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Comparative Study
. 2013 Apr;108(4):594-601.
doi: 10.1038/ajg.2012.471. Epub 2013 Jan 22.

Similar risk of depression and anxiety following surgery or hospitalization for Crohn's disease and ulcerative colitis

Ashwin N Ananthakrishnan  1 , Vivian S Gainer, Tianxi Cai, Raul Guzman Perez, Su-Chun Cheng, Guergana Savova, Pei Chen, Peter Szolovits, Zongqi Xia, Philip L De Jager, Stanley Shaw, Susanne Churchill, Elizabeth W Karlson, Isaac Kohane, Roy H Perlis, Robert M Plenge, Shawn N Murphy, Katherine P Liao
Affiliations
Comparative Study

Similar risk of depression and anxiety following surgery or hospitalization for Crohn's disease and ulcerative colitis

Ashwin N Ananthakrishnan et al. Am J Gastroenterol. 2013 Apr.

Abstract

Objectives: Psychiatric comorbidity is common in Crohn's disease (CD) and ulcerative colitis (UC). Inflammatory bowel disease (IBD)-related surgery or hospitalizations represent major events in the natural history of the disease. The objective of this study is to examine whether there is a difference in the risk of psychiatric comorbidity following surgery in CD and UC.

Methods: We used a multi-institution cohort of IBD patients without a diagnosis code for anxiety or depression preceding their IBD-related surgery or hospitalization. Demographic-, disease-, and treatment-related variables were retrieved. Multivariate logistic regression analysis was performed to individually identify risk factors for depression and anxiety.

Results: Our study included a total of 707 CD and 530 UC patients who underwent bowel resection surgery and did not have depression before surgery. The risk of depression 5 years after surgery was 16% and 11% in CD and UC patients, respectively. We found no difference in the risk of depression following surgery in the CD and UC patients (adjusted odds ratio, 1.11; 95% confidence interval, 0.84-1.47). Female gender, comorbidity, immunosuppressant use, perianal disease, stoma surgery, and early surgery within 3 years of care predicted depression after CD surgery; only the female gender and comorbidity predicted depression in UC patients. Only 12% of the CD cohort had ≥4 risk factors for depression, but among them nearly 44% subsequently received a diagnosis code for depression.

Conclusions: IBD-related surgery or hospitalization is associated with a significant risk for depression and anxiety, with a similar magnitude of risk in both diseases.

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Figures

Figure 1
Figure 1
Flowchart demonstrating development of Crohn’s disease and ulcerative colitis cohorts
Figure 2
Figure 2
Risk of depression following IBD-related surgery in Crohn’s disease and ulcerative colitis
Figure 3
Figure 3
Risk of depression following surgery in Crohn’s disease, stratified by requirement for a stoma
Figure 4
Figure 4. Frequency of depression following surgery in Crohn’s disease, stratified by the number of risk factors
(a) Distribution of risk factors for depression following CD-related surgery (b) Frequency of depression stratified by presence of risk factors
Figure 4
Figure 4. Frequency of depression following surgery in Crohn’s disease, stratified by the number of risk factors
(a) Distribution of risk factors for depression following CD-related surgery (b) Frequency of depression stratified by presence of risk factors
See this image and copyright information in PMC

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