Psychiatric Co-Morbidity Is Associated With Increased Risk of Surgery in Crohn's Disease

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Psychiatric Co-Morbidity Is Associated With Increased Risk of Surgery in Crohn's Disease

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Title: Psychiatric Co-Morbidity Is Associated With Increased Risk of Surgery in Crohn's Disease
Author: Ananthakrishnan, Ashwin N; Gainer, V. S.; Perez, R. G.; Cai, T.; Cheng, S.-C.; Savova, G.; Chen, P.; Szolovits, P.; Xia, Z.; De Jager, P. L.; Shaw, S. Y.; Churchill, S.; Karlson, E. W.; Kohane, I.; Perlis, R. H.; Plenge, R. M.; Murphy, S. N.; Liao, K. P.

Note: Order does not necessarily reflect citation order of authors.

Citation: Ananthakrishnan, 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.
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Abstract: Introduction

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.
Published Version: 10.1111/apt.12195
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