New Research Explores IBD, Depression Connection

Bing Zhang, MD

Data on patients with inflammatory bowel disease (IBD) and depression and their unaffected siblings could shed light on the gut-brain axis influence on the pathophysiology of IBD.

A team, led by Bing Zhang, MD, Department of Medicine, Division of Gastrointestinal and Liver Disease, Keck School of Medicine, University of Southern California, identified the risk of depression among patients with IBD and their unaffected siblings, as well as the risk of IBD among patients with depression and their unaffected siblings.

Depression and IBD

About 30% of patients with IBD also have concurrent depression. However, recent studies have shown increased IBD risk for patients with depression, but the bidirectional relationship has not been identified within 1 representative cohort. In addition, this relationship has not been investigated among patient’s family members, which could further implicate the gut-brain axis in patients with IBD.

In the parallel, retrospective, cohort analysis, the investigators used data from the Taiwanese National Health Insurance Research Database to follow individuals up to 11 years for new-onset depression or IBD.

The investigators also matched unaffected siblings to controls based on predefined characteristics.

Overall, the investigators enrolled 422 patients with IBD, 537 unaffected siblings, and 2148 control participants.

Patients With IBD

In the follow-up period, 18.5% (n = 78) of patients with IBD, 4.8% (n = 26) of unaffected siblings, and 2.5% (n = 54) of the control group developed depression.

The adjusted odds-ratios (OR) for depression for patients with IBD was 9.43 (95% CI, 6.43-13.81; P <0.001), compared to 1.82 (95% CI, 1.14-2.91; P = 0.013) for unaffected siblings.

Patients With Depression

The investigators also looked at the risk of IBD for patients with depression. In this group, the investigators identified 25,552 patients with depression, 26,147 unaffected siblings, and 104,588 control participants.

In the follow-up period, 18 (0.70 per 1000) depression patients developed IBD, compared to 25 (0.96 per 1000) unaffected siblings, and 58 (0.55 per 1000). The odds ratios for IBD for patients with depression was 1.87 (95% CI, 1.07-3.26; P = 0.028), compared to 1.69 (95% CI, 1.05-2.69; P = 0.029) for the unaffected siblings.

“This population-based study elucidates bidirectional association between IBD and depression,” the authors wrote. “Elevated risk for either disease among patients and their unaffected siblings suggest shared etiologic contributors, offering novel insight into the gut-brain axis’ influence in IBD pathophysiology.”

IBD and Psychiatric Disorders

Last year, investigators found patients with IBD are not significantly linked to most psychiatric symptoms, including depression, anxiety, and stress.

The investigators did not find a significant link between objective disease activity, whether it is endoscopic scores, fecal calprotectin, or C-reactive protein and depression, anxiety, or stress scores (P >0.05 for all comparisons).

On the other hand, gastrointestinal symptoms were significantly associated with depression, anxiety, and stress in patients with either IBD disorder (P <0.05).

After implementing the multivariable analysis, only the gastrointestinal symptoms were significantly linked to the severe symptoms of depression (OR, 20.78; 95% CI, 6.71-92.37; P <0.001) and anxiety (OR, 4.26; 95% CI, 1.70-12.25; P = 0.004).

The study, “Bidirectional association between inflammatory bowel disease and depression among patients and their unaffected siblings,” was published online in the Journal of Gastroenterology and Hepatology.