Depression Rates Rising Among Younger Patients with IBD-RA

A rise in the prevalence of depression in younger patients with concomitant inflammatory bowel disease and rheumatoid arthritis (IBD-RA) was observed when compared with their counterparts, according to research presented at the 2023 Congress of Clinical Rheumatology West.¹ This patient population was also at a higher risk for an increased cost of care and poor treatment compliance. Investigators encourage educating clinicians in ways to better identify the early signs and symptoms of depression in patients with IBD, RA, or IBD-RA to ensure a better overall prognosis.

Brinda Basida, MD

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“Autoimmune diseases like IBD and RA are found to have a substantial societal burden, increased healthcare cost, and progressive disability,” wrote Brinda Basida, MD, rheumatology fellow at the Medical College of Georgia at Augusta University, and colleagues. “This study emphasizes the timely recognition of prevalence of major depressive disorder (MDD) in patients with RA and IBD combined and thus prevent disability.”

Previous research has shown patients with comorbid depression experience greater disability and are less likely to achieve remission compared to patients without depression. Additionally, elevated levels of interleukin (IL)-Iβ and IL-6 are linked to the development of depression by the impaired physiological responses to stress, leading to worse long-term outcomes.

Adult patients included in the study were hospitalized between January 2000 and December 2019 in a nationwide inpatient sample (NIS). The population analyzed had a diagnosis of primary or secondary IBD-RA overlap disease, defined by the International Classification of Diseases (ICD)-9 or ICD-10 codes. Patients were further categorized as IBD-RA without MDD or IBD-RA with MDD.

The primary outcome was to evaluate the temporal trends and prevalence of depression in patients with IBD-RA by age, race, and gender. A multivariate analysis using a weighted multi-level mixed-effects model and a logistic regression analysis further assessed this relationship. The Student’s t-test for continuous variables and Rao-Scott Chi-square tests determined the categorical variables between cohorts.

A total of 133,315 records with IBD-RA overlap were identified, of which 26,155 patients (19.62%) were diagnosed with MDD. Compared to those without a diagnosis of MDD, patients with MDD were younger (mean age 56 years; P <.0001), were more likely to be female (80% vs 73%, respectively), and were more frequently White (79% vs 73%, respectively).

In the year 2000, MDD in patients with IBD-RA was 54; in 2019, this number increased 5233% to 2880 in weighted NIS (P <.001). There was also an increased total cost of care from $20,564 in 2000 to $60,428 in 2019 (P <.001). The comorbidities linked to higher MDD in this patient population were smoking (adjusted odds ratio [aOR], 1.23; 95% confidence interval [CI], 1.19 – 1.27; P <.0001) and esophageal disorders (aOR, 1.53; 95% CI 1.48 – 1.58; P <.0001).

“Multimorbidity, coexistence of multiple health conditions, is a growing public health challenge,” investigators concluded. “Depression screening is a useful tool for interventions aimed at improving health-related quality of life in individuals with immune‐mediated inflammatory diseases and hence better outcomes.”

References

1. ^{Basida B, Haider M, Kaur J. Temporal Trends, Outcomes, and Predictors of Depression in Patients with Inflammatory Bowel Disease and Rheumatoid Arthritis. Congress of Clinical Rheumatology. September 2023.}