Association Between Affective-Cognitive Symptoms of Depression and Exacerbation of Crohn’s Disease

Abstract

Objectives The prevalence of depression is high in patients with Crohn’s Disease (CD). We examined the influence of affective-cognitive symptoms of depression on the risk of exacerbation of CD. Methods We studied 2144 adult volunteers with a self-reported diagnosis of CD who completed a baseline survey that included demographics, CD status and an affective-cognitive index of depression. Linear and logistic regression analyses were used to determine if CD status at 12 months was associated with the baseline measure of depression. Analyses were adjusted for confounders including age, gender, race, baseline disease activity, disease duration, prior hospitalization and surgery, corticosteroid and anti-TNF use, medication adherence, BMI, current smoking, education, and sleep quality. Results Depression was significantly associated with subsequent increases in SCDAI score in both unadjusted (p<0.001) and adjusted (p< 0.001) analyses. This association was non-linear, with a shallower slope for lower levels of depression. A 10 point increase in depression t-scores from 55 to 65 was associated with a 18.6 point increase in SCDAI (95% CI 11.5–25.6) and an odds ratio of 1.27 for SCDAI > 150 at follow up (CI: 1.01–1.60). We also found a significant association between depressive symptoms and hospitalization. Conclusion Cognitive-affective depressive symptoms were significantly associated with a risk of exacerbation of CD and hospitalization.

Systematic review with meta‐analysis: the impact of a depressive state on disease course in adult inflammatory bowel disease

“…Research from cross‐sectional studies generally conclude a correlation between depression and worsening disease activity but cannot account for any temporal association between the exposure and outcome . A large prospective survey‐based study also reported that depressive symptoms were associated with an increased risk of patient‐reported disease activity . Patients who experience an improvement in disease activity also suffer less from depressive symptoms .…”

High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease

“…Despite the relatively selected population of the IBD Partners cohort, including a large number of college graduates, prior studies of IBD Partners participants have replicated the findings of these studies using other methods. 28,29 Although the population represented all regions of the United States, we did not have access to other geographic or socioeconomic factors that may also influence patient activation such as urban or rural location, household income, 40 or employment status. To evaluate patient activation and clinical remission in this population, we used validated survey instruments that have been utilized previously in IBD Partners.…”

“…We intentionally did not include anxiety or depression in the analyses of patient activation and disease activity in the follow-up period. This decision was based on prior evaluations that have demonstrated an association between anxiety and depression and disease activity in the IBD Partners population 28,29 and prior demonstrations of a significant relationship between patient activation and depression. 30 We believe that the relationship between anxiety and depression and clinical remission may be in part mediated by patient activation (and thus patient activation may be on the causal pathway between anxiety/depression and disease activity).…”

Modifiable Environmental Factors in Inflammatory Bowel Disease

“…The data on the impact of stress and depression in established disease is more heterogeneous. While some studies have demonstrated increased risk of clinical flares 116, 117 , non-response to therapy 118 , and IBD-related surgery, others have suggested an association primarily with symptomatic worsening of symptoms but not intestinal inflammation measured by fecal calprotectin levels 116, 119 .…”