title: Risk of Psychiatric Disorders following Irritable Bowel Syndrome: A Nationwide Population-Based Cohort Study.
abstract: BACKGROUND
  Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder observed in patients who visit general practitioners for GI-related complaints. A high prevalence of psychiatric comorbidities, particularly anxiety and depressive disorders, has been reported in patients with IBS. However, a clear temporal relationship between IBS and psychiatric disorders has not been well established.
  
  
  OBJECTIVE
  We explored the relationship between IBS and the subsequent development of psychiatric disorders including schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and sleep disorder.
  
  
  METHODS
  We selected patients who were diagnosed with IBS caused by gastroenteritis, according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort was formed of patients without IBS who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of subsequent new-onset psychiatric disorders were calculated for both cohorts, based on psychiatrist diagnoses.
  
  
  RESULTS
  The IBS cohort consisted of 4689 patients, and the comparison cohort comprised 18756 matched control patients without IBS. The risks of depressive disorder (HR = 2.71, 95% confidence interval [CI] = 2.30-3.19), anxiety disorder (HR = 2.89, 95% CI = 2.42-3.46), sleep disorder (HR = 2.47, 95% CI = 2.02-3.02), and bipolar disorder (HR = 2.44, 95% CI = 1.34-4.46) were higher in the IBS cohort than in the comparison cohort. In addition, the incidence of newly diagnosed depressive disorder, anxiety disorder, and sleep disorder remained significantly increased in all of the stratified follow-up durations (0-1, 1-5, ≥5 y).
  
  
  CONCLUSIONS
  IBS may increase the risk of subsequent depressive disorder, anxiety disorder, sleep disorder, and bipolar disorder. The risk ratios are highest for these disorders within 1 year of IBS diagnosis, but the risk remains statistically significant for more than 5 years. Clinicians should pay particular attention to psychiatric comorbidities in IBS patients.
authors.affiliation: Department of Psychiatry, Taipei Medical University, Shuang-Ho Hospital, New Taipei City, Taiwan.
authors.forename: Yao-Tung
authors.initials: YT
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Hu
authors.affiliation: Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan; Department of information magagement, National Chung-Cheng University, Chiayi, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Shen
authors.affiliation: Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei, Taiwan.
authors.forename: Min-Wei
authors.initials: MW
authors.lastname: Huang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Tsai
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Yang
authors.affiliation: Division of Neurosurgery, Department of surgery, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
authors.forename: Chang-Kuo
authors.initials: CK
authors.lastname: Hu
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Perng
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yi-Shin
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Jeng-Hsiu
authors.initials: JH
authors.lastname: Hung
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D001714:Bipolar Disorder / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D016022:Case-Control Studies; D016208:Databases, Factual; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult