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Depression and insomnia among individuals with celiac disease or on a gluten-free diet in the USA: results from a national survey

Zylberberg, Haley M.a; Demmer, Ryan T.b; Murray, Joseph A.c; Green, Peter H.R.a; Lebwohl, Benjamina,b

European Journal of Gastroenterology & Hepatology: September 2017 - Volume 29 - Issue 9 - p 1091–1096
doi: 10.1097/MEG.0000000000000932
Original Articles: Coeliac Disease

Background There is uncertainty regarding the prevalence of psychiatric illnesses in patients with celiac disease (CD) and people who avoid gluten (PWAG) without a diagnosis of CD.

Participants and methods We obtained data from 22 274 participants from the 2009–2014 National Health and Nutrition Examination Survey to compare the prevalence of depression, insomnia, quality-of-life variables, and psychotropic medication use in CD participants and PWAGs to controls. We used multivariable logistic regression to assess for independent associations between CD/PWAG status and the outcomes of these variables.

Results Depression was present in 8.2% of controls compared with 3.9% of participants with CD (P=0.18) and 2.9% of PWAGs (P=0.002). After adjustment for age, sex, race, income, and access to healthcare, PWAGs maintained lower odds of depression compared with controls (odds ratio=0.25; 95% confidence interval: 0.12–0.51; P=0.0001). The prevalence estimates of sleep difficulty among controls (27.3%) compared to participants with CD or PWAGs were 37.7% (P=0.15) and 34.1% (P=0.11). Those with diagnosed CD had increased odds of sleep difficulty (odds ratio=2.41; 95% confidence interval 1.04–5.60), but this was no longer significant after multivariable adjustment (P=0.17).

Conclusion Among a nationally representative US sample, participants with CD overall showed no increased odds of depression or sleep difficulty. PWAGs showed lower odds of depression compared with controls. Future research should investigate the relationship between a diagnosis of CD and the development of psychiatric conditions.

Supplemental Digital Content is available in the text.

aDepartment of Medicine, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons

bDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

cDepartment of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

Correspondence to Benjamin Lebwohl, MD, MS, The Celiac Disease Center at Columbia University, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA Tel: +1 212 305 5590; fax: +1 212 305 3738; e-mail:

Received March 28, 2017

Accepted June 1, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.