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Cited by 178Inflammatory Bowel DiseaseTryptophan and brain disordersOcular Diseases and Behçet’s Syndrome

Depression is associated with more aggressive inflammatory bowel disease

Open access
Kochar, Bharati, Barnes, Edward L, Long, Millie D, Cushing, Kelly C, Galanko, Joseph, Martin, Christopher F, Raffals, Laura E, Sandler, Robert S·2018·American Journal of Gastroenterology
DOI 10.1038/ajg.2017.423PMC PMC5962285
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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.

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  • Both retrospective and prospective cohort studies found a significantly greater likelihood of disease relapse, hospitalization, emergency department visits, and higher healthcare costs in individuals with IBD who had elevated depression and anxiety.

    “Both retrospective and prospective cohort studies, ranging in sample size from 400 to over 300,000, and following individuals with IBD who had elevated depression and anxiety found a significantly greater likelihood of disease relapse, hospitalization, emergency department (ED) visits, and higher healthcare costs (Table 1) (29–34).”

    From The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease (2023) · cites this paper as [30]

    The Results report that patients with Crohn’s disease who were depressed at baseline had significantly higher risks of relapse and hospitalization at follow-up. This prospective cohort does not report outcomes for elevated anxiety, emergency department visits, or healthcare costs, so it supports only part of the claim. (LLM, conf=0.88)

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  • IBD is negatively affected by mental disorders, resulting in a more aggressive presentation.

    “a more aggressive presentation,9”

    From Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme (2022) · cites this paper as [9]

    The Discussion reports that IBD patients with depression at baseline had a significantly greater risk of more aggressive disease over time. The claim broadens depression to mental disorders generally and describes a resulting aggressive presentation, whereas the paper reports an association with later outcomes, not a demonstrated causal effect or a more aggressive initial presentation. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The 13 eligible articles reported on 12 separate study populations containing 9192 patients.

    “The 13 eligible articles reported on 12 separate study populations,[11, 20-30, 33] containing 9192 patients.”

    From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [22]

  • Patients with symptoms of depression at baseline were more likely to require hospitalisation due to IBD when data were pooled from three studies recruiting 5151 patients (RR = 1.35; 95% CI 1.17-1.57), with moderate heterogeneity (I2 = 40.7%).

    “Patients with symptoms of depression at baseline were also more likely to require hospitalisation due to IBD when data were pooled from three studies,[22, 26, 30] recruiting 5151 patients (RR = 1.35; 95% CI 1.17-1.57) (Figure 3c), with moderate heterogeneity between studies ( I 2 =40.7%).”

    From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [22]

  • Pooled from eight studies including 7606 patients, symptoms of depression at baseline were associated with a significantly increased risk of flare of disease activity during longitudinal follow-up (RR = 1.60; 95% CI 1.21-2.12), with high heterogeneity (I2 = 73.5%).

    “When data were pooled from eight studies,[20-23, 26, 27, 29, 30] which included 7606 patients, symptoms of depression at baseline were associated with a significantly increased risk of flare of disease activity during longitudinal follow-up (RR = 1.60; 95% CI 1.212.12), with high heterogeneity between studies ( I 2 =73.5%)”

    From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [22]

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Authors
Kochar, B., Barnes, E. L., Long, M. D., Cushing, K. C., Galanko, J., Martin, C. F., Raffals, L. E., & Sandler, R. S.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Washington University in St. Louis (US)
  • Mayo Clinic (US)
Corresponding author
Sandler, Robert S
ORCID
Venue
American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-01
Volume
113
Issue
1
Pages
80-85
ISSN
0002-9270 (ISSN-L)
DOI
10.1038/ajg.2017.423
PMC
PMC5962285
OpenAlex
W2769079550
Cited by
178
References
39
Citations by year
2026: 13 · 2025: 21 · 2024: 13 · 2023: 21 · 2022: 21 · 2021: 32 · 2020: 25 · 2019: 14 · 2018: 15
FWCI
9.78
Type
journal article
Language
en
Open access
Locations
  • The American Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
  • Leona M. and Harry B. Helmsley Charitable Trust
  • National Institutes of Health (UL1TR000448, UL1TR002345)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007634, P30DK034987, T32DK007130)
  • National Center for Advancing Translational Sciences
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
  • Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
Keywords
depression, inflammatory bowel disease, Crohn's disease, ulcerative colitis, recurrence, PHQ-8, depression screening, hospitalization, disease activity
MeSH terms
Patient Health Questionnaire, Adult, Colitis, Ulcerative, Crohn Disease, Depression, Depressive Disorder, Female, Hospitalization, Humans, Male, Middle Aged, Recurrence, Severity of Illness Index, Digestive System Surgical Procedures, Inflammatory Bowel Diseases, Cohort Studies, Odds Ratio, Self Report

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