Zylberberg Haley M, Demmer Ryan T, Murray Joseph A, Green Peter H R, Lebwohl Benjamin
aDepartment of Medicine, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons bDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York cDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Eur J Gastroenterol Hepatol. 2017 Sep;29(9):1091-1096. doi: 10.1097/MEG.0000000000000932.
There is uncertainty regarding the prevalence of psychiatric illnesses in patients with celiac disease (CD) and people who avoid gluten (PWAG) without a diagnosis of CD.
We obtained data from 22 274 participants from the 2009-2014 National Health and Nutrition Examination Survey to compare the prevalence of depression, insomnia, quality-of-life variables, and psychotropic medication use in CD participants and PWAGs to controls. We used multivariable logistic regression to assess for independent associations between CD/PWAG status and the outcomes of these variables.
Depression was present in 8.2% of controls compared with 3.9% of participants with CD (P=0.18) and 2.9% of PWAGs (P=0.002). After adjustment for age, sex, race, income, and access to healthcare, PWAGs maintained lower odds of depression compared with controls (odds ratio=0.25; 95% confidence interval: 0.12-0.51; P=0.0001). The prevalence estimates of sleep difficulty among controls (27.3%) compared to participants with CD or PWAGs were 37.7% (P=0.15) and 34.1% (P=0.11). Those with diagnosed CD had increased odds of sleep difficulty (odds ratio=2.41; 95% confidence interval 1.04-5.60), but this was no longer significant after multivariable adjustment (P=0.17).
Among a nationally representative US sample, participants with CD overall showed no increased odds of depression or sleep difficulty. PWAGs showed lower odds of depression compared with controls. Future research should investigate the relationship between a diagnosis of CD and the development of psychiatric conditions.
乳糜泻（CD）患者以及无CD诊断但避免食用麸质的人群（PWAG）中精神疾病的患病率尚不确定。
我们从2009 - 2014年国家健康与营养检查调查的22274名参与者中获取数据，以比较CD参与者、PWAG与对照组中抑郁症、失眠、生活质量变量以及精神药物使用情况的患病率。我们使用多变量逻辑回归来评估CD/PWAG状态与这些变量结果之间的独立关联。
对照组中有8.2%的人患有抑郁症，而CD参与者中这一比例为3.9%（P = 0.18），PWAG中为2.9%（P = 0.002）。在对年龄、性别、种族、收入和医疗保健可及性进行调整后，与对照组相比，PWAG患抑郁症的几率更低（优势比 = 0.25；95%置信区间：0.12 - 0.51；P = 0.0001）。对照组中睡眠困难的患病率估计为27.3%，而CD参与者或PWAG中的患病率分别为37.7%（P = 0.15）和34.1%（P = 0.11）。被诊断为CD的人睡眠困难的几率增加（优势比 = 2.41；95%置信区间1.04 - 5.60），但在多变量调整后这一结果不再显著（P = 0.17）。
在具有全国代表性的美国样本中，总体而言，CD参与者患抑郁症或睡眠困难的几率没有增加。与对照组相比，PWAG患抑郁症的几率更低。未来的研究应调查CD诊断与精神疾病发展之间的关系。
