Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

Abstract

Background Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) Evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD, (2) Determine predictors of abdominal pain in Crohn’s disease (CD) and ulcerative colitis (UC). Methods 765 patients ages 9–17 with IBD seen over 3 years at two sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results 217 patients with IBD (161 CD, 56 UC) were depressed. 163 (120 CD, 43 UC) patients had complete API scores. In CD, abdominal pain was associated with depression (r=0.33; p<0.001), diarrhea (r=0.34; p=0.001), ESR (r=0.22; p=0.02), low albumin (r=0.24; p=.01), weight loss (r=0.33; p=0.001), and abdominal tenderness (r=0.38, p=0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (p=0.03), weight loss (p=0.04), and abdominal tenderness (p=0.01) predicted pain for CD patients. In UC, pain was associated with depression (r=0.46; p=0.002) and nocturnal stools (r=.32; p=.046). In the multivariate model with these significant correlates 23% of the variance was explained, and only depression (p=0.02) predicted pain. Conclusions The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications.

Clinical disease activity is associated with anxiety and depressive symptoms in adolescents and young adults with inflammatory bowel disease

“…For example, a prevalence of ±5% was reported in a study cohort of mild and uncomplicated disease (only patients in remission, oral medication (no steroids) and IBD diagnosis >1 year) . The most prevalent anxiety domains found in our study were social phobia, generalised anxiety and specific phobia, which is similar to other studies . The low prevalence of depressive symptoms in our cohort can be explained by the low CDI total cut‐off score used in the other studies, using cut‐off points of 9 or 10, which correspond to (T‐)scores within the average range .…”

“…Symptoms of anxiety and/or depression are often found in paediatric IBD patients. Reported prevalence rates range from 20% to 50% for anxiety and 25% to 40% for depression . Although some studies report lower rates, prevalence in paediatric IBD seems to be higher compared to other chronic diseases .…”

“…In paediatric IBD, the majority of studies also show active disease to be associated with both anxiety and depressive symptoms . Furthermore, female gender, older age at diagnosis, fatigue, abdominal pain, low socioeconomic status and steroid use were correlated with depression. In addition, female gender and abdominal pain have shown a correlation with anxiety.…”

Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease

“…Although depression and anxiety were not specific targets of intervention, higher prevalence of these psychological problems has been reported in children with IBD as noted in the introduction 18,19 and it was of interest to determine if an intervention to improve stress management and coping might have secondary effects on psychosocial function. Children in both conditions reported significant improvement on psychosocial functioning and depression symptoms with no difference between groups.…”

“…7,13-17 Typical of these, recently Reigada et al 18 found that anxiety symptoms were significantly associated with moderate/severe disease activity among children and adolescents with CD. Similarly, Srinath et al 19 found that depression was a significant predictor of abdominal pain in children and adolescents with IBD, perhaps more so in UC than in CD. Reed-Knight et al 20 also found that higher ratings of disease severity were related to greater depressive symptoms in youth with IBD.…”