Risk Factors for Depression after IBD Diagnosis

Depression risk in IBD patients linked to female gender and disease state

(RxWiki News) Depression is more common in people with inflammatory bowel disease (IBD) than in the general population, but some people with IBD have an even higher risk for depression.

Inflammatory bowel diseases (IBD) are disorders of the gastrointestinal tract such as Crohn’s disease and ulcerative colitis. Often diagnosed at a young age and faced with a disease that keeps flaring, people with IBD are more prone to depression.

Sorting out exactly which IBD patients are at greater risk for depression was the subject of a recent study.

This study showed that women and people with aggressive or more active IBD were at a higher risk for depression.

"Tell your doctor how you feel about living with IBD."

Dr. Daniel A. Sussman, MD, of the Department of Internal Medicine at the University of Miami in Miami, FL, and a research team conducted this study.

The study enrolled 393 patients with Crohn’s disease or ulcerative colitis. The average age of the patients was 43. Data was collected on the study subjects for an average of eight years.

Diagnosis of depression was based on review of the patients’ medical records and depression prescription medication records. The researchers looked for information on the patients' IBD to determine if the disease was active or aggressive.

The researchers defined active disease as findings of bowel inflammation on endoscopic examination, in which a scope was used to visualize the bowel. Aggressive disease was defined as use of medications called biologics at any time during the disease course, current or prior surgery for IBD or presence of any fistulas (abnormal openings or connections in the bowel).

Overall, 20 percent of the patients in the study were depressed.

Compared to people with IBD only, people who had IBD and depression were 30 percent more likely to be women, 40 percent more likely to have aggressive/hard to treat disease and 50 percent more likely to have active/symptomatic IBD.

Of the people who were diagnosed with depression, 65 percent were treated with medication for their depression.

Limitations of the study noted by the authors were that this was a study that looked back on already existing information, rather than starting from a certain date and looking forward, where it might have been possible to evaluate other factors. This study also lacked a control group of people without IBD.

Since only 65 percent of the depressed patients were receiving medication for their depression, the authors noted that it was unclear if this might be due to the non-referral of depressed patients to mental health providers or if they were receiving non-medication based therapy.

According to the authors, "Changes in IBD activity significantly affect psychological well-being; these changes closely correspond to depressive symptoms in IBD patients. ... Several researchers have reported that mental health status in IBD patients in remission is comparable to that of the general population."

Other studies noted by the authors report that patients who are depressed are less likely to adhere to other medical advice, thereby impacting effective IBD treatment.

“Given the high prevalence of depression in IBD and its impact on quality of life, screening for mood disorders should be considered as a quality of care standard in patients with IBD,” the authors wrote.

This study was published in the March issue of Alimentary Pharmacology and Therapeutics.

Dr. Sussman disclosed serving on an advisory board for Exact Sciences Corporation. Dr. Sussman also reported receiving research funding from Olympus America, Bankhead-Coley Team Science Program, Sylvester Comprehensive Cancer Center of University of Miami and the American Cancer Society.

Review Date: 
March 12, 2014