Careful Assessment for Depression Required for Patients With IBD
People with depression and IBD are more likely to experience a lower quality of life.
Baseline depression increases the risk for a more aggressive course in patients with inflammatory bowel disease (IBD), according to a study published in The American Journal of Gastroenterology. The study results also suggest that a single question is not sufficient to establish whether a patient has depression and that providers should consider administering a patient health questionnaire (PHQ-8) to better assess the patient's status.
Researchers from the Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, and from the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, Minnesota, used data from a prospective observational cohort of patients with IBD to assess methods for diagnosing depression and the effects of baseline depression on disease activity at follow-up. They included 2798 people with Crohn's disease and 1516 people with ulcerative colitis.
At baseline, disease was in remission in 64% of those with Crohn's disease and in 45% of those with ulcerative colitis. As assessed by self-report, 20% of patients with Crohn's disease and 14% of patients with ulcerative colitis were depressed. Use of the PHQ-8 identified much higher levels of depression, with 38% of those with Crohn's disease and 32% of those with ulcerative colitis having scores that indicated depression (P <.01). Overall, depression within the cohort was identified at 36% by the PHQ-8 scale.
After adjusting for gender, remission, and disease activity, patients with Crohn's disease with baseline depression had an increased risk for disease relapse (adjusted risk ratio [RR]: 2.3; 95% CI, 1.9-2.8), surgery, or hospitalization (RR: 1.3; 95% CI, 1.1-1.6) at follow-up. Patients with ulcerative colitis had an RR of 1.3 for relapse and an RR of 1.3 for surgery or hospitalization (95% CI, 0.9-1.7 and 1.1-1.5, respectively).
Limitations of the study included the lack of objective data, such as inflammatory markers or endoscopic scale of disease activity, lack of data on all comorbidities, and that all patients were treated at tertiary care centers in the United States, thus limiting the generalizability of the results.
The authors contend that the PHQ-8 is better at detecting moderate to severe depression than simply asking patients whether they are depressed. Furthermore, given the correlation between depression and worsening IBD disease activity, the authors suggest that assessing depression accurately is critical to the care of these patients.
Disclosures: Dr Long reports relationships with Abbvie, Takeda, and Theravance.
Kochar B, Barnes EL, Long MD, et al. Depression is associated with more aggressive inflammatory bowel disease [published online November 14, 2017]. Am J Gastroenterol. doi: 10.1038/ajg.2017.423