Do People With Ulcerative Colitis Have an Increased Suicide Risk?

Learn how experts explain the link between suicide and UC, and what you can do to protect your mental health when you have an IBD.

Why Do People With Ulcerative Colitis Have a Higher Risk of Suicide?

People with UC face a higher risk of suicide because of a combination of physical symptoms, medication side effects, and significant emotional distress, says the gastroenterologist Tauseef Ali, MD, the medical executive director of SSM Health St. Anthony Digestive Care and the director of the Crohn’s and Colitis Center in Oklahoma City, Oklahoma. “Living with UC can be stressful and exhausting, affecting mental health,” Dr. Ali says.

“Inflammatory markers like [interleukin 6] and [tumor necrosis factor]-alpha, which are elevated in UC, can cross into the brain and act on the same systems involved in depression and anxiety,” says Riley Guinan, a physician assistant who has UC herself and specializes in psychiatry in private practice in Perkasie, Pennsylvania.

These inflammatory chemicals make you vulnerable, even before you factor in hurdles associated with living with the disease, says Guinan.

According to Ali the following UC-related factors can also increase the risk of suicide:

• Anxiety about a UC flare
• Work absences
• Financial strain
• Changes in body image
• Side effects of steroid medication (like depression and irritability, and in rare cases, mania or psychosis)

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“When you put all of these factors together, UC patients are at much higher risk for mental health struggles — and ultimately suicide,” says Guinan. But the risk doesn’t go away during remission, Guinan says.

Long-term exposure to stress hormones like cortisol, which are elevated significantly during UC flares, can cause brain changes that can pave the way for future depressive episodes, says Guinan, which makes suicide prevention vital.

Warning Signs of Suicidal Thoughts Among People With Ulcerative Colitis

But UC-specific warning signs can appear more subtle, says Guinan. “Patients with UC tend to describe emotional pain in the language of their illness, and that can hide suicidal thinking.”

“When someone says 'I can't do this anymore,' it’s often interpreted as physical exhaustion when it may be something more,” says Guinan. “The other warning sign I look for is a patient backing away from their own care, which shows up as skipping medications or canceling GI appointments.”

• Canceling plans often
• Talking about body shame
• Despair after surgery
• Discouragement after failed treatments

5 Ways to Manage Suicide Risk With Ulcerative Colitis

You can manage your risk of suicide with UC by communicating early and often with your healthcare team. “These conversations are essential, not a sign of weakness,” says Ali.

1. Ask About Mental Health Treatments Early

And you don’t have to wait for your provider to ask. “If you are struggling emotionally, bringing it up is important and valid, even if your provider doesn’t ask first,” says Ali. “Talking openly can help reduce stigma and improve care.”

“Therapists experienced in chronic illness or GI psychology provide valuable support for coping with disease-related psychological challenges,” says Ali.

2. Request Coordinated Care

“Integrated, team-based care is essential for effectively managing UC,” says Ali. “This means not just seeing a gastroenterologist but involving all relevant providers and addressing both emotional and physical symptoms together.”

This might mean asking to connect your therapist (a gastrointestinal psychologist, if you have one) or psychiatrist with your gastroenterologist, or other relevant providers, such as your primary care doctor or specialists who handle any extraintestinal manifestations (EIMs) of IBD you experience, such as the rheumatologist who treats your arthritis, or a hematologist who provides care for anemia.

When you have a coordinated care team, they can treat you holistically — understanding the way biology, social, lifestyle, and treatment factors interact, says Guinan.

3. Work Toward Longer Remissions

“Maintaining remission, given the stress of flares and some treatments, is also a mental health strategy,” says Ali.

4. Make Time for Exercise, Sleep, and Relaxation

• Go to bed and wake up at the same time each day, even on days off.
• Spend time outside every day.
• Create a soothing pre-bed routine.
• Eat only light snacks (not heavy meals) right before bed.
• Make your sleep space dark, cool, and cozy.
• Avoid caffeine, nicotine, and alcohol in the afternoon and evening.

5. Connect With Peer Support Groups

You don’t have to navigate your UC journey alone. Peer support and connecting with others with IBD through groups or forums can lessen isolation and help you feel understood, says Ali.

You can find an in-person or online community through these groups:

• Crohn's & Colitis Foundation
• Girls with Guts
• The Great Bowel Movement

How to Get Emergency Help for Suicidal Thoughts

• Call or text 988 to reach the Suicide & Crisis Lifeline any time of day or night.
• Text “HOME” to 741741 24/7.
• Go to your nearest emergency room.
• Call 911.

You may feel more comfortable calling or texting a family member or friend who can call someone for you.

The Takeaway

• People with ulcerative colitis (UC) have a higher risk of suicidal thoughts, attempts, and death by suicide than the general population.
• The social isolation, uncomfortable symptoms, and uncertainty of UC flares can lead to anxiety and depression, which raises the risk of suicide.
• You can protect your mental health with UC by talking to your provider about it regularly, asking for coordinated care between your providers, and making time to get plenty of exercise, sleep, and rest.
• If you are having thoughts of suicide or harming yourself, call or text 988, or call 911 immediately.

If you or a loved one is experiencing significant distress or having thoughts about suicide and needs support, call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24/7. If you need immediate help, call 911.