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. 2001 Oct;55(10):716–720. doi: 10.1136/jech.55.10.716

Depression and anxiety in people with inflammatory bowel disease

L Kurina 1, M Goldacre 1, D Yeates 1, L Gill 1
PMCID: PMC1731788  PMID: 11553654

Abstract

STUDY OBJECTIVE—To determine whether depression or anxiety co-occurs with ulcerative colitis (UC) or Crohn's disease (CD) more often than expected by chance, and, if so, whether the mental disorders generally precede or follow the inflammatory bowel diseases (IBD).
DESIGN—Nested case-control studies using a database of linked hospital record abstracts.
SETTING—Southern England.
MAIN RESULTS—Both depression and anxiety preceded UC significantly more often than would be predicted from the control population's experience. The associations were strongest when the mental conditions were diagnosed shortly before UC, although the association between depression and UC was also significant when depression preceded UC by five or more years. Neither depression nor anxiety occurred before CD more often than expected by chance. However, depression and anxiety were significantly more common after CD; the associations were strongest in the year after the initial record of CD. UC was followed by anxiety, but not by depression, more often than expected by chance and, again, the association was strongest within one year of diagnosis with UC.
CONCLUSIONS—The concentration of risk of depression or anxiety one year or less before diagnosis with UC suggests that the two psychiatric disorders might be a consequence of early symptoms of the as yet undiagnosed gastrointestinal condition. The data are also, however, compatible with the hypothesis that the psychiatric disorders could be aetiological factors in some patients with UC. Most of the excess anxiety or depression diagnosed subsequent to diagnosis of IBD occurs during the year after IBD is diagnosed and the probable explanation is that the mental disorders are sequelae of IBD.


Keywords: record linkage; ulcerative colitis; Crohn's disease; anxiety; depression

