The incidence and risk factors for developing depression after being diagnosed with inflammatory bowel disease: a cohort study
Abstract
Summary: Background: Studies have found that depression is more frequent in patients with inflammatory bowel disease ( IBD ) than the general population. Clinicians are now trying to pinpoint risk factors for psychological impairment in the IBD population. Aims: To examine the demographic and phenotypic variables associated with the development of depression among a diverse cohort of IBD patients. We also sought to describe psychotropic therapy prescribed to IBD patients. Methods: We conducted a retrospective cohort study including patients with Crohn's disease ( CD ) and ulcerative colitis ( UC ) without a prior psychiatric diagnosis and followed in the gastroenterology clinics of the private university hospital and public safety net hospital at a large academic centre in Miami (Florida). Predictive variables included demographic characteristics, IBD phenotype, exposure to IBD medications, history of a surgical stoma or seton placement, extra‐intestinal manifestations, laboratory indices, aggressive disease and disease activity (based on imaging and endoscopic parameters). Proportional hazard regression models and stepwise Cox regression analysis were used for statistical analysis. Results: Independent predictors of depression were female gender [ HR : 1.3 (95% CI : 1.1–1.7), P = 0.01], aggressive disease [ HR : 1.4 (95% CI : 1.02–1.9), P = 0.03] and active disease [ HR : 1.5 (95% CI : 1.1–2.0), P = 0.04]. In the group that did develop a depressive disorder, 65% received pharmacologic therapy with one or more psychotropic agents. Conclusions: We found female gender, aggressive disease and increased endoscopic/radiological activity to be independently associated with the development of depression in inflammatory bowel disease.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a systematic review examining gut-to-brain effects, there was a statistically significant association between aggressive disease and subsequent development of depression in patients with IBD, but only in a single study.
“In a systematic review examining gut-to-brain effects there was a statistically significant association between aggressive disease and subsequent development of depression in patients with IBD,[10] but only in a single study.[11]”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [11]
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 [11]
Five included studies scored 7 or more on the Newcastle-Ottawa scale.
“Study quality is provided in Supplementary Tables 1 and 2; five studies scored 7 or more on the NewcastleOttawa scale.[11, 20, 23, 24, 26]”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [11]
Clinically active disease at baseline had a significant effect on future symptoms of depression (RR = 1.49; 95% CI 1.11-1.98) in three studies with 642 patients, with no heterogeneity (I2 = 0%).
“Similarly, the effect of clinically active disease at baseline on future symptoms of depression was also significant (RR = 1.49; 95% CI 1.11-1.98), with no heterogeneity ( I 2 =0%).[11, 26, 29]”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [11]
Cites
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.617 · Cited by 12,052 · see citing works
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., & Wang, P. S. (2003) · JAMA · doi:10.1001/jama.289.23.3095 · Cited by 7,988 · see citing works
DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.14.2101 · Cited by 4,177 · see citing works
Silverberg, M. S., Satsangi, J., Ahmad, T., Arnott, I. D., Bernstein, C. N., Brant, S. R., Caprilli, R., Colombel, J., Gasché, C., Geboes, K., et al. (2005) · Canadian Journal of Gastroenterology · doi:10.1155/2005/269076 · Cited by 3,408 · see citing works
(2007) · PubMed Central · Cited by 2,521 · see citing works
