title: Association Between Affective-Cognitive Symptoms of Depression and Exacerbation of Crohn's Disease.
abstract: OBJECTIVE
  The prevalence of depression is high in patients with Crohn's disease (CD). We examined the influence of affective-cognitive symptoms of depression on the risk of exacerbation of CD.
  
  
  METHODS
  We studied 2,144 adult volunteers with a self-reported diagnosis of CD who completed a baseline survey that included demographics, CD status, and an affective-cognitive index of depression. Linear and logistic regression analyses were used to determine whether CD status at 12 months was associated with the baseline measure of depression. Analyses were adjusted for confounders including age, gender, race, baseline disease activity, disease duration, prior hospitalization and surgery, corticosteroid and anti-TNF use, medication adherence, body mass index, current smoking, education, and sleep quality.
  
  
  RESULTS
  Depression was significantly associated with subsequent increases in SCDAI score in both unadjusted (P<0.001) and adjusted (P<0.001) analyses. This association was non-linear, with a shallower slope for lower levels of depression. A 10-point increase in depression t-scores from 55 to 65 was associated with a 18.6-point increase in SCDAI (95% CI 11.5-25.6) and an odds ratio of 1.27 for SCDAI>150 at follow-up (CI: 1.01-1.60). We also found a significant association between depressive symptoms and hospitalization.
  
  
  CONCLUSIONS
  Cognitive-affective depressive symptoms were significantly associated with a risk of exacerbation of CD and hospitalization.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.|Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Gaines
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Slaughter
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Horst
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Schwartz
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Dawn B
authors.initials: DB
authors.lastname: Beaulieu
authors.affiliation: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Haman
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Martin
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Millie D
authors.initials: MD
authors.lastname: Long
authors.affiliation: Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology