Systematic review: psychological morbidity in young people with inflammatory bowel disease – risk factors and impacts

Summary Background Psychological morbidity in young people aged 10–24 years, with inflammatory bowel disease (IBD) is increased, but risk factors for and impacts of this are unclear. Aim To undertake a systematic literature review of the risk factors for and impact of psychological morbidity in young people with IBD. Methods Electronic searches for English‐language articles were performed with keywords relating to psychological morbidity according to DSM‐IV and subsequent criteria; young people; and IBD in the MEDLINE, PsychInfo, Web of Science and CINAHL databases for studies published from 1994 to September 2014. Results One thousand four hundred and forty‐four studies were identified, of which 30 met the inclusion criteria. The majority measured depression and anxiety symptoms, with a small proportion examining externalising behaviours. Identifiable risk factors for psychological morbidity included: increased disease severity ( r 2 = 0.152, P < 0.001), lower socioeconomic status ( r 2 = 0.046, P < 0.001), corticosteroids ( P ≤ 0.001), parental stress ( r = 0.35, P < 0.001) and older age at diagnosis ( r = 0.28, P = 0.0006). Impacts of psychological morbidity in young people with IBD were wide‐ranging and included abdominal pain ( r = 0.33; P < 0.001), sleep dysfunction ( P < 0.05), psychotropic drug use (HR 4.16, 95% CI 2.76–6.27), non‐adherence to medication (12.6% reduction) and negative illness perceptions ( r = −0.43). Conclusions Psychological morbidity affects young people with IBD in a range of ways, highlighting the need for psychological interventions to improve outcomes. Identified risk factors provide an opportunity to develop targeted therapies for a vulnerable group. Further research is required to examine groups under‐represented in this review, such as those with severe IBD and those from ethnic minorities.