AffiliationThe University of Arizona College of Medicine - Phoenix
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractIntroduction Individuals with IBD have been shown to be at an increased risk of developing depression and anxiety. Previous work has demonstrated patients with UC were more likely to report depressive symptoms preceding their diagnosis of IBD than the general population. Young patients with CD also have a greater risk for developing anxiety disorders. One study demonstrated mental conditions are often diagnosed within one year prior to UC diagnosis. This signifies that psychiatric disorders may either be a consequence of early symptoms of the undiagnosed gastrointestinal condition or may increase an individual’s susceptibility to develop IBD. Psychological disease may amplify symptom severity, particularly abdominal pain perception in adults with IBD. Previous work has demonstrated that psychological state may influence perception of abdominal pain and patients with depression were more likely to take IBD-related disability. Methods This was a retrospective chart review. We used a subset of Veterans charts from the national VA database. Patient charts were divided into two groups: CD with depression and CD without depression (control). From the CD with depression group, all patients with a diagnosis of Crohn’s disease with depression were used, however, patients with a diagnosis of CD who did not receive treatment at the VA were excluded. Patients were considered in remission if their most recent colonoscopy showed no active disease. Patients were considered to have active disease if their most recent colonoscopy demonstrated signs of inflammation. When reported, depression severity was recorded in charts as mild, moderate or severe. From this we created a depression severity score by converting them to numerical values (mild=1, moderate=2, severe=3). Severity score is recorded as an average of these values. Results A total of 159 patient charts were included in this study, 122 from the Depression group and 37 from the no depression group. The odds of active Crohn’s Disease increased with depression (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.21-6.81; p>0.016). The odds of depression also increased with substance abuse (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.28-11.7; p>0.016) and PTSD (odds ratio [OR], 6.39; 95% confidence interval [CI], 1.85-22.0; p>0.003). Mean depression severity score of remission patients was 2.00 and mean depression severity score for active Crohn’s patients was 2.06. Notably, patients the odds of having more severe depression were higher for tobacco users (users: odds ratio [OR], 2.14; mean [SD], 2.14 [0.38]; 95% confidence interval [CI], 0.35-6.14; p>0.59; non-users: mean [SD], 1.96 [0.77]) and patients with substance abuse (users: odds ratio [OR], 2.37; 95% confidence interval [CI], 0.69-8.20; mean [SD], 2.21 [0.58]; p>0.17; non-users: mean [SD], 1.88 [0.77]) . Discussion These findings provide additional evidence that depression is associated with increased Crohn’s disease activity in the Veteran population. Based on this data, one may consider that treating an individual’s depression may reduce the frequency and severity of Crohn’s disease activity. There may be benefits to holistically treating a patient’s IBD through also evaluating and monitoring his or her psychological health. Other studies have demonstrated the likelihood that psychiatric disorders often co-exist with inflammation, infections, and autoimmune diseases. Furthermore, our data demonstrated strong associations found between substance abuse and the likelihood of depression. Interestingly, our results indicated no association for the measured CRP and calprotectin between the Crohn’s Disease with depression and the Crohn’s disease without depression groups.