Depression Results in Worse Clinical Course for IBD Patients

A depression diagnosis could actually result in worse outcomes for patients with inflammatory bowel disease (IBD).

A team, led by Hideaki Oyama, Division of Gastroenterology, Tohoku University Graduate School of Medicine, evaluated the impact of psychiatric disorders, especially depression, on the clinical course of IBD.

The Risk

Patients with IBD are at a heightened risk of psychiatric disorders. There have been several studies showing that psychiatric disorders, such as depression and anxiety, could negatively impact the clinical course of IBD, especially for patients with ulcerative colitis.

However, it is uncertain and at times controversial whether psychiatric disorders affect the clinical course of IBD.

Data Collection

In the study, the investigators collected data on hospital admissions of patients with IBD from the Diagnosis Procedure Combination database system in Japan. The study included 81,251 eligible cases of patients with ulcerative colitis, of which 611 were assigned to the depression group and 80,640 of which were in the non-depression group. The study also included 78,230 patients with Crohn’s disease, of which 524 were assigned to the Crohn’s disease depression group and 77,706 of which were part of the Crohn’s disease non-depression group.

The investigators divided eligible admissions into IBD with and without depression groups using propensity score matching. They also compared the rates of surgery, the use of molecular targeted drugs and biologics, systemic steroid administrations, and in-hospital death.

Finally, the team conducted a logistic regression analysis to identify clinical factors affecting surgery, the use of molecular targeted drugs and biologics, and systemic steroid administrations.

Ulcerative Colitis

In patients with ulcerative colitis, the rates of surgery, the use of 2 or more molecular targeted drugs, systemic steroid administrations, and in-hospital deaths was higher in a cohort of patients with depression, compared to those with ulcerative colitis without depression.

After conducting a multivariate analysis of ulcerative colitis, the investigators found that depression increased the odds of systemic steroid administrations, the use of 2 or more molecular targeted drugs, and surgery.

They also found the proportion of women with ulcerative colitis in the depression group was significantly higher than in the non-depression group (50.4% vs 43.3%, P = 0.0005). The average age of the patients in the depression group were also higher (51.7 vs 49.0 years, P = 0.0003). The rate of admission to academic hospitals was higher in the depression group (39.6% vs 25.3%, P < 0.0001), but there was no difference in smoking history between the 2 groups.

Crohn's Disease

Next, they focused on patients with Crohn’s disease.

Here, they found that only steroid administration was associated with depression in patients with Crohn’s disease.

The number of academic hospitals in the depression group for Crohn’s disease was also significantly higher, but there were no differences in sex, age, and smoking history.

“Our study demonstrated an association between a worse clinical course of UC and depression,” the authors wrote. “Although this result indicates that depression might be associated with increased disease activity in patients with UC, the causal relationship is still unclear. Further prospective studies are warranted.”

The study, “Depression is associated with increased disease activity in patients with ulcerative colitis: A propensity score-matched analysis using a nationwide database in Japan,” was published online in JGH Open.