Depression Is Associated With More Aggressive Inflammatory Bowel Disease

Kochar, Bharati; Barnes, Edward L.; Long, Millie D.; Cushing, Kelly C.; Galanko, Joseph A.; Martin, Christopher F.; Raffals, Laura E.; Sandler, Robert S.

doi:10.1038/ajg.2017.423

Cited by 133 publications

(136 citation statements)

References 37 publications

(34 reference statements)

Supporting

Mentioning

126

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, in the present survey, psychological distress was associated with several important clinical parameters: active disease, hospitalization, presence of fistulas, perianal disease, pain, and fatigue and the current use of steroids, opioids, and psychotropics. This is in line with the findings of previous studies showing that poor mental health is associated with disease flares and a generally poorer IBD prognosis . Poor mental health has also been previously reported as a significant predictor of hospitalization, readmission, and increased risk of surgery in those with IBD.…”

Section: Discussionsupporting

confidence: 92%

“…The bidirectional links between mental and physical health in IBD have also been established: Baseline IBD activity is associated with a nearly sixfold increase in the risk of anxiety over a period of 2 years, while anxious patients in IBD remission at baseline have a greater need for steroids, escalation of therapy, or IBD flare over time than those without anxiety. Moreover, the course of IBD is negatively affected by mental illness, resulting in more frequent flare ups, a more aggressive presentation, hospital readmissions, and increased risk of surgery …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Psychological distress is highly prevalent in inflammatory bowel disease: A survey of psychological needs and attitudes

et al. 2019

View full text Add to dashboard Cite

Background and Aim Data on patient needs and access to psychological services in inflammatory bowel disease (IBD) are scarce. This study aimed to describe the levels of distress and the needs, attitudes, and access to psychological services for people within Australia against established Australian IBD Standards. Methods An online cross‐sectional survey was conducted with Australians ≥16 years old recruited via Crohn's & Colitis Australia membership, public and private clinics, and the Royal Flying Doctor Service. K10 was used to measure psychological distress. The Chi‐square test was used to compare those with and without distress on key variables. Results Overall, 731 respondents provided complete data (71.5% female, mean age 46.5 years). Overall, 50% of respondents reported distress; only 15.2% were currently seeing a mental health practitioner; only 16.1% were asked about their mental health by their IBD specialist or IBD nurse; and only 12.2% reported access to a mental health practitioner as part of their IBD service. Those with psychological distress were significantly less satisfied with their IBD care; more commonly hospitalized; had an active disease, fistula or perianal disease, pain, or fatigue; and were receiving steroids, opioids, or antidepressants (all P < 0.05). As many as 68.2% of those with severe distress were not seeing a mental health practitioner. Conclusions The integrated biopsychosocial model of health care, with regular mental health screening and good access to mental health professionals, is requested by people living with IBD to improve their outcomes.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Psychological distress is highly prevalent in inflammatory bowel disease: A survey of psychological needs and attitudes

et al. 2019

View full text Add to dashboard Cite

show abstract

“…15–18 Anxiety and depression rates were comparable to published rates. 19, 20 Psychosocial complexity influenced the IBD course. 21 Less than one half of our cohort had active IBD at baseline with psychosocial factors adversely impacting quality of life and medical utilization.…”

Section: Discussionmentioning

confidence: 99%

Reduced Unplanned Care and Disease Activity and Increased Quality of Life After Patient Enrollment in an Inflammatory Bowel Disease Medical Home

Regueiro

Click

Anderson

et al. 2018

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

show abstract

“…In database studies, a pre‐existing diagnosis of clinical depression is associated with adverse outcomes in IBD . A recent high‐quality prospective cohort study of 4314 patients with IBD over 2 years found significant associations between depressive symptoms and increased risk of multiple adverse outcomes, including relapse, hospitalization, requirement for biologicals and surgery . Further, another prospective study of 2007 patients found that depressive symptoms expedited clinical recurrence .…”

Section: Epidemiologymentioning

confidence: 99%

“…Notably, depressive symptoms occur in more than 20% of people with IBD, which is approximately two to four times more common than in the general population . As well as reduced quality of life, the co‐morbidity of depressive symptoms and IBD is associated with poor biomedical outcomes, including increased risk of IBD relapse, hospitalization and surgery .…”

Section: Introductionmentioning

confidence: 99%

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Moulton

Pavlidis

Norton

et al. 2019

Clinical and Experimental Immunology

View full text Add to dashboard Cite

Summary Depressive symptoms are reported by more than 20% of people with inflammatory bowel disease (IBD), while sleep difficulties and fatigue are even more common. Co‐morbid depressive symptoms predict a poor IBD course, including increased risk of relapse and surgery, which is inconsistently improved by psychological treatments. Rather than being distinct systems, there is compelling evidence for bidirectional communication between gut and brain, driven by neural, metabolic, endocrine and inflammatory mediators. An emerging concept is that depressive symptoms may be mechanistically linked to excess inflammation and dysregulation of the gut–brain axis. Given the close link between the intestinal microbiota and host immune responses, patients prone to shifts in their intestinal microbiome, including smokers, those with poor diet and early life stress, may be exposed to exaggerated immune responses. Excess inflammation is associated with brain changes (depressive symptoms, fatigue, sleep difficulties) and worsening gastrointestinal symptoms, which are exacerbated by psychological distress. Equally, treatments both for depressive symptoms and IBD provide opportunities to break this cycle by reducing the causes and effects of inflammation. As well as addressing potential risk factors such as smoking and diet, treatments to alter the microbiome may reduce depressive symptoms. Observational evidence suggests that anti‐inflammatory treatments for IBD may improve co‐morbid depressive symptoms correlating with reduction in inflammation. With a growing range of treatments targeting inflammation centrally, peripherally and in the gut, IBD provides a unique model to understand the interplay between brain and gut in the pathogenesis of depressive symptoms, both in IBD and in the whole population.

show abstract

Depression Is Associated With More Aggressive Inflammatory Bowel Disease

Abstract: Baseline depression is associated with a higher risk for aggressive IBD at follow-up. A single question is not a sensitive method of assessing depression. Providers should consider administering the PHQ-8 to capture those at greater risk for aggressive disease.

Cited by 133 publications

References 37 publications

Psychological distress is highly prevalent in inflammatory bowel disease: A survey of psychological needs and attitudes

Psychological distress is highly prevalent in inflammatory bowel disease: A survey of psychological needs and attitudes

Reduced Unplanned Care and Disease Activity and Increased Quality of Life After Patient Enrollment in an Inflammatory Bowel Disease Medical Home

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Contact Info

Product

Resources

About