Depression Subtypes in Pediatric Inflammatory Bowel Disease

Abstract

Objective The association between inflammatory bowel disease (IBD) and depression provides a unique opportunity to understand the relation between systemic inflammation and depressive symptom profiles. Methods Youth (n = 226) ages 9 to 17 years with comorbid IBD and depression underwent psychiatric assessment and evaluation of IBD activity. Latent profile analysis (LPA) identified depressive subgroups based on similar responses to the Children’s Depression Rating Scale-Revised. Demographic factors, depression severity, anxiety, IBD activity, inflammatory markers, IBD-related medications, and illness perception were evaluated as predictors of profile membership. Results Mean age was 14.3 years; 75% had Crohn disease; 31% were taking systemic corticosteroids. Mean depressive severity was moderate, whereas IBD activity, which reflects inflammation, was mild. LPA identified 3 subgroups: Profile-1 (mild, 75%) had diverse low-grade depressive symptoms and highest quality of life; Profile-2 (somatic, 19%) had severe fatigue, appetite change, anhedonia, decreased motor activity, and depressed mood with concurrent high-dose steroid therapy and the highest IBD activity; and Profile-3 (cognitive, 6%) had the highest rates of self-reported depressive symptoms, ostomy placements, and anxiety with IBD symptoms in the relative absence of inflammation. Conclusions Evidence was found for 3 depression profiles in youth with IBD and depression. Our analyses determined that patients with predominantly somatic or cognitive symptoms of depression comprised 25% of our cohort. These findings may be used to design subgroup-specific interventions for depression in adolescents with IBD and other physical illnesses associated with systemic inflammation.

Randomized Efficacy Trial of Two Psychotherapies for Depression in Youth With Inflammatory Bowel Disease

“…Because the PCDAI and PUCAI yield different indices, both measures were separately converted to z-scores to combine them into one disease activity variable. 11 …”

“…9,10 Findings suggest that depression in pediatric IBD is a heterogeneous condition with etiologically different subtypes (mild–low-grade symptoms, somatic–IBD-related symptoms, and cognitive–cognitive despair symptoms), 11 making psychiatric treatment challenging.…”

Pediatric inflammatory bowel disease and depression

“…(13) This group had a greater number of ostomies and longest IBD duration, as well as pain in the relative absence of inflammation. Suicidal ideation has been understudied in pediatric IBD.…”

“…(10, 11) In patients with IBD, such depressive subtypes can have many different etiological underpinnings,(12) In a recent study, we conducted latent profile analysis to evaluate the relationship between systemic inflammation and depressive symptom profiles in 226 depressed youth with IBD. (13) Three distinct depressive profiles were identified: (1) youth with diverse milder depressive symptoms in the relative absence of systemic inflammation (75%); (2) youth with (13) high levels of somatic depressive symptoms in the presence of elevated inflammation (19%); and (3) youth with high levels of cognitive despair, including suicidal ideation, with relatively low inflammation (6%). These clusters of depressive symptoms may have unique etiological underpinnings including neurobiological effects of inflammation, gastrointestinal symptoms (e.g., abdominal pain), medication side effects and/or a psychological reaction to a new diagnosis, hospital admission, poor disease course, or other life stressor.…”

“…(16) In pediatric IBD, somatic depressive symptoms (e.g., fatigue, sleep disturbance) have most correlated with IBD activity. (13) From a phylogenetic survival perspective, these depressive symptoms may play a protective role during threat states such as severe acute IBD flares by shunting energy resources from the brain to the gastrointestinal tract to facilitate healing. (17) Thus, in some patients, rest and medical management of their IBD may sufficiently facilitate improvement in depressive symptoms.…”