Irritable bowel syndrome and suicide risk among adolescents: a prospective cohort study.
Adolescent suicide is a global public health concern. Emerging evidence from the gut-brain axis and interoception framework suggests links between functional gastrointestinal disorders, visceral bodily signals, and mental health vulnerability. However, evidence on the association between irritable bowel syndrome (IBS) and adolescent suicidality remains scant. This study aimed to examine the longitudinal associations of IBS with suicide risk and attempts among Chinese adolescents.
Data were drawn from a school-based prospective cohort study with citywide census-style recruitment in Southern China. IBS, demographic, behavioural, and emotional symptom measures were assessed, along with two suicidality outcomes: overall suicide risk and past-12-month suicide attempts as a behavioural indicator. Mixed-effects multivariable logistic regression was used to examine the associations between baseline IBS and follow-up suicidality. Subgroup analyses (sex, age group, residential area, only-child status, and subjective SES) tested the robustness of these associations. Alternative indirect pathways linking IBS, depressive and anxiety symptoms, and suicidality outcomes were examined.
The analytic sample comprised 92,120 adolescents with matched baseline and 12-month follow-up data (46,852 [50.9%] females, M = 13.27 years, SD = 1.99). IBS prevalence was 7.0% (n = 6435). Suicide risk and suicide attempts had incidence rates of 6.1% (n = 4454) and 3.5% (n = 3035), respectively. IBS was prospectively associated with increased suicide risk (OR [95% CI] = 2.33 [2.18, 2.49], p < 0.0001) and attempts (OR [95% CI] = 2.17 [1.93, 2.44], p < 0.0001). These associations remained significant after adjustment for demographic, behavioural, emotional symptom, and baseline suicidality covariates (suicide risk: aOR [95% CI] = 1.27 [1.18, 1.37], p < 0.0001; suicide attempts: aOR [95% CI] = 1.21 [1.06, 1.38], p = 0.0060). Depressive and anxiety symptoms partially mediated these associations.
IBS was prospectively associated with adolescents' elevated risk of suicidality. IBS may serve as a meaningful marker of suicide risk, potentially reflecting altered gut-brain and interoceptive processes, and underscoring the need to integrate mental health screening with gastrointestinal care for early suicide identification and prevention.
Research fund of Vanke School of Public Health, Tsinghua University.
Data were drawn from a school-based prospective cohort study with citywide census-style recruitment in Southern China. IBS, demographic, behavioural, and emotional symptom measures were assessed, along with two suicidality outcomes: overall suicide risk and past-12-month suicide attempts as a behavioural indicator. Mixed-effects multivariable logistic regression was used to examine the associations between baseline IBS and follow-up suicidality. Subgroup analyses (sex, age group, residential area, only-child status, and subjective SES) tested the robustness of these associations. Alternative indirect pathways linking IBS, depressive and anxiety symptoms, and suicidality outcomes were examined.
The analytic sample comprised 92,120 adolescents with matched baseline and 12-month follow-up data (46,852 [50.9%] females, M = 13.27 years, SD = 1.99). IBS prevalence was 7.0% (n = 6435). Suicide risk and suicide attempts had incidence rates of 6.1% (n = 4454) and 3.5% (n = 3035), respectively. IBS was prospectively associated with increased suicide risk (OR [95% CI] = 2.33 [2.18, 2.49], p < 0.0001) and attempts (OR [95% CI] = 2.17 [1.93, 2.44], p < 0.0001). These associations remained significant after adjustment for demographic, behavioural, emotional symptom, and baseline suicidality covariates (suicide risk: aOR [95% CI] = 1.27 [1.18, 1.37], p < 0.0001; suicide attempts: aOR [95% CI] = 1.21 [1.06, 1.38], p = 0.0060). Depressive and anxiety symptoms partially mediated these associations.
IBS was prospectively associated with adolescents' elevated risk of suicidality. IBS may serve as a meaningful marker of suicide risk, potentially reflecting altered gut-brain and interoceptive processes, and underscoring the need to integrate mental health screening with gastrointestinal care for early suicide identification and prevention.
Research fund of Vanke School of Public Health, Tsinghua University.