Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease
Article first published online: 7 JAN 2013
© 2013 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 37, Issue 4, pages 445–454, February 2013
How to Cite
Ananthakrishnan, A. N., Gainer, V. S., Perez, R. G., Cai, T., Cheng, S.-C., Savova, G., Chen, P., Szolovits, P., Xia, Z., De Jager, P. L., Shaw, S. Y., Churchill, S., Karlson, E. W., Kohane, I., Perlis, R. H., Plenge, R. M., Murphy, S. N. and Liao, K. P. (2013), Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease. Alimentary Pharmacology & Therapeutics, 37: 445–454. doi: 10.1111/apt.12195
- Issue published online: 22 JAN 2013
- Article first published online: 7 JAN 2013
- Manuscript Accepted: 10 DEC 2012
- Manuscript Revised: 9 DEC 2012
- Manuscript Revised: 24 OCT 2012
- Manuscript Received: 8 OCT 2012
- American Gastroenterological Association
- US National Institutes of Health. Grant Number: K23 DK097142
- NIH. Grant Number: K08 AR060257
- Katherine Swan Ginsburg Fund. Grant Numbers: U01-GM092691, R01-AR056768, R01-AR059648
- Burroughs Wellcome Fund. Grant Numbers: K24 AR052403, P60 AR047782, R01 AR049880
Psychiatric co-morbidity, in particular major depression and anxiety, is common in patients with Crohn's disease (CD) and ulcerative colitis (UC). Prior studies examining this may be confounded by the co-existence of functional bowel symptoms. Limited data exist examining an association between depression or anxiety and disease-specific endpoints such as bowel surgery.
To examine the frequency of depression and anxiety (prior to surgery or hospitalisation) in a large multi-institution electronic medical record (EMR)-based cohort of CD and UC patients; to define the independent effect of psychiatric co-morbidity on risk of subsequent surgery or hospitalisation in CD and UC, and to identify the effects of depression and anxiety on healthcare utilisation in our cohort.
Using a multi-institution cohort of patients with CD and UC, we identified those who also had co-existing psychiatric co-morbidity (major depressive disorder or generalised anxiety). After excluding those diagnosed with such co-morbidity for the first time following surgery, we used multivariate logistic regression to examine the independent effect of psychiatric co-morbidity on IBD-related surgery and hospitalisation. To account for confounding by disease severity, we adjusted for a propensity score estimating likelihood of psychiatric co-morbidity influenced by severity of disease in our models.
A total of 5405 CD and 5429 UC patients were included in this study; one-fifth had either major depressive disorder or generalised anxiety. In multivariate analysis, adjusting for potential confounders and the propensity score, presence of mood or anxiety co-morbidity was associated with a 28% increase in risk of surgery in CD (OR: 1.28, 95% CI: 1.03–1.57), but not UC (OR: 1.01, 95% CI: 0.80–1.28). Psychiatric co-morbidity was associated with increased healthcare utilisation.
Depressive disorder or generalised anxiety is associated with a modestly increased risk of surgery in patients with Crohn's disease. Interventions addressing this may improve patient outcomes.