Original Contribution

Inflammatory Bowel Disease

Depression Is Associated With More Aggressive Inflammatory Bowel Disease

Published online:



Depression is prevalent in inflammatory bowel disease (IBD) patients. The impact of depression on IBD is not well-studied. It is unknown how providers should assess depression.


We used data from the Sinai–Helmsley Alliance for Research Excellence cohort, to assess methods of diagnosing depression and effects of baseline depression on disease activity at follow-up. A patient health questionnaire (PHQ-8) score ≥5 was consistent with mild depression. Relapse was defined as a modified Harvey–Bradshaw Index ≥5 or Simple Clinical Colitis Activity Index >2. We performed binomial regression to calculate adjusted risk ratios (RRs).


We included 2,798 Crohn’s disease (CD) patients with 22-month mean follow-up and 1,516 ulcerative colitis (UC) patients with 24-month mean follow-up. A total of 64% of CD patients and 45% of UC patients were in remission at baseline. By self-report, 20% of CD and 14% of UC patients were depressed. By PHQ-8, 38% of CD and 32% of UC patients were depressed (P<0.01). Adjusted for sex, remission, and disease activity, CD patients with baseline depression were at an increased risk for relapse (RR: 2.3; 95% confidence interval (CI): 1.9–2.8), surgery, or hospitalization (RR: 1.3 95% CI: 1.1–1.6) at follow-up. UC patients with baseline depression were also at increased risk for relapse (RR: 1.3; 95% CI: 0.9–1.7), surgery, or hospitalization (RR: 1.3; 95% CI: 1.1–1.5) at follow-up.


Baseline depression is associated with a higher risk for aggressive IBD at follow-up. A single question is not a sensitive method of assessing depression. Providers should consider administering the PHQ-8 to capture those at greater risk for aggressive disease.

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Author information


  1. Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA

    • Bharati Kochar
    • , Edward L Barnes
    • , Millie D Long
    • , Joseph Galanko
    • , Christopher F Martin
    •  & Robert S Sandler
  2. Division of Gastroenterology, Washington University at St Louis, St Louis, MO, USA

    • Kelly C Cushing
  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    • Laura E Raffals


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Competing interests

Guarantor of the article: Robert S. Sandler, MD, MPH.

Specific author contributions: Bharati Kochar: planning and conducting the study, interpreting data, drafting the manuscript, and critical revisions of the manuscript. Edward L. Barnes: interpreting data, drafting the manuscript, and critical revisions of the manuscript. Millie D. Long: planning and conducting the study, collecting the data, interpreting data, and critical revisions of the manuscript. Kelly C. Cushing: interpreting data, and critical revisions of the manuscript. Joseph Galanko: conducting the study, interpreting data, and critical revisions of the manuscript. Christopher F. Martin: collecting the data, conducting the study, interpreting data, and critical revisions of the manuscript. Laura E. Raffals: collecting the data, interpreting data, and critical revisions of the manuscript. Robert S. Sandler: planning and conducting the study, interpreting data, and critical revisions of the manuscript. All authors approved the final manuscript.

Financial support: This research was supported by grants from the National Institutes of Health (P30DK034987, T32DK07634, T32DK007130, and UL1TR000448) and by the Helmsley Charitable Trust.

Potential competing interests: Bharati Kochar: none. Edward L. Barnes: none. Millie D. Long: Consultant Abbvie, Takeda, and Theravance. Kelly C. Cushing: none. Joseph Galanko: none. Christopher F. Martin: none. Laura E. Raffals: none. Robert S. Sandler: none.

Corresponding author

Correspondence to Robert S Sandler.