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Crohn's disease related surgery more common among patients with anxiety, depression
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ORLANDO, Fla. — Patients with Crohn’s disease and psychiatric comorbidities such as anxiety or depression are more likely to require disease-related surgery, according to data presented at Digestive Disease Week in Orlando.
Researchers assessed the prevalence of major depressive disorder and anxiety among 5,405 patients with Crohn’s disease (CD) and 5,429 with ulcerative colitis (UC). All patient medical records were collected from a multi-institutional electronic medical record cohort covering the greater Boston area.
“We know that depression and anxiety are common in patients with inflammatory bowel diseases, that active disease and related symptoms themselves can induce symptoms of depression and anxiety,” researcher Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital Crohn’s and Colitis Center, said here. “… Prior studies examining the association between [psychiatric] comorbidity and disease course have been limited by a reliance on symptom-based disease activity indices, which can potentially be confounded by functional symptoms that are common in such patients.”
Depression or anxiety was observed in 1,050 of participants prior to their first IBD-related surgery, with a mean of 19 months between diagnosis and surgery among those with CD, and 17 months among those with UC. Those with psychiatric comorbidities were more likely to be female, older and have more comorbidities unrelated to IBD than those without psychiatric comorbidities. Patients with CD and psychiatric comorbidities underwent significantly more CT scans (mean per patient 2.1 compared with 0.9, P<.001) and colonoscopies (2.5 vs. 1.9, P<.001) than those without depression or anxiety.
Multivariate analysis indicated a significantly increased risk of the need for surgery among those with depression or anxiety (adjusted OR=1.27, 1.03-1.58) in the CD cohort, but not in the UC cohort (aOR=1.01, 0.8-1.29). Among CD patients, those with psychiatric comorbidities were significantly more likely to use immunomodulators (aOR=1.43, 1.21-1.67) and corticosteroids (aOR=1.83, 1.57-2.13), and were also at increased risk for all-cause hospitalization (aOR=1.48, 1.19-1.83) (95% CI for all).
“The presence of depression or anxiety was associated with a modest increase in risk of surgery for patients with CD, and no effect was seen on UC,” Ananthakrishnan concluded. “Psychiatric comorbidity was associated with significantly greater disease- and non-disease-related healthcare utilization, both from CD and UC. We need high-quality intervention studies addressing psychiatric comorbidity, and its potential effect on disease course.”
Disclosures: The researchers reported numerous financial disclosures.
Ananthakrishnan AN. #220: Psychiatric Co-Morbidity is Associated With Increased Risk of Surgery in Crohn’s Disease. Presented at: Digestive Disease Week; May 18-21, Orlando, Fla.