Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Clin Gastroenterol Hepatol. 2013 Jan;11(1):57-62. doi: 10.1016/j.cgh.2012.08.032. Epub 2012 Aug 31.
BACKGROUND & AIMS: Depression and psychosocial stress are believed to contribute to the pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC). Although many mechanisms have been proposed to link these disorders, few prospective studies have examined the relationship between depressed mood and incidence of CD or UC.
We analyzed data from 152,461 women (aged 29-72 years) enrolled since 1992-1993 in the Nurses' Health Study cohorts I and II. Self-reported depressive symptoms were assessed by using the Mental Health Index (MHI)-5, a validated 5-item subscale of the 36-item Short-Form health survey, which is designed to estimate psychological distress on the basis of scores that range from 0 to 100. Self-reported CD and UC were confirmed through blinded record review by 2 gastroenterologists. Cox proportional hazards models were used to associate recent (within 4 years) and baseline MHI-5 scores with risk for CD or UC, adjusting for other risk factors.
During 1,787,070 person-years of follow-up, we documented 170 cases of CD and 203 cases of UC. Compared with women with recent MHI-5 scores of 86-100, women with recent depressive symptoms (MHI-5 scores <52) had an increased risk of CD (multivariate-adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.40-3.98; P trend = .001). Baseline depressive symptoms, assessed from the baseline MHI-5 score, were also associated with CD, although with a lower HR (1.62; 95% CI, 0.94-2.77). Recent (HR, 1.14; 95% CI, 0.68-1.92) and baseline depressive symptoms were not associated with increased risk of UC (HR, 1.07; 95% CI, 0.63-1.83).
On the basis of data from the Nurses' Health Study, depressive symptoms increase the risk for CD, but not UC, among women. Psychological factors might therefore contribute to development of CD. Further studies are needed to determine the mechanisms of this association.
抑郁和心理社会应激被认为是导致克罗恩病（CD）和溃疡性结肠炎（UC）发病的因素。尽管已经提出了许多将这些疾病联系起来的机制，但很少有前瞻性研究检查抑郁情绪与 CD 或 UC 发生率之间的关系。
我们分析了自 1992-1993 年以来参加护士健康研究 I 期和 II 期队列的 152461 名女性（年龄 29-72 岁）的数据。使用心理健康指数（MHI）-5 评估自我报告的抑郁症状，这是 36 项简短健康调查问卷的 5 项有效子量表，旨在根据 0 到 100 分的分数来估计心理困扰。通过由 2 名胃肠病学家进行的盲法记录审查来确认自我报告的 CD 和 UC。使用 Cox 比例风险模型将最近（4 年内）和基线 MHI-5 评分与 CD 或 UC 的风险相关联，同时调整其他危险因素。
在 1787070 人年的随访期间，我们记录了 170 例 CD 和 203 例 UC。与最近 MHI-5 评分为 86-100 的女性相比，最近有抑郁症状（MHI-5 评分<52）的女性发生 CD 的风险增加（多变量调整后的危险比 [HR]，2.39；95%置信区间 [CI]，1.40-3.98；P 趋势 =.001）。从基线 MHI-5 评分评估的基线抑郁症状也与 CD 相关，尽管 HR 较低（1.62；95%CI，0.94-2.77）。最近（HR，1.14；95%CI，0.68-1.92）和基线抑郁症状与 UC 风险增加无关（HR，1.07；95%CI，0.63-1.83）。
基于护士健康研究的数据，抑郁症状会增加女性患 CD 的风险，但不会增加 UC 的风险。因此，心理因素可能有助于 CD 的发展。需要进一步的研究来确定这种关联的机制。