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Selected References

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  1. Addolorato G., Capristo E., Stefanini G. F., Gasbarrini G. Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol. 1997 Oct;32(10):1013–1021. doi: 10.3109/00365529709011218. [DOI] [PubMed] [Google Scholar]
  2. Andrews H., Barczak P., Allan R. N. Psychiatric illness in patients with inflammatory bowel disease. Gut. 1987 Dec;28(12):1600–1604. doi: 10.1136/gut.28.12.1600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Goldacre M. J., Simmons H., Henderson J., Gill L. E. Trends in episode based and person based rates of admission to hospital in the Oxford record linkage study area. Br Med J (Clin Res Ed) 1988 Feb 20;296(6621):583–585. doi: 10.1136/bmj.296.6621.583. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Goldacre M., Kurina L., Yeates D., Seagroatt V., Gill L. Use of large medical databases to study associations between diseases. QJM. 2000 Oct;93(10):669–675. doi: 10.1093/qjmed/93.10.669. [DOI] [PubMed] [Google Scholar]
  5. Goldacre M., Shiwach R., Yeates D. Estimating incidence and prevalence of treated psychiatric disorders from routine statistics: the example of schizophrenia in Oxfordshire. J Epidemiol Community Health. 1994 Jun;48(3):318–322. doi: 10.1136/jech.48.3.318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Helzer J. E., Chammas S., Norland C. C., Stillings W. A., Alpers D. H. A study of the association between Crohn's disease and psychiatric illness. Gastroenterology. 1984 Feb;86(2):324–330. [PubMed] [Google Scholar]
  7. Helzer J. E., Stillings W. A., Chammas S., Norland C. C., Alpers D. H. A controlled study of the association between ulcerative colitis and psychiatric diagnoses. Dig Dis Sci. 1982 Jun;27(6):513–518. doi: 10.1007/BF01296730. [DOI] [PubMed] [Google Scholar]
  8. Henk H. J., Katzelnick D. J., Kobak K. A., Greist J. H., Jefferson J. W. Medical costs attributed to depression among patients with a history of high medical expenses in a health maintenance organization. Arch Gen Psychiatry. 1996 Oct;53(10):899–904. doi: 10.1001/archpsyc.1996.01830100045006. [DOI] [PubMed] [Google Scholar]
  9. Magni G., Bernasconi G., Mauro P., D'Odorico A., Sturniolo G. C., Canton G., Martin A. Psychiatric diagnoses in ulcerative colitis. A controlled study. Br J Psychiatry. 1991 Mar;158:413–415. doi: 10.1192/bjp.158.3.413. [DOI] [PubMed] [Google Scholar]
  10. Manning W. G., Jr, Wells K. B. The effects of psychological distress and psychological well-being on use of medical services. Med Care. 1992 Jun;30(6):541–553. doi: 10.1097/00005650-199206000-00007. [DOI] [PubMed] [Google Scholar]
  11. Mendeloff A. I., Monk M., Siegel C. I., Lilienfeld A. Illness experience and life stresses in patients with irritable colon and with ulcerative colitis. An epidemiologic study of ulcerative colitis and regional enteritis in Baltimore, 1960-1964. N Engl J Med. 1970 Jan 1;282(1):14–17. doi: 10.1056/NEJM197001012820104. [DOI] [PubMed] [Google Scholar]
  12. Moser G. Ulcerative colitis and psychosocial factors. Ital J Gastroenterol Hepatol. 1997 Oct;29(5):387–390. [PubMed] [Google Scholar]
  13. North C. S., Clouse R. E., Spitznagel E. L., Alpers D. H. The relation of ulcerative colitis to psychiatric factors: a review of findings and methods. Am J Psychiatry. 1990 Aug;147(8):974–981. doi: 10.1176/ajp.147.8.974. [DOI] [PubMed] [Google Scholar]
  14. Ramchandani D., Schindler B., Katz J. Evolving concepts of psychopathology in inflammatory bowel disease. Implications for treatment. Med Clin North Am. 1994 Nov;78(6):1321–1330. doi: 10.1016/s0025-7125(16)30103-1. [DOI] [PubMed] [Google Scholar]
  15. Robertson D. A., Ray J., Diamond I., Edwards J. G. Personality profile and affective state of patients with inflammatory bowel disease. Gut. 1989 May;30(5):623–626. doi: 10.1136/gut.30.5.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Schwartz R. A., Schwartz I. K. Psychiatric disorders associated with Crohn's disease. Int J Psychiatry Med. 1982;12(1):67–73. doi: 10.2190/fl8y-1wu6-1n5l-1fqv. [DOI] [PubMed] [Google Scholar]
  17. Smith G. J., van der Meer G., Ursing B., Prytz H., Benoni C. Psychological profile of patients suffering from Crohn's disease and ulcerative colitis. Acta Psychiatr Scand. 1995 Sep;92(3):187–192. doi: 10.1111/j.1600-0447.1995.tb09566.x. [DOI] [PubMed] [Google Scholar]
  18. Stein M. Stress, depression, and the immune system. J Clin Psychiatry. 1989 May;50 (Suppl):35–42. [PubMed] [Google Scholar]
  19. Tarter R. E., Switala J., Carra J., Edwards K. L., Van Thiel D. H. Inflammatory bowel disease: psychiatric status of patients before and after disease onset. Int J Psychiatry Med. 1987;17(2):173–181. doi: 10.2190/cb02-2v8b-y624-r781. [DOI] [PubMed] [Google Scholar]
  20. Tocchi A., Lepre L., Liotta G., Mazzoni G., Costa G., Taborra L., Miccini M. Familial and psychological risk factors of ulcerative colitis. Ital J Gastroenterol Hepatol. 1997 Oct;29(5):395–398. [PubMed] [Google Scholar]
  21. Walker E. A., Roy-Byrne P. P., Katon W. J., Li L., Amos D., Jiranek G. Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. Am J Psychiatry. 1990 Dec;147(12):1656–1661. doi: 10.1176/ajp.147.12.1656. [DOI] [PubMed] [Google Scholar]

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