Raison, C. L., Rutherford, R. E., Woolwine, B. J., Shuo, C., Schettler, P., Drake, D. F., Haroon, E., & Miller, A. H. (2013) · JAMA Psychiatry · doi:10.1001/2013.jamapsychiatry.4 · Cited by 1,617 · see citing works
Depression and anxiety in inflammatory bowel disease: A review of comorbidity and management
Graff, L. A., Walker, J. R., & Bernstein, C. N. (2009) · Inflammatory Bowel Diseases · doi:10.1002/ibd.20873 · Cited by 586 · see citing works
Mittermaier, C., Dejaco, C., Waldhoer, T., Oefferlbauer-Ernst, A., Miehsler, W., Beier, M., Tillinger, W., Gangl, A., & Moser, G. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000106907.24881.f2 · Cited by 532 · see citing works
Case-Finding Instruments for Depression in Primary Care Settings
Mulrow, C. D., Williams, J. W., Gerety, M. B., Ramirez, G., Montiel, O. M., & Kerber, C. (1995) · Annals of Internal Medicine · doi:10.7326/0003-4819-122-12-199506150-00004 · Cited by 456 · see citing works
Walker, J. R., Ediger, J. P., Graff, L. A., Greenfeld, J. M., Clara, I., Lix, L., Rawsthorne, P., Miller, N., Rogala, L., McPhail, C. M., et al. (2008) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2008.01980.x · Cited by 437 · see citing works
The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis
Norton, S., Cosco, T. D., Doyle, F., Done, J., & Sacker, A. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.10.010 · Cited by 407 · see citing works
Graff, L. A., Walker, J. R., Lix, L., Clara, I., Rawsthorne, P., Rogala, L., Miller, N., Jakul, L., McPhail, C., Ediger, J., et al. (2006) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2006.09.027 · Cited by 292 · see citing works
Fuller-Thomson, E., & Sulman, J. (2006) · Inflammatory Bowel Diseases · doi:10.1097/00054725-200608000-00005 · Cited by 292 · see citing works
Psychological issues in inflammatory bowel disease: an overview
Sajadinejad, M. S., Asgari, K., Molavi, H., Kalantari, M., & Adibi, P. (2012) · Gastroenterology Research and Practice · doi:10.1155/2012/106502 · Cited by 242 · see citing works
Risk factors of anxiety and depression in inflammatory bowel disease
Nahon, S., Lahmek, P., Durance, C., Olympie, A., Lesgourgues, B., Colombel, J., & Gendre, J. (2012) · Inflammatory Bowel Diseases · doi:10.1002/ibd.22888 · Cited by 201 · see citing works
Levenstein, S., Prantera, C., Varvo, V., Scribano, M. L., Berto, E., Andreoli, A., & Luzi, C. (1994) · PubMed · Cited by 188 · see citing works
Simrén, M. (2002) · The American Journal of Gastroenterology · doi:10.1016/s0002-9270(01)04037-0 · Cited by 186 · see citing works
Mikocka-Walus, A. A., Turnbull, D. A., Moulding, N. T., Wilson, I. G., Andrews, J. M., & Holtmann, G. J. (2007) · Inflammatory Bowel Diseases · doi:10.1002/ibd.20062 · Cited by 178 · see citing works
Anxiety and depression in patients with inflammatory bowel disease
Häuser, W., Janke, K.-H., Klump, B., & Hinz, A. (2010) · Inflammatory Bowel Diseases · doi:10.1002/ibd.21346 · Cited by 163 · see citing works
Porcell, P., Leoci, C., & Guerra, V. (1996) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365529609010354 · Cited by 139 · cited 2× · see citing works
“reported that mental health status in IBD patients in remission is comparable to that of the general population, 21, 22 and longitudinal studies have shown that there is a decrease in anxiety and depression when patients transition from active disease to remission.(20)”
BackgroundResultAnanthakrishnan, A. N., Gainer, V. S., Cai, T., Perez, R. G., Cheng, S., Savova, G., Chen, P., Peter Szolovits, B., Xia, Z., Jager, P. L. D., et al. (2013) · The American Journal of Gastroenterology · doi:10.1038/ajg.2012.471 · Cited by 93 · see citing works
Means‐Christensen, A. J., Sherbourne, C. D., Roy‐Byrne, P., Craske, M. G., & Stein, M. B. (2006) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2005.08.010 · Cited by 85 · see citing works
Mental Health Outcome Measures
Lewis, G. (2002) · International Journal of Epidemiology · doi:10.1093/ije/31.1.271 · Cited by 78 · see citing works
