Psychiatric and educational aspects of familial adenomatous polyposis - a nationwide Danish cohort study with matched non-exposed individuals.

Familial adenomatous polyposis (FAP) is an autosomal, dominantly inherited disorder that predisposes to colorectal cancer. An increased risk of cancer may affect mental health, but the magnitude of this effect remains unknown. We assessed the psychosocial functioning, including the educational level attained and risk of psychiatric comorbidity, of FAP patients by comparing them with matched non-exposed individuals. All Danish FAP patients diagnosed before April 2021 were identified in the Danish Polyposis Register and paired with four matched non-exposed. Educational history, psychiatric contacts or diagnoses (ICD-10), and treatment with antidepressants, anxiolytics, or antipsychotics were compared between FAP patients and non-exposed. The analysis included 445 FAP patients and 1,538 non-exposed. The highest educational level reached was significantly lower for FAP patients ( p <0.001). When comparing FAP patients and non-exposed and adjusting for a cancer diagnosis, an increased risk was observed for a psychiatric contact (1.69, CI 95%, 1.25-2.29, p <0.001), any psychiatric prescription (1.39, CI 95%, 1.17-1.66, p <0.001), a psychiatric diagnosis (1.64, CI 95%, 1.19-2.26, p =0.002), and experiencing any psychiatric event (HR 1.42, CI 95%, 1.20-1.68, p <0.001). An increased risk was specifically seen for mood (affective) disorders (1.76, CI 95%, 1.09-2.83, p =0.02) and behavioural and emotional disorders (2.01, CI 95%, 1.10-3.69, p =0.02), as well as the need for antidepressants (1.59, CI 95%, 1.24-2.03, p <0.001) and antipsychotics (1.85, CI 95%, 1.26-2.70, p =0.002). Compared to non-exposed individuals, FAP patients had significantly less education and an increased risk of developing mood and behavioural disorders, with an increased likelihood of needing antidepressants and antipsychotics.

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