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

Citation:

Ananthakrishnan AN, Gainer VS, Perez RG, Cai T, Cheng SC, Savova G, Chen P, Szolovits P, Xia Z, De Jager PL, et al. Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease. Alimentary pharmacology & therapeutics. 2013;37 :445-54.

Date Published:

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.

Notes:

Ananthakrishnan, A NGainer, V SPerez, R GCai, TCheng, S-CSavova, GChen, PSzolovits, PXia, ZDe Jager, P LShaw, S YChurchill, SKarlson, E WKohane, IPerlis, R HPlenge, R MMurphy, S NLiao, K PAR047782/AR/NIAMS NIH HHS/K08 AR060257/AR/NIAMS NIH HHS/K23 DK097142/DK/NIDDK NIH HHS/K24 AR052403/AR/NIAMS NIH HHS/R01 AR049880/AR/NIAMS NIH HHS/R01 AR056768/AR/NIAMS NIH HHS/R01-AR056768/AR/NIAMS NIH HHS/R01-AR059648/AR/NIAMS NIH HHS/U01-GM092691/GM/NIGMS NIH HHS/U54 LM008748/LM/NLM NIH HHS/U54-LM008748/LM/NLM NIH HHS/EnglandAliment Pharmacol Ther. 2013 Feb;37(4):445-54. doi: 10.1111/apt.12195. Epub 2013 Jan 7.