The mental health of celiac patients and their families

Byström and others in 2012 presented a crosssectional study with consecutive selection. A study aimed at examining how children and adolescents with celiac disease who followed a gluten-free diet assessed their health-related quality of life, and whether age and severity of disease initially affected the self-evaluation of children later in life. The study included 160 families who had a person with celiac disease, as it was found that parents rated their children's quality of life as lower than other children, but the result differed from the children's point of view as children who were diagnosed before the age of five years scored higher than children who were diagnosed after this age, and children who were diagnosed more than eight years ago, they scored higher than newly diagnosed children, and children who first showed classic symptoms of the disease scored higher than those who had atypical or no symptoms did not, and the age or gender of the patients did not affect the outcome [13].

Children who suffer from Celiac Disease and their families are common to have mental disorders, confirmed by the results reached by Coburn and others in 2020 through a study they conducted with 73 parents, mostly women of children with Celiac Disease between the ages of 3 and 18 years attending a clinic Multidisciplinary Celiac Disease Study data were collected and managed using REDCap tools to capture electronic data, mental and physical health history of children were taken, psychosocial experiences of children and parents, the result was 34% of children with celiac disease had a mental health disorder (MHD) such as anxiety disorders (16%) and attention deficit / hyperactivity disorder (ADHD; 16%). While the result of the parents was a quarter of parents having psychosocial distress for children present (28% - 39%). Almost half of them had parental stress (51%) and the financial burden (46%) associated with GFD. But MHD, stress, and financial burden did not differ over time since the celiac disease diagnosis, Children with MHD were more anxious, angry, general distress, and parental distress than those without MHD.

In another study Stojanović and others in 2019 presented to assess the level of health-related quality of life (QoL) and the presence of symptoms of anxiety and depression in Serbian children with celiac disease from the perspective of patients and their parents, the study included 116 children and adolescents between the ages of 5 and 18 years who were diagnosed with a CD and one parent for each child 76 % Of mothers and 24% of fathers The PedsQL questionnaire was filled out by the children and their parents, and there was no significant difference between the mean values of children and parents in the total PedsQL scores in addition to the individual measures (physical, emotional, social, school and psychosocial) and through the SCARED questionnaire. It indicated the presence of anxiety in 34.5% of children and 23.3% of parents. Using the MFQ questionnaire, which indicates depression, it was found that 32.8% of children had depression and 41.4% of parents [14].

Similarly, Celiac Disease patients at diagnosis and their parents suffer from psychological problems, including anxiety and depression, more than others, according to a Prospective study presented by Giannakopoulos and others in 2020 that aimed to estimate levels of mental health problems in children with celiac disease (CD) along with The mental health status of their parents, and to compare these levels with those in healthy controls and to check how these problems are affected by celiac disease. A gluten-free diet (GFD) and the study sample of three groups, the first group had 50 patients with CD at diagnosis before starting GFD (age 8.6 ± 3.7 years), and the second group had 39 patients with a CD on GFD for at least 12 months (age 10.4 ± 3.4 years) and the third group had 38 healthy controls (age 7.7 ± 3.8 years,), as well as their parents. One parent of each child completed the Child Behavior Checklist (CBCL) and Symptom Checklist 90 (SCL-90-R) to assess the child and parental mental health problems, respectively. At least 12 months after starting GFD for the first group, twenty patients were re-evaluated and the results were that the parents had mental health problems such as anxiety and depression compared to the parents of healthy controls (0.72 ± 0.49 versus 0.54 ± 0.58, P = 0.013). CD patients scores higher in CBCL are regarding absorption problems than healthy controls (55.7 ± 10.3 versus 47.9 ± 15.4, P = 0.007) [15].

In contrast, levels of depression and anxiety in children with celiac disease and their parents did not differ even after following a gluten-free diet, which was presented by Esenyel and others in a study that aimed to explore diet compliance and levels of depression and anxiety in children with celiac disease and their families after following a diet. The sample was 30 pediatric celiac patients, 17 children and 13 adolescents, 20 healthy controls, 11 children and 9 adolescents, which were studied as controls and the result was no significant difference in depression and anxiety among celiac patients in children who consumed a free diet of the gluten and health control group. Diet compliance was 73.3% in study participants. The anxiety levels of the parents of the CD patients were not statistically significantly different from those of the parents in the control group [16].

