Inflammatory Bowel Disease

Subject Category: Inflammatory Bowel Disease

Am J Gastroenterol 2013; 108:594–601; doi:10.1038/ajg.2012.471; published online 22 January 2013

Similar Risk of Depression and Anxiety Following Surgery or Hospitalization for Crohn's Disease and Ulcerative Colitis

Ashwin N Ananthakrishnan MD, MPH1,2, Vivian S Gainer MS3, Tianxi Cai PhD4, Raul Guzman Perez3, Su-Chun Cheng ScD4, Guergana Savova5, Pei Chen5, Peter Szolovits PhD6, Zongqi Xia MD, PhD2,7, Philip L De Jager MD, PhD2,7, Stanley Shaw MD, PhD2,8, Susanne Churchill PhD9, Elizabeth W Karlson MD2,10, Isaac Kohane MD, PhD2,5,9, Roy H Perlis MD, MSc2,11, Robert M Plenge MD, PhD2,10, Shawn N Murphy MD, PhD2,3,12 and Katherine P Liao MD, PhD2,10

  1. 1Crohn's and Colitis Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Harvard Medical School, Boston, Massachusetts, USA
  3. 3Research Computing, Partners HealthCare, Charlestown, Massachusetts, USA
  4. 4Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
  5. 5Children's Hospital Boston, Boston, Massachusetts, USA
  6. 6Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
  7. 7Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  8. 8Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
  9. 9i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts, USA
  10. 10Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  11. 11Psychiatry Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Boston, Massachusetts, USA
  12. 12Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence: Ashwin N. Ananthakrishnan, MD, MPH, Crohn's and Colitis Center, Division of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, Massachusetts 02114, USA. E-mail: aananthakrishnan@partners.org

Received 8 October 2012; Accepted 17 December 2012
Advance online publication 22 January 2013

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Abstract

OBJECTIVES:

 

Psychiatric comorbidity is common in Crohn's disease (CD) and ulcerative colitis (UC). Inflammatory bowel disease (IBD)-related surgery or hospitalizations represent major events in the natural history of the disease. The objective of this study is to examine whether there is a difference in the risk of psychiatric comorbidity following surgery in CD and UC.

METHODS:

 

We used a multi-institution cohort of IBD patients without a diagnosis code for anxiety or depression preceding their IBD-related surgery or hospitalization. Demographic-, disease-, and treatment-related variables were retrieved. Multivariate logistic regression analysis was performed to individually identify risk factors for depression and anxiety.

RESULTS:

 

Our study included a total of 707 CD and 530 UC patients who underwent bowel resection surgery and did not have depression before surgery. The risk of depression 5 years after surgery was 16% and 11% in CD and UC patients, respectively. We found no difference in the risk of depression following surgery in the CD and UC patients (adjusted odds ratio, 1.11; 95% confidence interval, 0.84–1.47). Female gender, comorbidity, immunosuppressant use, perianal disease, stoma surgery, and early surgery within 3 years of care predicted depression after CD surgery; only the female gender and comorbidity predicted depression in UC patients. Only 12% of the CD cohort had ≥4 risk factors for depression, but among them nearly 44% subsequently received a diagnosis code for depression.

CONCLUSIONS:

 

IBD-related surgery or hospitalization is associated with a significant risk for depression and anxiety, with a similar magnitude of risk in both diseases.