This nationwide Swedish cohort study (2007–2023) examined the temporal pattern of psychiatric disorder risk in 43,862 IBD patients compared with 178,821 matched population controls and IBD-free full siblings, spanning 5 years before to 10 years after IBD diagnosis.
Psychiatric disorder risk rose 2–3 years before IBD diagnosis (HR 1.15 at −2 years), peaked at 0.5 years post-diagnosis (HR 1.50, 95% CI 1.41–1.59), and remained elevated at 10 years (HR 1.19, 95% CI 1.13–1.24); major depression, anxiety, and substance misuse drove most of the excess risk, and the sibling-controlled analysis confirmed the risk is not fully explained by shared familial factors.
Psychiatric diagnoses rely on registry data (specialist/inpatient contacts), likely underestimating milder cases managed in primary care. The study is observational and cannot establish causation. Residual confounding from unmeasured environmental factors cannot be excluded despite the sibling-controlled design.
Screen IBD patients for depression, anxiety, and substance misuse starting at diagnosis and continue monitoring for at least 10 years. Because risk also rises 2–3 years *before* IBD is confirmed, clinicians evaluating new GI symptoms should consider early psychiatric co-assessment.
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