Patients with IBD Show Higher Risk of Psychiatric Disorders 

By Irene Yeh 

September 11, 2026 | Evidence suggests that patients with inflammatory bowel disease (IBD), comprising Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), may be more susceptible to psychiatric disorders, such as major depressive disorder and anxiety disorders. The correlation between IBD and psychiatric disorders is still unclear. 

Jiangwei Sun, Ph.D., assistant professor of medical epidemiology and biostatistics at Karolinska Institutet and lead study author, and his team conducted a nationwide cohort study of patients in Sweden who were diagnosed with IBD between 2007 and 2023. They examined occurrences of psychiatric disorders from five years before to 10 years after IBD diagnosis, comparing patients with individuals from the general population and with IBD-free full siblings. Their findings were published in Clinical Gastroenterology and Hepatology (DOI: 10.1016/j.cgh.2026.05.034). 

Psychiatric Risk Before and After Diagnosis 

Each IBD patient was matched with up to five reference individuals from the general population by birth year, sex, and county of residence. The researchers also compared patients with their IBD-free full siblings to assess whether shared genetic or early-life environmental factors might help explain the association. 

In the prediagnostic analysis, the researchers examined 48,230 patients with IBD (14,728 with CD; 28,044 with UC; and 5,458 with IBD-U) and 210,582 matched reference individuals. During a median follow-up of 5.0 years, 8.6% of patients with IBD were diagnosed with a psychiatric disorder before IBD diagnosis, compared with 6.8% of the reference group.  

For the postdiagnostic analysis, there were 43,862 people with IBD (13,282 with CD; 25,714 with UC; and 4,866 with IBD-U) who were compared with 178,821 matched reference individuals. During a median follow-up of 7.4 years, the team found that 7,465 IBD patients were diagnosed with a psychiatric disorder after IBD diagnosis or 16.5% vs. 12.8% in the reference group. The most common disorders were major depressive disorder, anxiety disorders, and substance misuse.  

Substance misuse also showed a significant elevation from pre- to postdiagnostic period. There were hazard ratios of 1.21 (1.05-1.40), 1.14 (1.01–1.30), and 1.09 (1.00–1.20) at -0.5 year, 0.5 year, 10 years, respectively. According to Sun, this is “clinically relevant,” as substances such as cannabis and alcohol have been associated with worse clinical outcomes for CD patients including, for example, increased risk of relapse, corticosteroid and opioid use, emergency department visits, and hospitalization. His team’s study showed that CD patients were exposed to much more opioid treatment — also several years before IBD diagnosis — than the general population. 

“Some individuals with mild psychiatric symptoms or those not seeking health care may have been missed, which would underestimate true absolute risk of psychiatric disorders in IBD patients,” said Sun. 

To capture potentially milder psychiatric symptoms that may not have resulted in specialist care, the researchers examined psychotropic medication use among patients diagnosed with IBD since January 2010, tracking use from five years before IBD diagnosis to five years after. Among these patients, use of psychotropic medications began increasing about one year before IBD diagnosis, peaked around diagnosis, and remained elevated five years afterward. The increase was mainly driven by antidepressants and medications used for anxiety, insomnia, and related symptoms. “Similar temporal pattern of increased use of psychotropic medications implies the impact of an IBD diagnosis may also extend to milder psychiatric disorders.” 

Comparisons between siblings suggested that shared family factors, such as genetics or family environment, did not completely explain the connection between IBD and psychiatric disorders.  

Additionally, patients with IBD were more likely to use antidepressants and medications for anxiety, sleep, and related symptoms both before and after their IBD diagnosis. The increased risk began about 2 to 3 years before IBD diagnosis and remained elevated for up to 10 years afterward. This pattern was similar regardless of IBD type, sex, age, or calendar period and was mainly linked to major depressive disorder, anxiety disorders, and substance misuse. 

Integrating Mental Health into IBD Care 

The researchers said the results reinforce the need to consider mental health as part of routine IBD care. The researchers recommended closer collaboration between gastroenterologists and mental health professionals to identify patients at higher risk and provide early support. Although psychotherapy and medications may help manage short-term anxiety and depressive symptoms, it remains unclear whether these treatments directly improve IBD. The researchers also noted that limited access to mental health care, inadequate evaluation, and stigma may leave some psychiatric conditions undiagnosed, underscoring the need for routine mental health screening and management to be incorporated into IBD treatment and clinical guidelines. 

The study had limitations. Because the study did not include primary care data, some people with mild psychiatric symptoms or those who did not seek health care may have been missed. As a result, the study may underestimate the true absolute risk of psychiatric disorders among people with IBD.  

The researchers also lacked sufficient information to determine whether IBD disease activity or severity influenced psychiatric risk. They did not examine whether IBD medications contributed to psychiatric symptoms, although some treatments, including steroids, have been associated with psychiatric side effects. Further research will be needed to distinguish the effects of IBD itself from those of disease severity and treatment. 

The study also lacked detailed information on lifestyle factors, such as diet, that could have influenced the results. Finally, because the study was observational, the researchers could identify an association between IBD and psychiatric disorders but could not establish that IBD directly causes psychiatric conditions. The findings may also not apply in the same way to countries with different health care systems or rates of IBD and psychiatric disorders. 

What Clinicians Can Do for Patients 

Because the risk of psychiatric disorders may be elevated both before and after an IBD diagnosis, health care providers should be alert to symptoms of depression, anxiety, and substance misuse. Depression and anxiety may complicate IBD management and are associated with poorer outcomes, including flare-ups, treatment escalation, hospitalization, surgery, reduced quality of life, and mortality. The absolute risk of psychiatric disorders at 10 years after diagnosis was highest among those with childhood-onset IBD, those with nine or fewer years of education, those with a history of more health care visits, and those with a parental history of psychiatric disorders. 

Psychotherapy or medications may help manage short-term anxiety and depressive symptoms, although it remains unclear whether these treatments can directly improve IBD outcomes. At the same time, limited access to mental health services, inadequate evaluations, and stigma may prevent some psychiatric conditions from being diagnosed. The researchers recommended closer collaboration between gastroenterologists and mental health professionals to identify patients at higher risk and provide early support. The researchers also called for mental health screening and treatment to become a routine part of IBD care and to be incorporated into clinical guidelines.