Tanaka, M., & Kazuma, K. (2005) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2004.00955.x · Cited by 56 · see citing works
Gülöksüz, S., Wichers, M., Kenis, G., Rüssel, M. G., Wauters, A., Verkerk, R. M., Arts, B. M. G., & van Os, J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0060435 · Cited by 52 · see citing works
Major Depression in Medically III Patients
Sutor, B., Rummans, T. A., Jowsey‐Gregoire, S. G., Krahn, L. E., Martin, M. J., O'Connor, M. K., Philbrick, K. L., & Richardson, J. W. (1998) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)63698-7 · Cited by 47 · see citing works
Calvet, X., Gallardo, O., Coronas, R., Casellas, F., Montserrat, A., Torrejón, A., Vergara, M., Campo, R., & Brullet, E. (2006) · Inflammatory Bowel Diseases · doi:10.1097/00054725-200608000-00004 · Cited by 45 · see citing works
Hauser, G., Tkalčić, M., Štimac, D., Milić, S., & Sinčić, B. M. (2011) · PubMed · Cited by 39 · see citing works
Wïttchen, H., Kessler, R. C., & Üstün, B. (2001) · Max Planck Institute for Plasma Physics · Cited by 29 · see citing works
The Luebeck interview for psychosocial screening in patients with inflammatory bowel disease
Kunzendorf, S., Jantschek, G., Straubinger, K., Heberlein, I., Homann, N., Ludwig, D., & Benninghoven, D. (2006) · Inflammatory Bowel Diseases · doi:10.1002/ibd.20050 · Cited by 24 · see citing works
El papel de la ansiedad y la depresión en las recidivas de la enfermedad inflamatoria intestinal
Vidal, Á., Gómez‐Gil, E., Sans, M., Portella, M. J., Salamero, M., Pique, J. M., & Panés, J. (2009) · Medicina Clínica · doi:10.1016/j.medcli.2008.07.002 · Cited by 12 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment
Bisgaard, T. H., Allin, K. H., Keefer, L., Ananthakrishnan, A. N., & Jess, T. (2022) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-022-00634-6 · Cited by 572 · see citing works
Mikocka-Walus, A., Knowles, S. R., Keefer, L., & Graff, L. (2016) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000620 · Cited by 567 · see citing works
Bi-directionality of brain–gut interactions in patients with inflammatory bowel disease
Gracie, D. J., Guthrie, E. A., Hamlin, P. J., & Ford, A. C. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.01.027 · Cited by 408 · see citing works
Mikocka-Walus, A., Pittet, V., Rossel, J.-B., von Känel, R., Anderegg, C., Bauerfeind, P., Beglinger, C., Begré, S., Belli, D., Bengoa, J. M., et al. (2016) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2015.12.045 · Cited by 348 · see citing works
Gracie, D. J., Irvine, A. J., Sood, R., Mikocka-Walus, A., Hamlin, P. J., & Ford, A. C. (2017) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(16)30206-0 · Cited by 271 · see citing works
Luo, Y., Zeng, B., Zeng, L., Du, X., Li, B., Huo, R., Liu, L., Wang, H., Dong, M., Pan, J., et al. (2018) · Translational Psychiatry · doi:10.1038/s41398-018-0240-5 · Cited by 245 · see citing works
Fairbrass, K. M., Lovatt, J., Barberio, B., Yuan, Y., Gracie, D. J., & Ford, A. C. (2022) · Gut · doi:10.1136/gutjnl-2021-325985 · Cited by 225 · see citing works
Depression is associated with more aggressive inflammatory bowel disease
Kochar, B., Barnes, E. L., Long, M. D., Cushing, K. C., Galanko, J., Martin, C. F., Raffals, L. E., & Sandler, R. S. (2018) · American Journal of Gastroenterology · doi:10.1038/ajg.2017.423 · Cited by 178 · see citing works
Influences and impact of anxiety and depression in the setting of inflammatory bowel disease
Navabi, S., Gorrepati, V. S., Yadav, S., Chintanaboina, J., Maher, S., Demuth, P., Stern, B., Stuart, A., Tinsley, A., Clarke, K., et al. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy143 · Cited by 172 · see citing works
Szigethy, E. M., Allen, J. I., Reiss, M., Cohen, W., Perera, L. P., Brillstein, L., Cross, R. K., Schwartz, D. A., Kosinski, L. R., Colton, J. B., et al. (2017) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2017.02.037 · Cited by 107 · see citing works
