Depressive Symptoms Predict Clinical Recurrence of Inflammatory Bowel Disease

Abstract

Background Inflammatory bowel disease (IBD) patients are at high risk for depression, and depression has been shown to affect disease course. We examined interrelations between depression, genetic risk factors for depression, and IBD flares. Method In 1973 patients (1137 Crohn’s disease, 836 ulcerative colitis) of the Swiss IBD Cohort Study (SIBDCS), depressive status (hospital anxiety and depression subscale for depression, HADS-D ≥11) was assessed on a yearly basis. We investigated the impact of depression on IBD-relevant clinical outcomes in Cox proportional hazards models. We used active disease (CDAI ≥150 or MTWAI ≥10) and 2 published composite flare definitions—FNCE (physician-reported flare, nonresponse to therapy, new complication, or extraintestinal manifestation) and AFFSST (active disease, physician-reported flare, fistula, stenosis, and new systemic therapy)—as clinical end points. Additionally, 62 preselected single nucleotide polymorphisms (SNPs) were screened for cross-sectional associations with depression, and if present, their predictive value for future depression and clinical deterioration was assessed. Results Depression was a strong risk factor for disease-related end points, including active disease (adjusted hazard ratio [aHR], 3.55; P < 0.001), AFFSST (aHR, 1.62; P < 0.001), and FNCE (aHR, 1.35; P = 0.019). The SNP rs2522833 was significantly associated with depression at enrollment (q = 0.059). The TC allele of rs588765 was negatively associated with the presence of depression at enrollment (q = 0.050) and after enrollment (aHR, 0.67; P = 0.035) and with fewer active disease states (aHR, 0.72; P = 0.045) during follow-up. Conclusion In IBD, depressive symptoms and inflammatory activity are intimately related. Depressive symptoms were a strong predictor of clinical deterioration, and genetic markers may play a role in this relationship.

Relative Contribution of Disease Activity and Psychological Health to Prognosis of Inflammatory Bowel Disease During 6.5 Years of Longitudinal Follow-Up

“…However, many of these studies have not characterized patients based on presence or absence of disease activity at baseline. [15][16][17]36 In one study that restricted recruitment to patients with IBD in remission, a significant increase in risk of flare of disease activity and escalation was seen in those with symptoms of common mental disorders at baseline. 4 In other studies of similar design, stress also appears to be a predictor of relapse.…”

Online Mindfulness Intervention for Inflammatory Bowel Disease: Adherence and Efficacy

“…A systematic review found that people with comorbid anxiety and depression in IBD could benefit from non-pharmacologic interventions, yet often did not have access to interventions ( Dubinsky et al, 2021 ). In a longitudinal study, Jordi et al (2021) found that depression at enrollment was a robust risk factor for more severe IBD disease and inflammatory activity over time. Additionally, reduced depressive symptoms are associated with many health behaviors such as medication adherence, healthy diet, exercise, access to social support, and other behaviors that contribute to positive disease outcomes.…”

Can visceral adipose tissue and skeletal muscle predict recurrence of newly diagnosed Crohn’s disease in different treatments

“…(1) The patients got CDAI ≥ 150 [ 17 ] or simplified endoscopic activity score for Crohn’s disease (SES-CD) [ 18 ] ≥ 2 during the follow-up period within 1 year. (2) Any CD-related hospitalization, surgery, need for rescue corticosteroids, and treatment dose escalation within 1 year [ 4 , 19 , 20 ]. As long as one of the above conditions occurred, the patient was considered to have recurrence.…”