title: Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease.
abstract: BACKGROUND
  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 exist examining an association between depression or anxiety and disease-specific endpoints such as bowel surgery.
  
  
  OBJECTIVE
  To examine the frequency of depression and anxiety (prior to surgery or hospitalisation) in a large multi-institution electronic medical record (EMR)-based cohort of CD and UC patients; to define the independent effect of psychiatric co-morbidity on risk of subsequent surgery or hospitalisation in CD and UC, and to identify the effects of depression and anxiety on healthcare utilisation in our cohort.
  
  
  METHODS
  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 generalised 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 hospitalisation. 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.
  
  
  RESULTS
  A total of 5405 CD and 5429 UC patients were included in this study; one-fifth had either major depressive disorder or generalised 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 utilisation.
  
  
  CONCLUSIONS
  Depressive disorder or generalised anxiety is associated with a modestly increased risk of surgery in patients with Crohn's disease. Interventions addressing this may improve patient outcomes.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA. aananthakrishnan@partners.org
authors.forename: A N
authors.initials: AN
authors.lastname: Ananthakrishnan
authors.forename: V S
authors.initials: VS
authors.lastname: Gainer
authors.forename: R G
authors.initials: RG
authors.lastname: Perez
authors.forename: T
authors.initials: T
authors.lastname: Cai
authors.forename: S-C
authors.initials: SC
authors.lastname: Cheng
authors.forename: G
authors.initials: G
authors.lastname: Savova
authors.forename: P
authors.initials: P
authors.lastname: Chen
authors.forename: P
authors.initials: P
authors.lastname: Szolovits
authors.forename: Z
authors.initials: Z
authors.lastname: Xia
authors.forename: P L
authors.initials: PL
authors.lastname: De Jager
authors.forename: S Y
authors.initials: SY
authors.lastname: Shaw
authors.forename: S
authors.initials: S
authors.lastname: Churchill
authors.forename: E W
authors.initials: EW
authors.lastname: Karlson
authors.forename: I
authors.initials: I
authors.lastname: Kohane
authors.forename: R H
authors.initials: RH
authors.lastname: Perlis
authors.forename: R M
authors.initials: RM
authors.lastname: Plenge
authors.forename: S N
authors.initials: SN
authors.lastname: Murphy
authors.forename: K P
authors.initials: KP
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications* / Q000601:surgery; D003093:Colitis, Ulcerative / Q000150:complications* / Q000601:surgery; D015897:Comorbidity; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D003866:Depressive Disorder / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index