Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease.
Aliment Pharmacol Ther
; 37(4): 445-54, 2013 Feb.
Article
em En
| MEDLINE
| ID: mdl-23289600
ABSTRACT
BACKGROUND:
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.AIMS:
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.METHODS:
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.RESULTS:
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.CONCLUSIONS:
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.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Transtornos de Ansiedade
/
Colite Ulcerativa
/
Doença de Crohn
/
Transtorno Depressivo
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article