Abstract
Background and aim
Crohn’s disease is a life-long inflammatory disease which can impair quality of life, in particular in patients with psychiatric co-morbidities such as depression and anxiety. The aim of this prospective cohort study was to assess the prevalence of depression and anxiety and related risk factors in patients with quiescent Crohn’s disease.
Methods
A consecutive series of adult patients with confirmed diagnosis of Crohn’s disease, in clinical remission, were included and investigated during ambulatory visits using a standard questionnaire assessing demographic and clinical features of the disease. Within 1 month after the ambulatory visit, all patients were interviewed by phone to assess the presence of psychiatric disorders using standardized questionnaires. The questionnaire assessed the development of psychiatric disorders after the diagnosis of Crohn’s disease, the use of antidepressant or antianxiety therapy and current anxiety or depression by means of the Hospital Anxiety and Depression Scale.
Results
One hundred and ninety-five patients were included. Seventy-two (36.9 %) patients showed anxiety and/or depression symptoms, 46 (23.6 %) patients showed anxiety symptoms, 6 (3.1 %) patients showed depression symptoms and 20 (10.3 %) patients showed both symptoms. Forty-eight of these patients (58 %) were without any antidepressive or antianxiety treatment. Anxiety with or without depression was significantly correlated with female sex (p = 0.017), history of perianal disease (p = 0.003) and perianal surgery (p = 0.042).
Conclusion
Anxiety is a frequent, often untreated, condition in patient affected by Crohn’s disease in clinical remission. Female sex, history of perianal disease and perianal surgery are major risk factors for anxiety.
Similar content being viewed by others
References
Sachar DB (2006) Recurrence rates in Crohn’s disease: predicting the future and predicting the past. Gut 55:1069–1070
Sachar DB (1990) The problem of postoperative recurrence of Crohn’s disease. Med Clin N Am 74:183–188
Fazio VW, Marchetti F, Church M, Goldblum JR, Lavery C, Hull TL et al (1996) Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial. Ann Surg 224:563–571
Sampietro GM, Cristaldi M, Porretta T, Montecamozzo G, Danelli P, Taschieri AM (2000) Early perioperative results and surgical recurrence after strictureplasty and miniresection for complicated Crohn’s disease. Dig Surg 17:261–267
Cristaldi M, Sampietro GM, Danelli PG, Bollani S, Bianchi Porro G, Taschieri AM (2000) Long-term results and multivariate analysis of prognostic factors in 138 consecutive patients operated on for Crohn’s disease using “bowel-sparing” techniques. Am J Surg 179:266–270
Hellers G, Bergstrand O, Ewerth S, Holmstrom B (1980) Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut 21:525–527
Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR et al (2002) The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 122:875–880
Ingle SB, Loftus EV Jr (2007) The natural history of perianal Crohn’s disease. Digest Liver Dis 39:963–969
Graff LA, Walker JR, Bernstein CN (2009) Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis 15:1105–1118
Graff LA, Walker JR, Lix L, Clara I, Rawsthorne P, Rogala L et al (2006) The relationship of inflammatory bowel disease type and activity to psychological functioning and quality of life. Clin Gastroenterol Hepatol 4:1491–1501
Nahon S, Lahmek P, Durance C, Olympie A, Lesgourgues B, Colombel JF et al (2012) Risk factors of anxiety and depression in inflammatory bowel disease. Inflamm Bowel Dis 18:2086–2091
Loftus EV Jr, Guerin A, Yu AP, Wu EQ, Yang M, Chao J et al (2011) Increased risks of developing anxiety and depression in young patients with Crohn’s disease. Am J Gastroenterol 106:1670–1677
