.6 years) for the children with celiac disease and 17.9 years (IQR, 12.8-18.0

Discussion

In this nationwide Swedish cohort study of 10 903 children with celiac disease, we found a 1.4-fold increased risk of the subsequent development of psychiatric disorders, including mood, anxiety, eating, and behavioral disorders, as well as of neuropsychiatric disorders, including ADHD, ASD, and intellectual disability. In contrast, the only significant association between celiac disease and the later development of psychiatric disorders was seen for eating and behavioral disorders. Mood

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  • Cited by (0)

    Supported by the Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social and Medical Sciences framework (340-2013-5867). A.B. received grants from the Polish Ministry of Science and Higher Education (903/MOB/2012/0 and IP2012 006972). L.F. received financial support from the Swedish Research Council (523-2011-3807), the Karolinska Institute Foundation, and the Magnus Bergvall Foundation. J.L. was supported by grants from the Swedish Research Council (522-2009-1951), the Swedish Society of Medicine, and the Swedish Celiac Society. H.L. has served as a speaker for Eli-Lilly and Shire and has received a research grant from Shire; all outside the submitted work. P.L. has served as a speaker for Medice. The other authors declare no conflicts of interest.

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