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Depression Is Associated With More Aggressive Inflammatory Bowel Disease
Open accessAbstract
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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“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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“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]
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“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]
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“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]
In the citing paper
“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]
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“Pooling data from four studies,[21, 22, 26, 27] containing 6957 patients, there was an increased risk of escalation of therapy due to uncontrolled IBD activity in those reporting symptoms of depression at baseline (RR = 1.41; 95% CI 1.08-1.84) (Figure 3b), with low heterogeneity ( I 2 =43.1%).”
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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“When data were pooled from three studies,[21, 22, 26] containing 6710 patients, IBD-related surgery was also significantly more likely among those with symptoms of depression at baseline (RR = 1.63; 95% CI 1.19-2.22) (Figure 3e), with moderate heterogeneity between studies ( I 2 =57.4%).”
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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Metadata
- 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
- Published
- 2018-01
- Volume
- 113
- Issue
- 1
- Pages
- 80-85
- ISSN
- 0002-9270 (ISSN-L)
- 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
- green
- europepmc.org
- 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
- Health Sciences › Medicine › Gastroenterology › 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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