More evidence depression may exacerbate Crohn's disease

Last Updated: 2016-04-14

By Reuters Staff

NEW YORK (Reuters Health) - For patients with Crohn's disease, comorbid depressive symptoms raise the risk of CD flare-ups and hospitalization, new research confirms.

This finding "makes a strong case for routine assessment of depression when evaluating and treating CD," write Dr. Lawrence Gaines of Vanderbilt University Medical Center, Nashville, Tennessee, and colleagues in the American Journal of Gastroenterology, online April 5.

They studied more than 2,100 adults with a self-reported diagnosis of CD. Participants completed a baseline survey that included demographics, CD status, and an affective-cognitive index of depression. CD activity was assessed at baseline and 12 months using the Short Crohn's Disease Activity Index (SCADI).

After controlling for multiple potential confounding variables, patients who reported higher levels of depressive symptoms had greater odds than their less depressed peers of reporting more frequent diarrhea, pain, and reduced well-being 12 months later, the researchers found.

"Depression was significantly associated with subsequent increases in SCDAI score in both unadjusted (P<0.001) and adjusted (P<0.001) analyses. This association was non-linear, with a shallower slope for lower levels of depression," they report.

A 10-point increase in depression t-scores from 55 to 65 was associated with an 18.6-point increase in SCDAI and an odds ratio of 1.27 for SCDAI score above 150 at follow-up, they note.

Patients with more severe depressive symptoms also subsequently reported higher odds of hospitalization but not surgery or use of anti-TNF agents.

"Depression is a common comorbidity for patients with CD. Our study supports the findings of earlier cohort studies showing that depression is associated with subsequent CD activity, suggesting a temporal relationship between depression and subsequent CD activity," Dr. Gaines and colleagues conclude.

"The present study," they add, "expands and informs the field in two very important ways. The first is that it suggests that CD patients who also have affective-cognitive symptoms of depression are more likely to have more severe CD symptoms later in time. The second is that it starts to chart the map for future research about comorbid depression and CD, starting with the examination of possible reverse causality, the assessment of measurement invariance, and possible health behavior and immunological mediators of the relationship of depressive symptoms and CD activity."

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: http://bit.ly/1SMIWWA

Am J Gastroenterol 2016.