Increased suicide risk in coeliac disease-A Swedish nationwide cohort study

Background and aim: Individuals with coeliac disease have increased risk of depression and death from external causes, but conclusive studies on death from suicide are missing. We examined the risk of suicide in coeliac disease and amongst individuals where the small intestinal biopsy showed no villous atrophy. Methods: We collected biopsy data from all 28 clinical pathology departments in Sweden for individuals diagnosed during 1969-2007 with coeliac disease (Marsh 3: villous atrophy; n = 29,083 unique individuals), inflammation without villous atrophy (Marsh 1-2; n = 13,263) or positive coeliac disease serology but normal mucosa (Marsh 0, n = 3719). Through Cox regression we calculated Hazard ratios for suicide as recorded in the Swedish Cause of Death Register. Results: The risk for suicide was higher in patients with coeliac disease compared to general population controls (HR = 1.55; 95%Cl = 1.15-2.10; based on 54 completed suicides). Whilst suicide was also more common amongst individuals with inflammation (HR = 1.96; 95%Cl = 1.39-2.77), no such increase was seen amongst individuals with a normal mucosa but positive coeliac disease serology (HR = 1.06; 95%Cl = 0.37-3.02). Conclusions: We found a moderately increased risk of suicide amongst patients with coeliac disease. This merits increased attention amongst physicians treating these patients. (C) 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.