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Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

Srinath, Arvind I. MD*; Goyal, Alka MD*; Zimmerman, Lori A. MD; Newara, Melissa C. MS; Kirshner, Margaret A. BA; McCarthy, Francis Nicole MS; Keljo, David MD, PhD*; Binion, David MD§; Bousvaros, Athos MD; DeMaso, David R. MD; Youk, Ada PhD; Szigethy, Eva M. MD, PhD*,†,‡

doi: 10.1097/MIB.0000000000000104
Original Clinical Articles

Background: Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD and (2) determine predictors of abdominal pain in Crohn's disease (CD) and ulcerative colitis (UC).

Methods: Seven hundred sixty-five patients aged 9 to 17 years with IBD seen over 3 years at 2 sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms.

Results: Two hundred seventeen patients with IBD (161 CD, 56 UC) were depressed. One hundred sixty-three (120 CD, 43 UC) patients had complete abdominal pain index scores. In CD, abdominal pain was associated with depression (r = 0.33; P < 0.001), diarrhea (r = 0.34; P = 0.001), erythrocyte sedimentation rate (r = 0.22; P = 0.02), low albumin (r = 0.24; P = 0.01), weight loss (r = 0.33; P = 0.001), and abdominal tenderness (r = 0.38, P = 0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (P = 0.03), weight loss (P = 0.04), and abdominal tenderness (P = 0.01) predicted pain for patients with CD. In UC, pain was associated with depression (r = 0.46; P = 0.002) and nocturnal stools (r = 0.32; P = 0.046). In the multivariate model with these significant correlates, 23% of the variance was explained and only depression (P = 0.02) predicted pain.

Conclusions: The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications.

Article first published online 30 June 2014.

*Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;

Department of Pediatric Gastroenterology, Boston Children's Hospital, Boston, Massachusetts;

Departments of Psychiatry, and

§Gastroenterology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;

Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; and

Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania.

Reprints: Arvind I. Srinath, MD, Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224 (e-mail: arvind.srinath@chp.edu).

Supported by the National Institute of Mental Health (R01MH077770) and the NIH Director's Innovator Award (1DP2OD001210). This project was also supported by the National Institute of Health through Grant Numbers UL1 RR024153 and UL1TR000005.

E. M. Szigethy: NIMH grant funding and Consultant for Merck Advisory Board. The remaining authors have no conflicts of interest to disclose.

Received April 08, 2014

Accepted May 7, 2014

© Crohn's & Colitis Foundation of America, Inc.
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