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. 2013 Feb;37(4):445-54.
doi: 10.1111/apt.12195. Epub 2013 Jan 7.

Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease

A N Ananthakrishnan  1 , V S Gainer, R G Perez, T Cai, S-C Cheng, G Savova, P Chen, P Szolovits, Z Xia, P L De Jager, S Y Shaw, S Churchill, E W Karlson, I Kohane, R H Perlis, R M Plenge, S N Murphy, K P Liao
Affiliations

Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease

A N Ananthakrishnan et al. Aliment Pharmacol Ther. 2013 Feb.

Abstract

Background: Psychiatric co-morbidity, in particular major depression and anxiety, is common in patients with Crohn's disease (CD) and ulcerative colitis (UC). Prior studies examining this may be confounded by the co-existence of functional bowel symptoms. Limited data exist examining an association between depression or anxiety and disease-specific endpoints such as bowel surgery.

Aims: To examine the frequency of depression and anxiety (prior to surgery or hospitalisation) in a large multi-institution electronic medical record (EMR)-based cohort of CD and UC patients; to define the independent effect of psychiatric co-morbidity on risk of subsequent surgery or hospitalisation in CD and UC, and to identify the effects of depression and anxiety on healthcare utilisation in our cohort.

Methods: Using a multi-institution cohort of patients with CD and UC, we identified those who also had co-existing psychiatric co-morbidity (major depressive disorder or generalised anxiety). After excluding those diagnosed with such co-morbidity for the first time following surgery, we used multivariate logistic regression to examine the independent effect of psychiatric co-morbidity on IBD-related surgery and hospitalisation. To account for confounding by disease severity, we adjusted for a propensity score estimating likelihood of psychiatric co-morbidity influenced by severity of disease in our models.

Results: A total of 5405 CD and 5429 UC patients were included in this study; one-fifth had either major depressive disorder or generalised anxiety. In multivariate analysis, adjusting for potential confounders and the propensity score, presence of mood or anxiety co-morbidity was associated with a 28% increase in risk of surgery in CD (OR: 1.28, 95% CI: 1.03-1.57), but not UC (OR: 1.01, 95% CI: 0.80-1.28). Psychiatric co-morbidity was associated with increased healthcare utilisation.

Conclusions: Depressive disorder or generalised anxiety is associated with a modestly increased risk of surgery in patients with Crohn's disease. Interventions addressing this may improve patient outcomes.

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Figures

Figure 1
Figure 1
Flowchart demonstrating development of Crohn’s disease and ulcerative colitis cohorts
See this image and copyright information in PMC

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