Inflammatory markers, disease activity predict depression symptoms in pediatric IBD

ORLANDO — Inflammatory markers and disease activity were able to predict somatic-affective symptoms and anhedonia in pediatric IBD patients, according to a presentation at the 2015 Advances in IBD Meeting.

“Rates of depression across all pediatric IBD [patients] range from 12% to 25%, and previous work in our group showed that nearly 20% of depressed youth with IBD have a somatic symptom-predominant phenotype of depression,” Anne Levine, a medical student from University of Pittsburgh School of Medicine, said during her presentation. “It’s important to know that mood or affect itself can be associated with illness, and this has led to considerable debate over whether somatic symptoms truly represent depression or are simply a manifestation of [IBD]. With that debate in mind, we aimed to better understand the role that inflammation plays in somatic depression in this population. How much of somatic depression is and is not due to inflammation, and is it the whole story?”

Levine and colleagues evaluated 550 Crohn’s disease patients (51.8% male, mean age, 14.4 years) from Boston Children’s Hospital and Children’s Hospital Pittsburgh who were screened for depression using the Children’s Depressive Index. Based on Pediatric Crohn’s Disease Activity Index (PCDAI) Scores, 40.7% of participants were in remission, 32.7% had mild disease, 6.4% had moderate disease and 7.3% had severe disease. Moreover, 38.8% met criteria for clinically significant depressive symptoms at baseline, and among them 9.4% had previous surgery, 12.3% had an ostomy and 28.1% were on corticosteroids.

Depression symptom profiles developed by exploratory factor analysis included somatic-affective, low self-esteem, suicidality and anhedonia. Females, patients on corticosteroids, patients with high PCDAI scores, high erythrocyte sedimentation rate, low hematocrit or low albumin appeared to have a higher likelihood of somatic-affective symptoms based on univariate analysis (P < .01), and 27.9% of the variance in somatic-affective symptoms were explained by multiple regression modeling (P < .0005).

Subjective PCDAI symptoms, including pain, stool frequency and functional impairment, “made unique significant contributions to the model,” Levine and colleagues wrote.

High PCDAI subjective and objective lab scores, erythrocyte sedimentation rate, C-reactive protein and corticosteroid use were positively associated with anhedonia (P < .01), and 8.4% of the variance in anhedonia was explained by multiple regression modeling, “with subjective PCDAI symptoms making unique significant contributions.” Finally, low self-esteem and suicidality were found to correlate with the subjective PCDAI subscale (P <.01), but they did not correlate with markers of inflammation.

“Inflammatory markers and disease activity are significant predictors of somatic-affective symptoms and anhedonia in youth with IBD,” Levine and colleagues wrote.

“While we are still studying the exact nature or the relationship between inflammation and depression, we can make some suggestions here about treatment,” Levine said during her presentation. “Identifying depressive symptom clusters present in your patients with IBD can help guide treatment of comorbid IBD and depression. Previous work by our group has shown that patients with somatic affective symptoms can benefit from cognitive behavioral therapy.” – by Adam Leitenberger

Reference: Levine A, et al. Abstract O-017. Presented at Advances in Inflammatory Bowel Diseases; Dec. 10-12, 2015; Orlando, Fla.

Disclosures: Healio Gastroenterology was unable to confirm relevant financial disclosures at the time of publication.