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Similar Risk of Depression and Anxiety Following Surgery or Hospitalization for Crohn's Disease and Ulcerative Colitis

Ananthakrishnan, Ashwin N MD, MPH1, 2; Gainer, Vivian S MS3; Cai, Tianxi PhD4; Perez, Raul Guzman3; Cheng, Su-Chun ScD4; Savova, Guergana5; Chen, Pei5; Szolovits, Peter PhD6; Xia, Zongqi MD, PhD2, 7; De Jager, Philip L MD, PhD2, 7; Shaw, Stanley MD, PhD2, 8; Churchill, Susanne PhD9; Karlson, Elizabeth W MD2, 10; Kohane, Isaac MD, PhD2, 5, 9; Perlis, Roy H MD, MSc2, 11; Plenge, Robert M MD, PhD2, 10; Murphy, Shawn N MD, PhD2, 3, 12; Liao, Katherine P MD, PhD2, 10

American Journal of Gastroenterology: April 2013 - Volume 108 - Issue 4 - p 594–601
doi: 10.1038/ajg.2012.471
Inflammatory Bowel Disease
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OBJECTIVES: Psychiatric comorbidity is common in Crohn's disease (CD) and ulcerative colitis (UC). Inflammatory bowel disease (IBD)-related surgery or hospitalizations represent major events in the natural history of the disease. The objective of this study is to examine whether there is a difference in the risk of psychiatric comorbidity following surgery in CD and UC.

METHODS: We used a multi-institution cohort of IBD patients without a diagnosis code for anxiety or depression preceding their IBD-related surgery or hospitalization. Demographic-, disease-, and treatment-related variables were retrieved. Multivariate logistic regression analysis was performed to individually identify risk factors for depression and anxiety.

RESULTS: Our study included a total of 707 CD and 530 UC patients who underwent bowel resection surgery and did not have depression before surgery. The risk of depression 5 years after surgery was 16% and 11% in CD and UC patients, respectively. We found no difference in the risk of depression following surgery in the CD and UC patients (adjusted odds ratio, 1.11; 95% confidence interval, 0.84–1.47). Female gender, comorbidity, immunosuppressant use, perianal disease, stoma surgery, and early surgery within 3 years of care predicted depression after CD surgery; only the female gender and comorbidity predicted depression in UC patients. Only 12% of the CD cohort had ≥4 risk factors for depression, but among them nearly 44% subsequently received a diagnosis code for depression.

CONCLUSIONS: IBD-related surgery or hospitalization is associated with a significant risk for depression and anxiety, with a similar magnitude of risk in both diseases.

1 Crohn's and Colitis Center, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA

2 Harvard Medical School, Boston, Massachusetts, USA

3 Research Computing, Partners HealthCare, Charlestown, Massachusetts, USA

4 Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA

5 Children's Hospital Boston, Boston, Massachusetts, USA

6 Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

7 Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA

8 Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA

9 i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts, USA

10 Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA

11 Psychiatry Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Boston, Massachusetts, USA

12 Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence: Ashwin N. Ananthakrishnan, MD, MPH, Crohn's and Colitis Center, Division of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, Massachusetts 02114, USA. E-mail: aananthakrishnan@partners.org

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A718

Received 8 October 2012; accepted 17 December 2012

published online 22 January 2013

© The American College of Gastroenterology 2013. All Rights Reserved.
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