Depression is associated with more aggressive inflammatory bowel disease

Bharati Kochar, Edward L. Barnes, Millie D. Long, Kelly C. Cushing, Joseph Galanko, Christopher F. Martin, Laura E. H. Raffals, Robert S. Sandler

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVES: Depression is prevalent in inflammatory bowel disease (IBD) patients. The impact of depression on IBD is not well-studied. It is unknown how providers should assess depression. METHODS: We used data from the Sinai-Helmsley Alliance for Research Excellence cohort, to assess methods of diagnosing depression and effects of baseline depression on disease activity at follow-up. A patient health questionnaire (PHQ-8) score ≥5 was consistent with mild depression. Relapse was defined as a modified Harvey-Bradshaw Index ≥5 or Simple Clinical Colitis Activity Index >2. We performed binomial regression to calculate adjusted risk ratios (RRs). RESULTS: We included 2,798 Crohn's disease (CD) patients with 22-month mean follow-up and 1,516 ulcerative colitis (UC) patients with 24-month mean follow-up. A total of 64% of CD patients and 45% of UC patients were in remission at baseline. By self-report, 20% of CD and 14% of UC patients were depressed. By PHQ-8, 38% of CD and 32% of UC patients were depressed ( P <0.01). Adjusted for sex, remission, and disease activity, CD patients with baseline depression were at an increased risk for relapse (RR: 2.3; 95% confidence interval (CI): 1.9-2.8), surgery, or hospitalization (RR: 1.3 95% CI: 1.1-1.6) at follow-up. UC patients with baseline depression were also at increased risk for relapse (RR: 1.3; 95% CI: 0.9-1.7), surgery, or hospitalization (RR: 1.3; 95% CI: 1.1-1.5) at follow-up. CONCLUSIONS: Baseline depression is associated with a higher risk for aggressive IBD at follow-up. A single question is not a sensitive method of assessing depression. Providers should consider administering the PHQ-8 to capture those at greater risk for aggressive disease.

Original languageEnglish (US)
Pages (from-to)80-85
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume113
Issue number1
DOIs
StatePublished - Jan 1 2018

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Inflammatory Bowel Diseases
Ulcerative Colitis
Crohn Disease
Odds Ratio
Confidence Intervals
Recurrence
Hospitalization
Colitis
Self Report
Health

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Kochar, B., Barnes, E. L., Long, M. D., Cushing, K. C., Galanko, J., Martin, C. F., ... Sandler, R. S. (2018). Depression is associated with more aggressive inflammatory bowel disease. American Journal of Gastroenterology, 113(1), 80-85. https://doi.org/10.1038/ajg.2017.423

Depression is associated with more aggressive inflammatory bowel disease. / Kochar, Bharati; Barnes, Edward L.; Long, Millie D.; Cushing, Kelly C.; Galanko, Joseph; Martin, Christopher F.; Raffals, Laura E. H.; Sandler, Robert S.

In: American Journal of Gastroenterology, Vol. 113, No. 1, 01.01.2018, p. 80-85.

Research output: Contribution to journalArticle

Kochar, B, Barnes, EL, Long, MD, Cushing, KC, Galanko, J, Martin, CF, Raffals, LEH & Sandler, RS 2018, 'Depression is associated with more aggressive inflammatory bowel disease', American Journal of Gastroenterology, vol. 113, no. 1, pp. 80-85. https://doi.org/10.1038/ajg.2017.423
Kochar B, Barnes EL, Long MD, Cushing KC, Galanko J, Martin CF et al. Depression is associated with more aggressive inflammatory bowel disease. American Journal of Gastroenterology. 2018 Jan 1;113(1):80-85. https://doi.org/10.1038/ajg.2017.423
Kochar, Bharati ; Barnes, Edward L. ; Long, Millie D. ; Cushing, Kelly C. ; Galanko, Joseph ; Martin, Christopher F. ; Raffals, Laura E. H. ; Sandler, Robert S. / Depression is associated with more aggressive inflammatory bowel disease. In: American Journal of Gastroenterology. 2018 ; Vol. 113, No. 1. pp. 80-85.
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abstract = "OBJECTIVES: Depression is prevalent in inflammatory bowel disease (IBD) patients. The impact of depression on IBD is not well-studied. It is unknown how providers should assess depression. METHODS: We used data from the Sinai-Helmsley Alliance for Research Excellence cohort, to assess methods of diagnosing depression and effects of baseline depression on disease activity at follow-up. A patient health questionnaire (PHQ-8) score ≥5 was consistent with mild depression. Relapse was defined as a modified Harvey-Bradshaw Index ≥5 or Simple Clinical Colitis Activity Index >2. We performed binomial regression to calculate adjusted risk ratios (RRs). RESULTS: We included 2,798 Crohn's disease (CD) patients with 22-month mean follow-up and 1,516 ulcerative colitis (UC) patients with 24-month mean follow-up. A total of 64{\%} of CD patients and 45{\%} of UC patients were in remission at baseline. By self-report, 20{\%} of CD and 14{\%} of UC patients were depressed. By PHQ-8, 38{\%} of CD and 32{\%} of UC patients were depressed ( P <0.01). Adjusted for sex, remission, and disease activity, CD patients with baseline depression were at an increased risk for relapse (RR: 2.3; 95{\%} confidence interval (CI): 1.9-2.8), surgery, or hospitalization (RR: 1.3 95{\%} CI: 1.1-1.6) at follow-up. UC patients with baseline depression were also at increased risk for relapse (RR: 1.3; 95{\%} CI: 0.9-1.7), surgery, or hospitalization (RR: 1.3; 95{\%} CI: 1.1-1.5) at follow-up. CONCLUSIONS: Baseline depression is associated with a higher risk for aggressive IBD at follow-up. A single question is not a sensitive method of assessing depression. Providers should consider administering the PHQ-8 to capture those at greater risk for aggressive disease.",
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AU - Martin, Christopher F.

AU - Raffals, Laura E. H.

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AB - OBJECTIVES: Depression is prevalent in inflammatory bowel disease (IBD) patients. The impact of depression on IBD is not well-studied. It is unknown how providers should assess depression. METHODS: We used data from the Sinai-Helmsley Alliance for Research Excellence cohort, to assess methods of diagnosing depression and effects of baseline depression on disease activity at follow-up. A patient health questionnaire (PHQ-8) score ≥5 was consistent with mild depression. Relapse was defined as a modified Harvey-Bradshaw Index ≥5 or Simple Clinical Colitis Activity Index >2. We performed binomial regression to calculate adjusted risk ratios (RRs). RESULTS: We included 2,798 Crohn's disease (CD) patients with 22-month mean follow-up and 1,516 ulcerative colitis (UC) patients with 24-month mean follow-up. A total of 64% of CD patients and 45% of UC patients were in remission at baseline. By self-report, 20% of CD and 14% of UC patients were depressed. By PHQ-8, 38% of CD and 32% of UC patients were depressed ( P <0.01). Adjusted for sex, remission, and disease activity, CD patients with baseline depression were at an increased risk for relapse (RR: 2.3; 95% confidence interval (CI): 1.9-2.8), surgery, or hospitalization (RR: 1.3 95% CI: 1.1-1.6) at follow-up. UC patients with baseline depression were also at increased risk for relapse (RR: 1.3; 95% CI: 0.9-1.7), surgery, or hospitalization (RR: 1.3; 95% CI: 1.1-1.5) at follow-up. CONCLUSIONS: Baseline depression is associated with a higher risk for aggressive IBD at follow-up. A single question is not a sensitive method of assessing depression. Providers should consider administering the PHQ-8 to capture those at greater risk for aggressive disease.

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