Depression Common Among Individuals With Enterostomy

A meta-analytical review published in Frontiers in Psychiatry found that ~40% of patients with enterostomy experienced depression.

Investigators from the National University of Singapore searched publication databases through May 2022 for studies evaluating depression and psychological outcomes among patients with enterostomy.

A total of 9 studies comprising 823 patients were included in this analysis. The studies were published between 2005 and 2022, they were all conducted in unique countries, and were all of cross-sectional designs. The outcome of depression was assessed using the Patient Health Questionnaire-9; Hospital Anxiety and Depression Scale; Beck Depression Inventory; Depression, Anxiety Stress Scale 21; Major Depression Inventory; or clinician rating.

The average ages of the patients ranged between 36.2 and 62.6 years and patients had inflammatory bowel disease, fecal incontinence, or colorectal cancer.

The pooled prevalence of depression was 41.6% (95% CI, 25.4%-59.7%; I², 94.513; P <.001). Neither age (P =.4806) nor gender (P =.5674) had a moderation effect on depression.

In a subgroup analysis, significant group effects for region (P =0.00) and stomal indication (P =.003) were observed, in which the prevalence of depression was highest in Africa (88.2%), followed by the Middle East (52.1%), North America (51.9%), and Europe (15.4%) and the rate of depression was highest among patients with colorectal cancer (34.4%), followed by inflammatory bowel disease (32.7%) and fecal incontinence (11.0%).

The major limitation of this study was that there were not sufficient data to evaluate clinician- and patient-reported depression or duration of enterostomy in this analysis.

Study authors concluded. “The pooled prevalence of depression among patients with enterostomy is 41.6%. Upon meta-regression analysis, age and gender were not found to explain the high heterogeneity in the pooled prevalence, while the indications for enterostomy formation and geographic region were identified as potential sources of heterogeneity. This meta-analysis also draws attention to the importance of assessing the psychological aspects of health in surgical patients, including patients with enterostomy, and discusses possible factors influencing the development of clinical depression.”