*Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh †Department of Psychiatry, University of Pittsburgh School of Medicine ‡Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA §Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora ||Department of Psychiatry, Boston Children's Hospital ¶Department of Pediatric Gastroenterology, Boston Children's Hospital, Boston, MA.
J Pediatr Gastroenterol Nutr. 2014 May;58(5):574-81. doi: 10.1097/MPG.0000000000000262.
The association between inflammatory bowel disease (IBD) and depression provides a unique opportunity to understand the relation between systemic inflammation and depressive symptom profiles.
Youth (n = 226) ages 9 to 17 years with comorbid IBD and depression underwent psychiatric assessment and evaluation of IBD activity. Latent profile analysis (LPA) identified depressive subgroups based on similar responses to the Children's Depression Rating Scale-Revised. Demographic factors, depression severity, anxiety, IBD activity, inflammatory markers, IBD-related medications, and illness perception were evaluated as predictors of profile membership.
Mean age was 14.3 years; 75% had Crohn disease; 31% were taking systemic corticosteroids. Mean depressive severity was moderate, whereas IBD activity, which reflects inflammation, was mild. LPA identified 3 subgroups: Profile-1 (mild, 75%) had diverse low-grade depressive symptoms and highest quality of life; Profile-2 (somatic, 19%) had severe fatigue, appetite change, anhedonia, decreased motor activity, and depressed mood with concurrent high-dose steroid therapy and the highest IBD activity; and Profile-3 (cognitive, 6%) had the highest rates of self-reported depressive symptoms, ostomy placements, and anxiety with IBD symptoms in the relative absence of inflammation.
Evidence was found for 3 depression profiles in youth with IBD and depression. Our analyses determined that patients with predominantly somatic or cognitive symptoms of depression comprised 25% of our cohort. These findings may be used to design subgroup-specific interventions for depression in adolescents with IBD and other physical illnesses associated with systemic inflammation.
炎症性肠病（IBD）与抑郁症之间的关联为了解系统性炎症与抑郁症状特征之间的关系提供了独特的机会。
共纳入 226 例年龄在 9 至 17 岁之间的合并 IBD 和抑郁症的青少年，他们接受了精神科评估和 IBD 活动评估。潜在剖面分析（LPA）根据对儿童抑郁评定量表修订版的相似反应，确定了抑郁亚组。评估人口统计学因素、抑郁严重程度、焦虑、IBD 活动、炎症标志物、IBD 相关药物和疾病认知，以预测亚组归属。
平均年龄为 14.3 岁，75%的患者患有克罗恩病，31%的患者接受全身皮质类固醇治疗。抑郁严重程度的平均水平为中度，而反映炎症的 IBD 活动为轻度。LPA 确定了 3 个亚组：Profile-1（轻度，75%）表现为各种低度抑郁症状和最高的生活质量；Profile-2（躯体症状，19%）有严重的疲劳、食欲改变、快感缺失、运动活动减少和抑郁情绪，同时伴有高剂量皮质类固醇治疗和最高的 IBD 活动；Profile-3（认知，6%）有最高的自我报告抑郁症状、造口术安置和焦虑发生率，同时 IBD 症状相对缺乏炎症。
在患有 IBD 和抑郁症的青少年中发现了 3 种抑郁特征。我们的分析确定，以躯体或认知症状为主的抑郁患者占我们队列的 25%。这些发现可用于为患有 IBD 和其他与系统性炎症相关的躯体疾病的青少年设计特定亚组的抑郁干预措施。
