ORLANDO, Fla. — The severity of depressive symptoms among patients with inflammatory bowel disease was associated with disease activity and related quality of life, while suicidality was more associated with severity of depression rather than disease activity, according to a presenter here.
“Depressive symptoms are common among patients with IBD, but clinical correlates of more severe depression and suicidality have not been systematically examined in IBD patients,” Victor Chedid, MD, from the University of Pittsburgh, said in a presentation. “The most disturbing behavior linked to depression is suicidality, and it has been understudied in IBD.”
Over the course of 2 months, Chedid and colleagues prospectively studied 465 IBD patients (mean age 44 years; 93% white; 60% women; 65% with Crohn’s disease [CD]; 32% with ulcerative colitis [UC]; and 3% with indeterminate colitis) at their outpatient IBD clinic in order to identify rates and predictors of moderate depression and suicidality, and also identify the characteristics of patients most at risk for depression and suicidality to help prevent them earlier. During routine GI visits, they screened patients for depression and suicidality using the patient health questionnaire (PHQ9), assessed disease activity using the Harvey-Bradshaw CD Index or the UC Activity Index, evaluated QOL using the Short IBD Questionnaire (SIBDQ) and obtained data on patient demographics, narcotic use, pain and prior surgery from electronic medical records.
Overall, mean SIBDQ score was 51, pooled mean IBD activity was 4.25, 27% had acute pain, 23% were on narcotics, 51% had IBD-related surgery, 23% had at least moderate depression and 7% reported suicidality. Among patients with moderate depression, mean PHQ9 score was 14.5, mean SIBDQ score was 35, pooled mean IBD activity score was 7.3, 25% were suicidal, 55% reported acute pain, 41% were on narcotics and 58% had IBD-related surgery.
SIBDQ, IBD activity, narcotic use, pain and surgery correlated with severity of depression (P<.05), and regression modeling including these variables explained 61% of variance in depressive severity and disease activity. SIBDQ, depressive severity, IBD activity pain and surgery were predictors of suicidality and explained 15% of variance in suicidality, though depressive severity was the only significant predictor. Greater pain and narcotic use was also associated with depressive severity, and increased suicidality was associated with other medical comorbidities and childhood onset IBD.
“Depressive severity is most associated with disease activity and QOL while suicidality is most associated with depressive severity and less so with IBD activity,” Chedid said. “It is worthwhile to screen your patients with IBD for depression and suicidality … to improve the quality of care that’s provided.
“And remember, suicide is preventable,” he added.
For more information:
Chedid V. O-006. Presented at: 2014 Advances in Inflammatory Bowel Diseases, Dec. 4-6, 2014; Orlando, Fla.
Disclosures: Financial disclosures could not be confirmed at this time.