Original Contribution

Inflammatory Bowel Disease

Depression Is Associated With More Aggressive Inflammatory Bowel Disease

Received:
Accepted:
Published online:

Abstract

Objectives:

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.

Methods:

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).

Results:

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.

Conclusions:

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.

  • Subscribe to The American Journal of Gastroenterology for full access:

    $8.7E+2

    Subscribe

Additional access options:

Already a subscriber?  Log in  now or  Register  for online access.

References

  1. 1.

    , , et al. Long-term medical conditions and major depression: strength of association for specific conditions in the general population. Can J Psychiatry 2005;50:195–202.

  2. 2.

    , , . Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis 2009;15:1105–1118.

  3. 3.

    , , et al. Anxiety and depression in patients with inflammatory bowel disease: comparisons with chronic liver disease patients and the general population. Inflamm Bowel Dis 2011;17:621–632.

  4. 4.

    , . Depression and inflammatory bowel disease: findings from two nationally representative Canadian surveys. Inflamm Bowel Dis 2006;12:697–707.

  5. 5.

    , , et al. The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease. Neuropsychiatr Dis Treat 2016;12:673–683.

  6. 6.

    , , et al. Symptoms of depression and anxiety are independently associated with clinical recurrence of inflammatory bowel disease. Clin Gastroenterol Hepatol 2016;14:829–835 e1.

  7. 7.

    , , et al. Sexual dysfunctions in men and women with inflammatory bowel disease: the influence of IBD-related clinical factors and depression on sexual function. J Sex Med 2015;12:1557–1567.

  8. 8.

    , , et al. The incidence and risk factors for developing depression after being diagnosed with inflammatory bowel disease: a cohort study. Aliment Pharmacol Ther 2014;39:802–810.

  9. 9.

    , , et al. Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med 2004;66:79–84.

  10. 10.

    , , et al. Factors associated with anxiety and depression in Korean patients with inactive inflammatory bowel disease. Gut Liver 2016;10:399–405.

  11. 11.

    , , et al. Inflammatory bowel disease and completed suicide in Danish adults. Inflamm Bowel Dis 2010;16:2158–2161.

  12. 12.

    , , et al. Radiation exposure in patients with inflammatory bowel disease and irritable bowel syndrome in the years 2001-2011. Scand J Gastroenterol 2016, 1–6.

  13. 13.

    , , et al. Risk factors for depression in the elderly inflammatory bowel disease population. J Crohns Colitis 2014;8:113–119.

  14. 14.

    , , et al. Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol 1997;32:1013–1021.

  15. 15.

    , , et al. Depression subtypes in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2014;58:574–581.

  16. 16.

    , , et al. The influence of depression on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis 2013;19:1732–1739.

  17. 17.

    , , et al. Risk factors of anxiety and depression in inflammatory bowel disease. Inflamm Bowel Dis 2012;18:2086–2091.

  18. 18.

    , , et al. Depression and anxiety levels in therapy-naive patients with inflammatory bowel disease and cancer of the colon. World J Gastroenterol 2007;13:438–443.

  19. 19.

    , , et al. Depression and anxiety in people with inflammatory bowel disease. J Epidemiol Community Health 2001;55:716–720.

  20. 20.

    , . A simple index of Crohn’s-disease activity. Lancet 1980;1:514.

  21. 21.

    , , et al. A simple clinical colitis activity index. Gut 1998;43:29–32.

  22. 22.

    , , et al. The PHQ-9 versus the PHQ-8—is item 9 useful for assessing suicide risk in coronary artery disease patients? Data from the Heart and Soul Study. J Psychosom Res 2012;73:163–168.

  23. 23.

    , , . Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. Am J Manag Care 2004;10:839–845.

  24. 24.

    , , et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010;32:345–359.

  25. 25.

    , . The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 2002;32:509–515.

  26. 26.

    , , et al. Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract 2008;58:32–36.

  27. 27.

    , , . Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry 2007;29:417–424.

  28. 28.

    , , et al. The PHQ-8 as a measure of current depression in the general population. J Affect Disord 2009;114:163–173.

  29. 29.

    , , et al. Are depression and anxiety associated with disease activity in rheumatoid arthritis? A prospective study. BMC Musculoskelet Disord 2016;17:155.

  30. 30.

    , , et al. Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Rheumatology (Oxford) 2016;55:268–278.

  31. 31.

    , , et al. Self-reported depression in psoriasis is associated with subclinical vascular diseases. Atherosclerosis 2016;251:219–225.

  32. 32.

    , , et al. Reactivation of inflammatory bowel disease in a mouse model of depression. Gastroenterology 2009;136:2280–2288 e1-4.

  33. 33.

    , , et al. Depression moderates the associations between beliefs about medicines and medication adherence in patients with rheumatoid arthritis: cross-sectional study. J Health Psychol 2016 [e-pub ahead of print].

  34. 34.

    , , et al. Effect of psychotherapy on healthcare utilization in children with inflammatory bowel disease and depression. J Pediatr Gastroenterol Nutr 2016;63:658–664.

  35. 35.

    , , et al. Narcotic use for inflammatory bowel disease and risk factors during hospitalization. Inflamm Bowel Dis 2012;18:869–876.

  36. 36.

    , , . Narcotic use in patients with Crohn’s disease. Am J Gastroenterol 2005;100:2225–2229.

  37. 37.

    , , et al. Serious infections and mortality in association with therapies for Crohn’s disease: TREAT registry. Clin Gastroenterol Hepatol 2006;4:621–630.

  38. 38.

    , , et al. Variation in treatment of patients with inflammatory bowel diseases at major referral centers in the United States. Clin Gastroenterol Hepatol 2015;13:1197–1200.

Download references

Author information

Affiliations

  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

Authors

  1. Search for Bharati Kochar in:

  2. Search for Edward L Barnes in:

  3. Search for Millie D Long in:

  4. Search for Kelly C Cushing in:

  5. Search for Joseph Galanko in:

  6. Search for Christopher F Martin in:

  7. Search for Laura E Raffals in:

  8. Search for Robert S Sandler in:

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.