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Depression assessment crucial in care of patients with IBD
Accurately assessing depression is critical to the care of patients with inflammatory bowel diseases, according to a study published in The American Journal of Gastroenterology.
Although previous studies have indicated that depression correlated with more aggressive inflammatory bowel disease, Bharati Kochar, MD, MSCR, of the Center for Gastrointestinal Biology and Disease at the University of North Carolina, and colleagues wrote that a more accurate scale to test for patients with depression is required as part of routine clinical practice.
“Simply asking a patient whether they are depressed is not an adequate means of identifying those who are depressed and at increased risk for worsening IBD,” they wrote. “Although this method is specific for depression, it lacks sensitivity and therefore is not an appropriate screening tool.”
The researchers used data from The Sinai-Helmsley Alliance for Research Excellence cohort, which included patients with Crohn’s disease (CD) (n = 2,798) and ulcerative colitis (UC) (n = 1,516).
Investigators assessed patients for depression in two ways. First, they asked each patient if they had depression as a single question, which Kochar and colleagues defined as self-reported depression. Second, patients answered an 8-question public health questionnaire (PHQ-8), a common method of screening for depression. A score of 5 or greater was consistent with at least mild depression and a score of 10 or greater was consistent with moderate to severe depression.
Eighteen percent of the patients self-reported having depression at the baseline, while 36% scored positive for depression on the PHQ-8 scale.
The researchers found that patients with CD who had depression at baseline according to their PHQ scores had a significantly higher risk for worse disease at follow-up and were at higher risk for relapse (RR = 2.3; 95% CI, 1.9-2.8). Patients with UC were also at higher risk for more aggressive disease, according to the study.
The investigators found that IBD patients with depression also were more likely to receive new biologic and steroid prescriptions, to be hospitalized and to undergo surgery more often over time than those without.
“Given the important correlation between depression and worsening disease activity over time, assessing depression accurately is critical to the care of IBD patients,” the researchers wrote. “Providers caring for IBD patients should consider administering the PHQ-8 as part of their routine clinical practice to screen patients for depression.” – by Alex Young
Disclosures: Kochar reports no relevant financial disclosures. Please see the full study for all other authors’ financial disclosures.