Sex Differences in the Gut-Brain Axis: Implications for Mental Health
Holingue, C., Budavari, A. C., Rodriguez, K. M., Zisman, C. R., Windheim, G., & Fallin, M. D. (2020) · Current Psychiatry Reports · doi:10.1007/s11920-020-01202-y · Cited by 85 · see citing works
Symptoms of anxiety/depression is associated with more aggressive inflammatory bowel disease
Gao, X., Tang, Y., Lei, N., Luo, Y., Chen, P., Liang, C., Duan, S., & Zhang, Y. (2021) · Scientific Reports · doi:10.1038/s41598-021-81213-8 · Cited by 84 · see citing works
Ludvigsson, J. F., Olén, O., Larsson, H., Halfvarson, J., Almqvist, C., Lichtenstein, P., & Butwicka, A. (2021) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjab039 · Cited by 76 · see citing works
Yanartas, Ö., Kani, H. T., Bicakci, E., Kilic, I., Banzragch, M., Acikel, C., Atug, O., Kuscu, K., Imeryuz, N., & Akin, H. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s106039 · Cited by 69 · see citing works
Arp, L., Jansson, S., Wewer, V., & Burisch, J. (2022) · Journal of Crohn's and Colitis · doi:10.1093/ecco-jcc/jjac095 · Cited by 38 · see citing works
Tarar, Z. I., Zafar, M. U., Farooq, U., Ghous, G., Aslam, A., Inayat, F., & Ghouri, Y. A. (2022) · International Journal of Colorectal Disease · doi:10.1007/s00384-021-04056-9 · Cited by 37 · see citing works
Davis, S. P., Bolin, L. P., Crane, P. B., & Crandell, J. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.538741 · Cited by 32 · see citing works
Eindor- Abarbanel, A., Naftali, T., Ruhimovich, N., Bar-Gil Shitrit, A., Sklerovsky-Benjaminov, F., Konikoff, F., Matalon, S., Shirin, H., Milgrom, Y., Ziv-Baran, T., et al. (2021) · Frontline Gastroenterology · doi:10.1136/flgastro-2020-101412 · Cited by 28 · see citing works
Jain, A., Marrie, R. A., Shafer, L. A., Graff, L. A., Patten, S. B., El-Gabalawy, R., Sareen, J., Bolton, J. M., Fisk, J. D., & Bernstein, C. N. (2020) · Crohn's & Colitis 360 · doi:10.1093/crocol/otz053 · Cited by 16 · see citing works
Integrated Multidisciplinary Treatment for Pediatric Inflammatory Bowel Disease
Wren, A. A., & Maddux, M. H. (2021) · Children · doi:10.3390/children8020169 · Cited by 16 · see citing works
The relationship of major depressive disorder with Crohn's disease activity
Facanali, C. B. G., Sobrado Junior, C. W., Fraguas Junior, R., Facanali Junior, M. R., Boarini, L. R., Sobrado, L. F., & Cecconello, I. (2023) · Clinics · doi:10.1016/j.clinsp.2023.100188 · Cited by 10 · see citing works
Lee, J. W. (2020) · Gut and Liver · doi:10.5009/gnl20187 · Cited by 3 · see citing works
- Authors
- Panara, A. J., Yarur, A. J., Rieders, B., Proksell, S., Deshpande, A. R., Abreu, M. T., & Sussman, D. A.
- Affiliations
- University of Miami (US)
- Corresponding author
- Sussman, D. A.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2014-03-03
- Volume
- 39
- Issue
- 8
- Pages
- 802-810
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2163296225
- Cited by
- 168
- References
- 32
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 17 · 2023: 21 · 2022: 16 · 2021: 15 · 2020: 16 · 2019: 9 · 2018: 13 · 2017: 11 · 2016: 10 · 2015: 8 · 2014: 6
- FWCI
- 7.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Olympus America
- Bankhead-Coley Team Science Program
- Sylvester Comprehensive Cancer Center of University of Miami
- American Cancer Society
- 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, risk factors, disease activity, aggressive disease, female sex, psychotropic drugs, extraintestinal manifestations, stoma, seton placement
- MeSH terms
- Adult, Colitis, Ulcerative, Crohn Disease, Depressive Disorder, Endoscopy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Psychotropic Drugs, Regression Analysis, Retrospective Studies, Risk Factors, Sex Factors, Cohort Studies, Incidence, Proportional Hazards Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