Ananthakrishnan AN, Gainer VS, Cai T, Perez RG, Cheng SC, Savova G et al (2013) Similar risk of depression and anxiety following surgery or hospitalization for Crohn’s disease and ulcerative colitis. Am J Gastroenterol 108:594–601
Best WR, Becktel JM, Singleton JW, Kern F Jr (1976) Development of a Crohn’s disease activity index: National Cooperative Crohn’s Disease Study. Gastroenterology 70:439–444
Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340:1398–1405
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77
Mittermaier C, Dejaco C, Waldhoer T, Oefferlbauer-Ernst A, Miehsler W, Beier M et al (2004) Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med 66:79–84
Goodhand JR, Wahed M, Mawdsley JE, Farmer AD, Aziz Q, Rampton DS (2012) Mood disorders in inflammatory bowel disease: relation to diagnosis, disease activity, perceived stress, and other factors. Inflamm Bowel Dis 18:2301–2309
Addolorato G, Capristo E, Stefanini GF, Gasbarrini G (1997) Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand J Gastroenterol 32:1013–1021
Iglesias M, de Acosta Barreiro M, Vázquez I, Figueiras A, Nieto L, Lorenzo A, Domínguez-Muñoz JE (2009) Psychological impact of Crohn’s disease on patients in remission: anxiety and depression risks. Rev Esp Enferm Dig 101:249–257
Mikocka-Walus AA, Turnbull DA, Moulding NT, Wilson IG, Holtmann GJ, Andrews JM (2008) Does psychological status influence clinical outcomes in patients with inflammatory bowel diseases and other chronic gastroenterological diseases? An observational cohort prospective study. Biopsy Med 2:11
Porcelli P, Leoci C, Guerra V (1996) A prospective study of the relationship between disease activity and psychological distress in patients with inflammatory bowel disease. Scand J Gastroenterol 31:792–796
Mardini HE, Kip KE, Wilson JW (2004) Crohn’s disease: a two-year prospective study of the association between psychological distress and disease activity. Dig Dis Sci 49:492–497
Persoons P, Vermeire S, Demyttenaere K, Fischler B, Vandenberghe J, Van Oudenhove L et al (2005) The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Aliment Pharmacol Ther 22:101–110
Bennebroek Evertsz’ F, Thijssens NA, Stokkers PC, Grootenhuis MA, Bockting CL, Nieuwkerk PT et al (2012) Do inflammatory bowel disease patients with anxiety and depressive symptoms receive the care they need? J Crohns Colitis 6:68–76
Ananthakrishnan AN, Gainer VS, Perez RG, Cai T, Cheng SC, Savova G et al (2013) Psychiatric co-morbidity is associated with increased risk of surgery in Crohn’s disease. Aliment Pharmacol Ther 37:445–454
Zhang CK, Hewett J, Hemming J, Grant T, Zhao H, Abraham C et al (2013) The influence of depression on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis 19:1732–1739
Berrill JW, Green JT, Hood K, Campbell AK (2013) Symptoms of irritable bowel syndrome in patients with inflammatory bowel disease: examining the role of sub-clinical inflammation and the impact on clinical assessment of disease activity. Aliment Pharmacol Ther 38:44–51
Goodhand JR, Greig FI, Koodun Y, McDermott A, Wahed M, Langmead L et al (2012) Do antidepressants influence the disease course in inflammatory bowel disease? A retrospective case-matched observational study. Inflamm Bowel Dis 18:1232–1239
Mikocka-Walus A, Andrews JM (2013) Attitudes towards antidepressants among people living with inflammatory bowel disease: an online Australia-wide survey. J Crohns Colitis 8:296–303
Mahadev S, Young JM, Selby W, Solomon MJ (2012) Self-reported depressive symptoms and suicidal feelings in perianal Crohn’s disease. Color Dis 14:331–335
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maconi, G., Gridavilla, D., Viganò, C. et al. Perianal disease is associated with psychiatric co-morbidity in Crohn’s disease in remission. Int J Colorectal Dis 29, 1285–1290 (2014). https://doi.org/10.1007/s00384-014-1935-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-014-1935-6