Depression may be associated with higher risk for aggressive IBD

Baseline depression was associated with a higher risk for aggressive inflammatory bowel disease (IBD) at follow-up, a study found.

Researchers used data from the Sinai-Helmsley Alliance for Research Excellence cohort, a prospective observational cohort of patients with IBD from seven U.S. academic centers, to assess the effects of baseline depression on IBD. A Patient Health Questionnaire (PHQ-8) score of 5 or above signified mild depression. Relapse was defined as a modified Harvey-Bradshaw Index of 5 or above or a Simple Clinical Colitis Activity Index score greater than 2. Study results were published Nov. 14 by The American Journal of Gastroenterology.

There were 2,798 Crohn's disease patients with a mean of 22 months of follow-up and 1,516 ulcerative colitis patients with a mean of 24 months of follow-up. Twenty percent of Crohn's disease patients and 14% of ulcerative colitis patients were depressed according to self-report. According to PHQ-8, 38% of Crohn's disease patients and 32% of ulcerative colitis patients were depressed (P<0.01). Compared to Crohn's disease patients without depression, those who had depression at baseline were at higher risk for relapse (risk ratio [RR], 2.3; 95% CI, 1.9 to 2.8), surgery (RR, 1.3; 95% CI, 1.1 to 1.6), and hospitalization (RR, 1.3; 95% CI, 1.2 to 1.5) at follow-up. Ulcerative colitis patients who had depression at baseline versus those who did not were also at increased risk for relapse (RR, 1.3; 95% CI, 0.9 to 1.7), surgery (RR, 1.8; 95% CI, 1.2 to 2.6), and hospitalization (RR, 1.3; 95% CI, 1.1 to 1.5) at follow-up.

Similar trends were seen in analyses of the risk for aggressive disease in patients with IBD and moderate to severe depression (PHQ-8 score ≥10). Patients who had active Crohn's disease or ulcerative colitis at baseline were significantly more likely to be depressed than their counterparts who were in remission (59% vs. 26% and 45% vs. 16%, respectively; P<0.01 for both comparisons).

Patients who were depressed at baseline according to the PHQ-8 score were significantly more likely to be taking narcotics at follow-up. The risk was 2.5 times higher (95% CI, 1.1 to 6.3) for patients with Crohn's disease and 3.6 times higher (95% CI, 1.1 to 11.4) for patients with ulcerative colitis. In survival analyses of patients with Crohn's disease, those who were depressed at baseline relapsed (P<0.01), were prescribed a new biologic agent (P<0.01), were prescribed a new steroid (P=0.02), were hospitalized (P<0.01), and had surgery (P<0.01) significantly sooner than those who were not depressed at baseline. Patients with Crohn's disease who were depressed at baseline achieved a composite end point for surgery or hospitalization significantly sooner than patients with Crohn's disease who were not depressed at baseline (P<0.01)

A single question is not a sensitive method of assessing depression, so clinicians should consider administering the PHQ-8 to capture those at greater risk for aggressive disease, the authors noted. “Consideration should be given to treating depression, in order to improve quality of life and perhaps IBD-specific outcomes, in patients with IBD,” they wrote.