Adults with inflammatory bowel disease (IBD) have a greater than 10-fold increased risk for suicide, self-harm, and psychiatric and substance use disorders, although the overall self-harm rates are low, according to study results published in Inflammatory Bowel Diseases.

The cross-sectional study used data from the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project to assess the rate, trends, and risk factors for self-harm and suicide among adults with IBD from 2007 to 2017.

Participants were adults (aged >18 years) with an emergency department (ED) visit. Patients with Crohn disease (CD), ulcerative colitis (UC), celiac disease (CeD), psychiatric disorders, suicide, and self-harm were identified using International Classification of Diseases-Ninth and Tenth Revision codes.

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The risk for self-harm was reported as the relative risk (RR) in adults with IBD, with reference to adults who had CeD.

The analysis included 263,108,493 ED patient encounters from 2007 to 2017 — 994,979 with IBD, 86,509 with CeD, and 262,027,005 from the general population. Those who had IBD (median age, 46.0 [IQR, 32.0-62.0] years; P <.001) or CeD (median age, 53.0 years [IQR, 36.0-71.0] years; P <.001) were older vs the general population (median age, 45.0 [IQR, 30.0-62.0] years). Patients with ED encounters frequently had comorbid psychiatric/substance use disorders (IBD, 36.3%/30.2%; celiac disease, 43.0%/15.0%; and general population, 26.4%/14.6%).

Overall, fewer than 1% of all ED visits involved self-harm among adults with IBD (n=3911, 0.39%; average, 355.5/year) and CeD (n=533, 0.39%; average, 48.5/year).

The self-harm methods for patients with IBD and CeD were most commonly poisoning (>80%, including substance overdose) or cutting/piercing (11%-12%). A total of 56 suicide deaths (average, 5.1/year) were reported in adults with IBD and 5 in adults (average 0.5/year) with CeD. The risk for self-harm and suicide in adults with CeD compared with the general population was not statistically significant (RR, 1.0; 95% CI, 0.9-1.1).

IBD diagnosis was associated with an increased risk for suicide when accounting for the increased number of all-cause ED visits in adults with IBD (adjusted RR, 15.9; 95% CI, 13.6-18.3), self-harm (RR, 10.4; 95% CI, 8.1-12.8), substance use (RR, 32.9; 95% CI, 30.5-35.2), and psychiatric disorders (RR, 13.8; 95% CI, 11.4-16.1) compared with CeD. The risk for self-harm was greater for patients with CD vs those with UC (RR, 3.3; 95% CI, 1.2-5.4), although the risk for suicide was not statistically different (RR, 2.3; 95% CI, 0.8-4.5).

Limitations include the retrospective design with potential biases in measurement, misclassification, and unmeasured confounders.

“By identifying the risks for suicidal behavior from over 260 million ED visits from 2007 to 2017 across the United States, this study fills a knowledge gap in our understanding of the mental health and public health impact of IBD while offering an opportunity to inform the development and provision of concomitant psychosocial interventions in IBD care,” the researchers concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.


Tse CS, Weng C-H, Kwon M, et al. Increased risks for suicide, self-harm, substance use, and psychiatric disorders in adults with inflammatory bowel disease: a nationwide study in the United States from 2007 to 2017. Inflamm Bowel Dis. Published online April 7, 2023. doi:10.1093/ibd/izad062

This article originally appeared on Gastroenterology Advisor