title: Anxiety and depression in caregivers of individuals with celiac disease - A population-based study.
abstract: OBJECTIVE
  Partner burden is common in celiac disease (CD), but it is unclear if parents of children with CD have increased burden, and if this may translate into depression and anxiety meriting healthcare.
  
  
  METHODS
  Nationwide population-based study of 41,753 parents and spouses ("caregivers") to 29,096 celiac patients and 215,752 caregivers to 144,522 matched controls. Caregivers were identified from the Swedish Total Population Register, and linked to data on psychiatric disease in the National Patient Registry. Hazard ratios (HRs) for depression, anxiety, and (as a reference outcome measure) bipolar disorder were examined in a lifetime fashion but also in temporal relationship to date of CD diagnosis using Cox regression. A priori, we focused on parents of individuals diagnosed ≤19 years of age (children at the age of disease onset) and spouses of individuals diagnosed in adulthood, as such parents and spouses ("high-risk caregivers") were most likely to live together with the patient at time of disease onset.
  
  
  RESULTS
  On Cox analysis, depression was 11% more common in high-risk caregivers (HR=1.11: 95%CI=1.03-1.19) than in control caregivers while anxiety was 7% more common (HR=1.07: 95%CI=0.98-1.16). Combining anxiety and depression into a composite outcome measure, there was an 8% statistically significant risk increase (95%CI=1.02-1.14). The highest excess risks for both depression and anxiety were seen just before and 4-8 years after the CD diagnosis. In contrast, bipolar disorder was not more common in caregivers to CD patients.
  
  
  CONCLUSIONS
  Caregivers to patients with CD may be at increased risk of severe burden.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Abhik
authors.initials: A
authors.lastname: Roy
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lebwohl
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.affiliation: Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Primary Care Research Unit, Vårdcentralen Värmlands Nysäter, Värmland County, Sweden. Electronic address: lojsankik@hotmail.com.
authors.forename: Louise
authors.initials: L
authors.lastname: Emilsson
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D017028:Caregivers / Q000523:psychology*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
keywords: Burden of illness; Caregiver; Celiac; Coeliac; Cohort; Marital relationship; Relative burden