Document Detail


Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease.
MedLine Citation:
PMID:  23289600     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
A N Ananthakrishnan; V S Gainer; R G Perez; T Cai; S-C Cheng; G Savova; P Chen; P Szolovits; Z Xia; P L De Jager; S Y Shaw; S Churchill; E W Karlson; I Kohane; R H Perlis; R M Plenge; S N Murphy; K P Liao
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-07
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  37     ISSN:  1365-2036     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-22     Completed Date:  2013-06-26     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  445-54     Citation Subset:  IM    
Copyright Information:
© 2013 Blackwell Publishing Ltd.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anxiety Disorders / complications*,  surgery
Colitis, Ulcerative / complications*,  surgery
Comorbidity
Crohn Disease / complications*,  surgery
Depressive Disorder / complications*,  surgery
Female
Humans
Logistic Models
Male
Middle Aged
Risk Factors
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
AR047782/AR/NIAMS NIH HHS; K08 AR060257/AR/NIAMS NIH HHS; K08 AR060257/AR/NIAMS NIH HHS; K08 NS079493/NS/NINDS NIH HHS; K23 DK097142/DK/NIDDK NIH HHS; K23 DK097142/DK/NIDDK NIH HHS; K24 AR052403/AR/NIAMS NIH HHS; R01 AR049880/AR/NIAMS NIH HHS; R01 AR049880/AR/NIAMS NIH HHS; R01 AR056768/AR/NIAMS NIH HHS; R01-AR056768/AR/NIAMS NIH HHS; R01-AR059648/AR/NIAMS NIH HHS; U01-GM092691/GM/NIGMS NIH HHS; U54 LM008748/LM/NLM NIH HHS; U54-LM008748/LM/NLM NIH HHS
Comments/Corrections
Comment In:
Aliment Pharmacol Ther. 2013 Mar;37(6):653   [PMID:  23406406 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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