Risk Factors for Depression in the Elderly Inflammatory Bowel Disease Population

Abstract

Background and Aims-Little is known about depression in elderly individuals with inflammatory bowel diseases (IBD). We assessed the point prevalence of depression and determined associations with disease activity, quality of life, and medication adherence in elderly patients with IBD. Methods-We identified elderly (≥65 years) individuals within Crohn's and Colitis Foundation of America Partners, an online IBD cohort. Individuals completed the short-geriatric depression scale (GDS). We used bivariate statistics to determine whether demographic or disease-related factors, disease activity, quality of life or medication adherence was associated with depression. We used logistic regression to estimate independent effects of depression on medication adherence. Results-A total of 359 elderly individuals with IBD completed the GDS. The mean age was 70.2 years (sd 4.7); mean disease duration was 25.6 years (sd 17.6), 62.6% had Crohn's disease (CD). The point prevalence of depression was 22.6%. Lower education levels (p=0.001), higher corticosteroid use (<0.01) and lower exercise levels (<0.001) were associated with depression. For

Untitled

“…24 Although the literature has established that there is a significant relationship between depression and fistulizing Crohn's, surgery, biologic and steroid use, we did not find this in our study. 19 They also found that anxiety was associated with ulcerative colitis flares, biologic use in Crohn's disease, and steroid use in both Crohn's disease and ulcerative colitis.…”

“…36 Although studies have suggested that patients with IBD and depression are at higher risk for more aggressive disease, hospitalizations, surgeries, and new biologic prescriptions, the mechanism are less clear. 19 Perhaps people with depression are less compliant with their medications, thus increasing the risk of developing complications associated with IBD. Future studies should also consider evaluating the concomitant use of anti-depressants.…”

“…Much of what we know about depression and IBD is based on cross-sectional data 10,19 and only two prospective studies have assessed changes in disease activity in IBD patients with depression. 11,20 We aimed to assess the compliance of practitioners with depression screening of all patients seen in an outpatient, tertiary care, IBD clinic.…”

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).…”