Depression and Anxiety are linked to Celiac Disease

Feelings of fatigue, feeling overwhelmed, chronic sadness, anxiety, insomnia, depression and even headaches are all too common among people with celiac disease. Arigo and others in 2012 conducted a study aimed at identifying psychological risks and comorbidities of women with celiac disease, who may be more at risk of psychological symptoms (such as depression, and disordered eating behaviors). The sample was 177 women from the United States, aged over 18 years, previously diagnosed with Celiac disease most of them Caucasian (98%), married (56%) Secondary education (75%); Average age the sample is 39.24 years old, The comprehensive web-based survey was used to assess dietary compliance, disease symptoms, psychological functioning, and disordered eating, More than one scale was used, namely Dietary Compliance Scale, Celiac Disease Symptom Questionnaire., Short-Form Health Survey, Perceived Stress Scale, Center for Disease Studies - Depression Scale and Eating Disorders Examination Questionnaire, The result was that most of the participants repeatedly stick to a glutenfree diet. And only 8% of the participants (n-14) from the current sample are not committed, despite the high compliance, but the participants asserted that the levels of symptoms of the disease are high and that there are concerns about body image (concern in particular about the shape of the person), and there are symptoms of disorders Psychological: 37% suffered from depression, 22% suffered from an eating disorder, and that level of physical and emotional health varied. But for many patients it suggests marked impairment in the areas of physical pain, vitality, and social function.

Patients with untreated celiac disease experience anxiety, depression, and fatigue are common complaints and this leads to poor quality of life. These conditions may improve within a few months after starting a gluten-free diet, but some patients suffer from significant mental illness despite the diet and psychological symptoms may affect the quality of life and adherence to the diet this is the result of a study presented by Zingone and others in 2015 which It was a literary review and aimed at reviewing the literature on the psychological morbidity of celiac disease and the search was on PubMed between the time period from 1900 until June 1, 2014, to study, research papers that talk about the psychological aspects of celiac disease and its relationship to quality of life, anxiety, depression and fatigue.

Similarly, the mental disorders experienced by celiac disease patients usually precede the diagnosis and treatment of celiac disease with a gluten-free diet. In a study presented by Pynnönen and others in 2004, where the study sample was 29 adolescents with celiac disease and 29 identical subjects, it was found that adolescent celiac disease had an increased prevalence of behavioral disorders Depressive and disruptive, especially in the pre-nutritional phase, where the prevalence of major depressive disorder was 31% and disruptive behavior disorders 28% [17].

Smith and Gerdes also conducted a 2011 study aimed at testing hypotheses regarding whether celiac disease in adults was reliably associated with anxiety and / or depression using a meta-analysis and used PubMed to search for reports on emotional disorders in adults with celiac disease and they read each report with relevance (n = 67). First, three criteria were applied to select appropriate criteria for meta-analysis. First, the study must have compared a group of adults with celiac disease with another group of healthy adults and adults with celiac disease or other medical disease. Second, the study must have presented the original findings, expressed in the form of dichotomous data and or continuous data, for anxiety and depression in the groups. Third: The study should have provided adequate data to estimate the effect size and confidence intervals. Eighteen studies of depression and eleven studies of anxiety in adults with celiac disease fulfilled the selection criteria, and the results of Meta-analyzes were that depression was significantly more common and more severe in adults with celiac disease than healthy adults. The data indicated that the gluten-free diet was in many cases. It was sometimes unable to relieve depression in adult celiac disease, while anxiety was not reliably different from healthy adults or adults with other physical illnesses ) Smith & Gerdes [18].

On the contrary, in 2010 Häuser and others conducted a study that proved that the level of anxiety among celiac disease patients is very high, unlike depression. A sample 441 was taken from German adult patients with CD on GFD. The majority of the sample was women, 78.5%. Potential demographic factors (age and sex) were tested. Social class, familial (and disease-related) status (latency to diagnosis, duration of GFD-free food, compliance with GFD, and thyroid disease) levels of anxiety, depression, potential anxiety or depressive disorder was assessed by the Anxiety and Depression Scale, and the outcome was anxiety predicted only by the female sex. It was at 84.8% of the total patients. Those who live alone are less likely to be anxious while depression was not significantly predicted by any of the medical and social-demographic variables tested [19].

On the other hand, in 2015, Simsek and others conducted a study aimed at investigating the level of depression and quality of life in children with celiac disease (CD) and examining the relationships between the level of depression and quality of life with adherence to a gluten free diet (GFD) 50 children were taken from child psychiatric clinics and systemic diseases. Digestive system for children at the Tigris University Hospital (Diyarbakir, Turkey) between the ages of 9 and 16 years, 25 children with celiac disease and 25 healthy children matched with age and gender and without chronic physical and psychological diseases. A form was used that contained information about social, demographic and clinical characteristics, and an inventory Child Depression (CDI), and the General-Purpose Children's Health-Related Quality of Life Questionnaire (Kid-KINDL). After giving recommendations for follow-up of GFD, patients with CD in the pediatric psychiatric clinic were re-evaluated using the same inventories after at least 6 months and the result of the study was that there were no statistically significant differences in depression scores between patients and control subjects (P> 0.05).). Total scores and scores for the Affective Well-Being Sub-Scale of the Children's Quality of Life Scale were significantly lower in patients with CD compared to the control group (P <0.05) And there was no significant improvement in depression scores or quality of life for the overall sub-sample of celiac patients, all of whom received Recommendation to follow GFD (P> 0.05). Significant reductions in depression scores were noted for celiac patients who were committed to GFD compared to non-compliant patients [20].