Psychiatric Co-Morbidity Is Associated With Increased Risk of Surgery in Crohn's Disease
Gainer, V. S.
Perez, R. G.
De Jager, P. L.
Shaw, S. Y.
Karlson, E. W.
Perlis, R. H.
Plenge, R. M.
Murphy, S. N.
Liao, K. P.Note: Order does not necessarily reflect citation order of authors.
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CitationAnanthakrishnan, A. N., V. S. Gainer, R. G. Perez, T. Cai, S.-C. Cheng, G. Savova, P. Chen, et al. 2013. “Psychiatric Co-Morbidity Is Associated with Increased Risk of Surgery in Crohn’s Disease.” Alimentary Pharmacology & Therapeutics 37 (4) (January 7): 445–454. doi:10.1111/apt.12195.
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 exists examining an association between depression or anxiety and disease-specific endpoints such as bowel surgery.
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 generalized 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 hospitalization. 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.
A total of 5,405 CD and 5,429 UC patients were included in this study; one-fifth had either major depressive disorder or generalized 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 utilization.
Depressive disorder or generalized anxiety is associated with a modestly increased risk of surgery in patients with CD. Interventions addressing this may improve patient outcomes.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:33973668
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