Marrie Ruth Ann, Walld Randy, Bolton James M, Sareen Jitender, Walker John R, Patten Scott B, Singer Alexander, Lix Lisa M, Hitchon Carol A, El-Gabalawy Renée, Katz Alan, Fisk John D, Bernstein Charles N
Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
J Psychosom Res. 2017 Oct;101:17-23. doi: 10.1016/j.jpsychores.2017.07.015. Epub 2017 Aug 1.
Although psychiatric comorbidity is known to be more prevalent in immune-mediated inflammatory diseases (IMID) than in the general population, the incidence of psychiatric comorbidity in IMID is less understood, yet incidence is more relevant for understanding etiology.
Using population-based administrative (health) data, we conducted a retrospective cohort study over the period 1989-2012 in Manitoba, Canada. We identified 19,572 incident cases of IMID including 6119 persons with inflammatory bowel disease (IBD), 3514 persons with multiple sclerosis (MS), 10,206 persons with rheumatoid arthritis (RA), and 97,727 age-, sex- and geographically-matched controls. After applying validated case definitions, we estimated the incidence of depression, anxiety disorder, bipolar disorder and schizophrenia in each of the study cohorts. Using negative binomial regression models, we tested whether the incidence rate of psychiatric comorbidity was elevated in the individual and combined IMID cohorts versus the matched cohorts, adjusting for sex, age, region of residence, socioeconomic status and year.
The relative incidence of depression (incidence rate ratio [IRR] 1.71; 95%CI: 1.64-1.79), anxiety (IRR 1.34; 95%CI: 1.29-1.40), bipolar disorder (IRR 1.68; 95%CI: 1.52-1.85) and schizophrenia (IRR 1.32; 95%CI: 1.03-1.69) were elevated in the IMID cohort. Depression and anxiety affected the MS population more often than the IBD and RA populations.
Individuals with IMID, including IBD, MS and RA are at increased risk of psychiatric comorbidity. This increased risk appears non-specific as it is seen for all three IMIDs and for all psychiatric disorders studied, implying a common underlying biology for psychiatric comorbidity in those with IMID.
尽管已知精神疾病共病在免疫介导的炎症性疾病（IMID）中比在普通人群中更为普遍，但IMID中精神疾病共病的发病率仍了解较少，然而发病率对于理解病因更为重要。
利用基于人群的行政（健康）数据，我们于1989年至2012年期间在加拿大曼尼托巴省进行了一项回顾性队列研究。我们确定了19572例IMID发病病例，包括6119例炎症性肠病（IBD）患者、3514例多发性硬化症（MS）患者、10206例类风湿性关节炎（RA）患者以及97727例年龄、性别和地理位置匹配的对照。应用经过验证的病例定义后，我们估计了每个研究队列中抑郁症、焦虑症、双相情感障碍和精神分裂症的发病率。使用负二项回归模型，我们测试了IMID个体队列和合并队列中精神疾病共病的发病率是否高于匹配队列，并对性别、年龄、居住地区、社会经济地位和年份进行了调整。
IMID队列中抑郁症（发病率比[IRR]1.71；95%CI：1.64 - 1.79）、焦虑症（IRR 1.34；95%CI：1.29 - 1.40）、双相情感障碍（IRR 1.68；95%CI：1.52 - 1.85）和精神分裂症（IRR 1.32；95%CI：1.03 - 1.69）的相对发病率均有所升高。抑郁症和焦虑症对MS人群的影响比对IBD和RA人群更常见。
患有IMID（包括IBD、MS和RA）的个体患精神疾病共病的风险增加。这种风险增加似乎是非特异性的，因为在所有三种IMID以及所研究的所有精神疾病中均可见，这意味着IMID患者精神疾病共病存在共同的潜在生物学机制。
