Gastroenterology, St George's University of London, London, UK.
School of Primary Care and Public Health, Imperial College, London, UK.
Gut. 2021 Sep;70(9):1642-1648. doi: 10.1136/gutjnl-2020-322308. Epub 2020 Oct 27.
Depression is a potential risk factor for developing IBD. This association may be related to GI symptoms occurring before diagnosis. We aimed to determine whether depression, adjusted for pre-existing GI symptoms, is associated with subsequent IBD.
We conducted a nested case-control study using the Clinical Practice Research Datalink identifying incident cases of UC and Crohn's disease (CD) from 1998 to 2016. Controls without IBD were matched for age and sex. We measured exposure to prevalent depression 4.5-5.5 years before IBD diagnosis. We created two sub-groups with prevalent depression based on whether individuals had reported GI symptoms before the onset of depression. We used conditional logistic regression to derive ORs for the risk of IBD depending on depression status.
We identified 10 829 UC cases, 4531 CD cases and 15 360 controls. There was an excess of prevalent depression 5 years before IBD diagnosis relative to controls (UC: 3.7% vs 2.7%, CD 3.7% vs 2.9%). Individuals with GI symptoms prior to the diagnosis of depression had increased adjusted risks of developing UC and CD compared with those without depression (UC: OR 1.47, 95% CI 1.21 to 1.79; CD: OR 1.41, 95% CI 1.04 to 1.92). Individuals with depression alone had similar risks of UC and CD to those without depression (UC: OR 1.13, 95% CI 0.99 to 1.29; CD: OR 1.12, 95% CI 0.91 to 1.38).
Depression, in the absence of prior GI symptoms, is not associated with subsequent development of IBD. However, depression with GI symptoms should prompt investigation for IBD.
抑郁是发生 IBD 的潜在危险因素。这种关联可能与诊断前发生的胃肠道症状有关。我们旨在确定在调整了预先存在的胃肠道症状后，抑郁是否与随后发生的 IBD 相关。
我们使用临床实践研究数据链进行了一项嵌套病例对照研究，从 1998 年到 2016 年确定了 UC 和克罗恩病 (CD) 的新发病例。没有 IBD 的对照组按年龄和性别匹配。我们测量了在 IBD 诊断前 4.5-5.5 年内普遍存在的抑郁的暴露情况。我们根据个体在抑郁发作前是否报告过胃肠道症状，创建了两个基于普遍存在的抑郁的亚组。我们使用条件逻辑回归来获得取决于抑郁状态的 IBD 风险的 OR。
我们确定了 10829 例 UC 病例、4531 例 CD 病例和 15360 例对照。与对照组相比，IBD 诊断前 5 年存在抑郁的情况更为普遍（UC：3.7%比 2.7%，CD：3.7%比 2.9%）。与没有抑郁的人相比，在诊断为抑郁之前有胃肠道症状的人患 UC 和 CD 的调整后风险增加（UC：OR 1.47，95%CI 1.21-1.79；CD：OR 1.41，95%CI 1.04-1.92）。仅患有抑郁的个体患 UC 和 CD 的风险与没有抑郁的个体相似（UC：OR 1.13，95%CI 0.99-1.29；CD：OR 1.12，95%CI 0.91-1.38）。
在没有先前胃肠道症状的情况下，抑郁与随后发生的 IBD 无关。然而，有胃肠道症状的抑郁应该提示对 IBD 进行调查。
