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The Influence of Depression on Quality of Life in Patients with Inflammatory Bowel Disease

Zhang, Clarence K. PhD*; Hewett, Jennifer MD; Hemming, Jason MD; Grant, Taneisha MD§; Zhao, Hongyu PhD; Abraham, Clara MD§; Oikonomou, Ioannis MD§; Kanakia, Meera APRN§; Cho, Judy H. MD§; Proctor, Deborah D. MD§

doi: 10.1097/MIB.0b013e318281f395
Original Clinical Articles

Background: Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract that significantly impacts the health-related quality of life (HR-QOL). A decreased HR-QOL has been demonstrated in patients with active disease compared with patients in remission. In this cross-sectional study, we examined the role of depression and disease activity as independent factors in predicting patient’s HR-QOL.

Methods: Hundred and five patients with either Crohn’s disease (CD) or ulcerative colitis (UC) were enrolled. Disease activity was evaluated using Crohn’s Disease Activity Index or Seo’s Activity Index. Depressive symptoms were evaluated using Beck’s Depression Inventory-II and Beck’s Depression Inventory for Primary Care (BDI-PC). HR-QOL was evaluated using the Short Inflammatory Bowel Disease Questionnaire. Simple and multiple regressions were performed on quality of life score with demographic and clinical variables as predictors.

Results: The prevalence of depression in our study population is 25%. In patients with both CD and UC, depression is the most significant predictor to a poor HR-QOL (in CD, P = 8.22 × 10−6; in UC, P = 2.02 × 10−6). HR-QOL is weakly affected by disease activity (in CD, P = 0.110; in UC, P = 0.00492). In CD, biological use displays positive effect on HR-QOL (P = 0.00780). In total, the proportion of variance explained by all predictors is 61% for CD and 53% for UC, whereas the depression alone explains 44% and 36%.

Conclusions: Our study demonstrates the importance of depression toward the quality of life in patients with inflammatory bowel disease. The diagnosis of depression should be actively sought out and treated in outpatient inflammatory bowel disease practices.

Article first published online 10 May 2013Supplemental Digital Content is Available in the Text.

*Keck Biotechnology Laboratory, Yale University School of Medicine, New Haven, Connecticut;

Department of Gastroenterology, The Permanente Medical Group Inc, San Rafael, California;

Pentucket Medical, Haverhill, Massachusetts;

§Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut; and

School of Public Health, Yale University, New Haven, Connecticut.

Reprints: Clarence K. Zhang, 300 George Street Suite 503, New Haven, CT 06510 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have no conflicts of interest to disclose.

J. Hewett and J. Hemming contributed equally to this study.

Received November 13, 2012

Accepted November 14, 2012

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