Abstract

Depressive Symptoms Predict Clinical Recurrence of Inflammatory Bowel Disease

Inflamm Bowel Dis. 2021 Jun 7;izab136. doi: 10.1093/ibd/izab136. Online ahead of print.

Sebastian Bruno Ulrich Jordi 1 2, Brian Matthew Lang 3, Bianca Auschra 4, Roland von Känel 4, Luc Biedermann 2, Thomas Greuter 2, Philipp Schreiner 2, Gerhard Rogler 2, Niklas Krupka 1, Michael Christian Sulz 5, Benjamin Misselwitz 1 2, Stefan Begré 6 7, Swiss IBD Cohort Study Group

Collaborators

  • Swiss IBD Cohort Study Group: 

Claudia Anderegg, Peter Bauerfeind, Christoph Beglinger, Stefan Begré, Dominique Belli, José M Bengoa, Luc Biedermann, Beat Bigler, Janek Binek, Mirjam Blattmann, Stephan Boehm, Jan Borovicka, Christian P Braegger, Nora Brunner, Patrick Bühr, Bernard Burnand, Emanuel Burri, Sophie Buyse, Matthias Cremer, Dominique H Criblez, Philippe de Saussure, Lukas Degen, Joakim Delarive, Christopher Doerig, Barbara Dora, Gian Dorta, Mara Egger, Tobias Ehmann, Ali El-Wafa, Matthias Engelmann, Jessica Ezri, Christian Felley, Markus Fliegner, Nicolas Fournier, Montserrat Fraga, Pascal Frei, Remus Frei, Michael Fried, Florian Froehlich, Christian Funk, Raoul Ivano Furlano, Suzanne Gallot-Lavallée, Martin Geyer, Marc Girardin, Delphine Golay, Tanja Grandinetti, Beat Gysi, Horst Haack, Johannes Haarer, Beat Helbling, Peter Hengstler, Denise Herzog, Cyrill Hess, Klaas Heyland, Thomas Hinterleitner, Philippe Hiroz, Claudia Hirschi, Petr Hruz, Rika Iwata, Res Jost, Pascal Juillerat, Vera Kessler Brondolo, Christina Knellwolf, Christoph Knoblauch, Henrik Köhler, Rebekka Koller, Claudia Krieger-Grübel, Gerd Kullak-Ublick, Patrizia Künzler, Markus Landolt, Rupprecht Lange, Frank Serge Lehmann, Andrew Macpherson, Philippe Maerten, Michel H Maillard, Christine Manser, Michael Manz, Urs Marbet, George Marx, Christoph Matter, Valérie McLin, Rémy Meier, Martina Mendanova, Christa Meyenberger, Pierre Michetti, Benjamin Misselwitz, Darius Moradpour, Bernhard Morell, Patrick Mosler, Christian Mottet, Christoph Müller, Pascal Müller, Beat Müllhaupt, Claudia Münger-Beyeler, Leilla Musso, Andreas Nagy, Michaela Neagu, Cristina Nichita, Jan Niess, Natacha Noël, Andreas Nydegger, Nicole Obialo, Carl Oneta, Cassandra Oropesa, Ueli Peter, Daniel Peternac, Laetitia Marie Petit, Franziska Piccoli-Gfeller, Julia Beatrice Pilz, Valérie Pittet, Nadia Raschle, Ronald Rentsch, Sophie Restellini, Jean-Pierre Richterich, Sylvia Rihs, Marc Alain Ritz, Jocelyn Roduit, Daniela Rogler, Gerhard Rogler, Jean-Benoît Rossel, Markus Sagmeister, Gaby Saner, Bernhard Sauter, Mikael Sawatzki, Michela Schäppi, Michael Scharl, Martin Schelling, Susanne Schibli, Hugo Schlauri, Sybille Schmid Uebelhart, Jean-François Schnegg, Alain Schoepfer, Frank Seibold, Mariam Seirafi, Gian-Marco Semadeni, David Semela, Arne Senning, Marc Sidler, Christiane Sokollik, Johannes Spalinger, Holger Spangenberger, Philippe Stadler, Michael Steuerwald, Alex Straumann, Bigna Straumann-Funk, Michael Sulz, Joël Thorens, Sarah Tiedemann, Radu Tutuian, Stephan Vavricka, Francesco Viani, Jürg Vögtlin, Roland von Känel, Alain Vonlaufen, Dominique Vouillamoz, Rachel Vulliamy, Jürg Wermuth, Helene Werner, Paul Wiesel, Reiner Wiest, Tina Wylie, Jonas Zeitz, Dorothee Zimmermann

 
     

Author information

  • 1Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland.
  • 2Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
  • 3Clinic for Transplantation Immunology and Nephrology (Swiss Transplant Cohort Study), University Hospital of Basel, Basel, Switzerland.
  • 4Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
  • 5Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • 6Neurology, Department of Biomedical Research, Bern University Hospital, University of Bern, Bern, Switzerland.
  • 7Institute of Stress Diseases and Stressmanagement (ISFOM), Zurich, Switzerland.

Abstract

Background: Inflammatory bowel disease (IBD) patients are at high risk for depression, and depression has been shown to affect disease course. We examined interrelations between depression, genetic risk factors for depression, and IBD flares.

Method: In 1973 patients (1137 Crohn's disease, 836 ulcerative colitis) of the Swiss IBD Cohort Study (SIBDCS), depressive status (hospital anxiety and depression subscale for depression, HADS-D ≥11) was assessed on a yearly basis. We investigated the impact of depression on IBD-relevant clinical outcomes in Cox proportional hazards models. We used active disease (CDAI ≥150 or MTWAI ≥10) and 2 published composite flare definitions-FNCE (physician-reported flare, nonresponse to therapy, new complication, or extraintestinal manifestation) and AFFSST (active disease, physician-reported flare, fistula, stenosis, and new systemic therapy)-as clinical end points. Additionally, 62 preselected single nucleotide polymorphisms (SNPs) were screened for cross-sectional associations with depression, and if present, their predictive value for future depression and clinical deterioration was assessed.

Results: Depression was a strong risk factor for disease-related end points, including active disease (adjusted hazard ratio [aHR], 3.55; P < 0.001), AFFSST (aHR, 1.62; P < 0.001), and FNCE (aHR, 1.35; P = 0.019). The SNP rs2522833 was significantly associated with depression at enrollment (q = 0.059). The TC allele of rs588765 was negatively associated with the presence of depression at enrollment (q = 0.050) and after enrollment (aHR, 0.67; P = 0.035) and with fewer active disease states (aHR, 0.72; P = 0.045) during follow-up.

Conclusion: In IBD, depressive symptoms and inflammatory activity are intimately related. Depressive symptoms were a strong predictor of clinical deterioration, and genetic markers may play a role in this relationship.

 

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