Psychiatric co‐morbidity is associated with increased risk of surgery in Crohn's disease
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Summary: Background: Psychiatric co‐morbidity, in particular major depression and anxiety, is common in patients with Crohn's disease (CD) and ulcerative colitis (UC). Prior studies examining this may be confounded by the co‐existence of functional bowel symptoms. Limited data exist examining an association between depression or anxiety and disease‐specific endpoints such as bowel surgery. Aims: To examine the frequency of depression and anxiety (prior to surgery or hospitalisation) in a large multi‐institution electronic medical record (EMR)‐based cohort of CD and UC patients; to define the independent effect of psychiatric co‐morbidity on risk of subsequent surgery or hospitalisation in CD and UC, and to identify the effects of depression and anxiety on healthcare utilisation in our cohort. Methods: Using a multi‐institution cohort of patients with CD and UC, we identified those who also had co‐existing psychiatric co‐morbidity (major depressive disorder or generalised anxiety). After excluding those diagnosed with such co‐morbidity for the first time following surgery, we used multivariate logistic regression to examine the independent effect of psychiatric co‐morbidity on IBD‐related surgery and hospitalisation. To account for confounding by disease severity, we adjusted for a propensity score estimating likelihood of psychiatric co‐morbidity influenced by severity of disease in our models. Results: A total of 5405 CD and 5429 UC patients were included in this study; one‐fifth had either major depressive disorder or generalised anxiety. In multivariate analysis, adjusting for potential confounders and the propensity score, presence of mood or anxiety co‐morbidity was associated with a 28% increase in risk of surgery in CD (OR: 1.28, 95% CI: 1.03–1.57), but not UC (OR: 1.01, 95% CI: 0.80–1.28). Psychiatric co‐morbidity was associated with increased healthcare utilisation. Conclusions: Depressive disorder or generalised anxiety is associated with a modestly increased risk of surgery in patients with Crohn's disease. Interventions addressing this may improve patient outcomes.
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IBD is negatively affected by mental disorders, resulting in increased rates of hospital readmissions.
“increased rates of hospital readmissions and increased risk of surgery.10”
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 [10]
The Results (Hospitalizations and medication use; page not provided) report more all-cause hospitalizations among patients with depression or anxiety, but do not report hospital readmissions specifically. The Discussion reports a modestly increased risk of surgery in Crohn’s disease, not ulcerative colitis. The paper describes associations, rather than establishing that mental disorders caused these outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEpisodes of anxiety and depression have a significant impact on hospital readmissions and surgery.
“and hospital readmissions and surgery.10”
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 [10]
The Results (Hospitalizations and medication use; page unavailable) associate depression or anxiety with increased all-cause hospitalization in patients with Crohn’s disease or ulcerative colitis, and the Discussion associates these diagnoses with a modestly increased risk of subsequent surgery in Crohn’s disease. The paper measures hospitalization, not hospital readmission, and reports associations with diagnoses rather than effects of individual episodes; it does not establish a causal impact. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIBD is negatively affected by mental disorders, resulting in increased risk of surgery.
“increased rates of hospital readmissions and increased risk of surgery.10”
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 [10]
The Results (Risk of surgery; page not provided) associate depression or anxiety with increased surgery risk in Crohn’s disease, but not ulcerative colitis. The Results (Hospitalizations and medication use; page not provided) report increased all-cause hospitalizations, not hospital readmissions. The observational association also does not establish that mental disorders caused the increased risk. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn a Boston IBD cohort including 5,405 CD and 5,429 UC patients, CD patients with emotional or anxiety disorders had a 28% increase in the risk of surgery compared to those without psychosocial disorders.
“An IBD cohort study in Boston, including 5,405 CD and 5,429 UC patients, found that CD patients with emotional or anxiety disorders had a 28% increase in the risk of surgery compared to those without psychosocial disorders (105).”
From Stress triggers flare of inflammatory bowel disease in children and adults (2019) · cites this paper as [105]
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Perianal disease is associated with psychiatric co-morbidity in Crohn’s disease in remission
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“6,7,24,25 However, it is important to stress our analysis could not adjust for either non-response to treatment or potential drug-related adverse events, which may necessitate appropriate treatment discontinuation.”
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The Interaction between Stress and Inflammatory Bowel Disease in Pediatric and Adult Patients
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“…negatively impacts on physical health, with these patients demonstrating lowered adherence to treatment (Goodhand et al., 2012), increased disease activity (Kochar et al., 2018; Mikocka-Walus et al., 2016b), more hospitalisations (Allegretti et al., 2015) and surgery (Ananthakrishnan et al., 2013).”
BackgroundPsychological distress in inflammatory bowel disease
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Depression and resilience in ulcerative colitis and Crohn's disease patients with ostomy
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Value-Based Health Care in Inflammatory Bowel Disease
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Mental Illnesses in Inflammatory Bowel Diseases: mens sana in corpore sano
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The emerging role of mood disorders in inflammatory bowel diseases
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Self-citationE-cigarette Use and Disease Outcomes in Inflammatory Bowel Diseases: A Case-Control Study
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“, 2018), hospital readmissions and increased risk of surgery (Ananthakrishnan et al., 2013).”
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- Authors
- Ananthakrishnan, A. N., Gainer, V. S., Perez, R. G., Cai, T., Cheng, S. ‐., Savova, G., Chen, P., Szolovits, P., Xia, Z., De Jager, P. L., Shaw, S. Y., Churchill, S., Karlson, E. W., Kohane, I., Perlis, R. H., Plenge, R. M., Murphy, S. N., & Liao, K. P.
- Affiliations
- Harvard University (US)
- Research Computing Partners HealthCare Charlestown MA USA
- Boston Children's Hospital (US)
- Massachusetts Institute of Technology Cambridge MA USA
- Brigham and Women's Hospital (US)
- Harvard Medical School Boston MA USA
- Corresponding author
- Ananthakrishnan, A. N.
- ORCID
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2013-01-07
- Volume
- 37
- Issue
- 4
- Pages
- 445-454
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- PMC
- PMC3552092
- OpenAlex
- W2132089409
- Cited by
- 122
- References
- 49
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 10 · 2023: 6 · 2022: 16 · 2021: 7 · 2020: 10 · 2019: 15 · 2018: 12 · 2017: 8 · 2016: 12 · 2015: 3 · 2014: 10 · 2013: 3
- FWCI
- 6.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institutes of Health (7k08ns079493-05)
- National Institute of General Medical Sciences (U01GM092691)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK097142)
- National Institute of Neurological Disorders and Stroke (K08-NS079493)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR 047782, K08AR060257, P60AR047782, R01AR049880, R01AR059648, R01AR056768, K24AR052403)
- U.S. National Library of Medicine (U54LM008748)
- 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
- Crohn's disease, ulcerative colitis, psychiatric comorbidity, major depressive disorder, generalized anxiety disorder, intestinal surgery, hospitalization, health care utilization, inflammatory bowel disease, propensity score
- MeSH terms
- Adult, Aged, Anxiety Disorders, Colitis, Ulcerative, Crohn Disease, Depressive Disorder, Female, Humans, Male, Middle Aged, Risk Factors, Severity of Illness Index, Comorbidity, Logistic Models
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