Department of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Zurich, Switzerland.
Clinic for Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland.
Aliment Pharmacol Ther. 2021 Jul;54(1):53-67. doi: 10.1111/apt.16365. Epub 2021 May 11.
Inflammatory bowel disease (IBD) can be exacerbated by stress and depression. Type D personality, characterised by high negative affectivity and social inhibition, represents a vulnerability towards stressors and is associated with adverse outcomes in coronary heart disease.
To assess the prevalence of Type D personality in IBD patients and investigate potential associations with disease course.
We tested for associations between Type D (Type D Scale-14), depressive symptoms (Hospital Anxiety and Depression Scale's depression subscore ≥11) and recurrent IBD amongst Swiss IBD cohort patients. We built regression models for cross-sectional and Cox proportional hazards models for time-to-event analyses. IBD disease course was assessed by the future occurrence of active disease (Crohn's Disease Activity Index ≥150/Modified Truelove & Witts activity index ≥10) and several IBD-relevant endpoints.
Amongst 2275 patients (1005 ulcerative colitis, 1270 Crohn's disease), 672 (29.5%) had Type D. Type D was a significant risk factor for future active disease (adjusted hazard ratio, aHR: 1.60, corrected P value, q = 0.007) and predicted the future presence of depressive symptoms (aHR: 3.30, P < 0.001). The combination of Type D and depressive symptoms further increased the risk for active disease (aHR: 3.98, q < 0.001). However, Type D associated depressive symptoms seemed to be the main contributor to this effect as Type D's predictive power decreased considerably in models corrected for depressive symptoms (aHR: 1.32, CI: 0.97-1.79, q = 0.292).
Type D personality's prevalence amongst IBD patients was comparable with its prevalence in the general population. Type D was strongly associated with depressive symptoms and showed modest independent associations with IBD prognosis.
炎症性肠病（IBD）可能会因压力和抑郁而加重。具有高负性情感和社交抑制的 D 型人格代表对压力源的脆弱性，并与冠心病的不良结局相关。
评估 IBD 患者中 D 型人格的患病率，并探讨其与疾病过程的潜在关联。
我们在瑞士 IBD 队列患者中检测了 D 型（D 型量表-14）、抑郁症状（医院焦虑和抑郁量表的抑郁分量表≥11）与复发性 IBD 之间的关联。我们建立了横断面回归模型和 Cox 比例风险模型进行时间事件分析。IBD 疾病过程通过未来发生活动性病（克罗恩病活动指数≥150/改良 Truelove 和 Witts 活动指数≥10）和几个与 IBD 相关的终点来评估。
在 2275 名患者（溃疡性结肠炎 1005 名，克罗恩病 1270 名）中，有 672 名（29.5%）患有 D 型。D 型是未来发生活动性病的显著危险因素（校正后的危险比，aHR：1.60，校正的 P 值，q=0.007），并预测未来出现抑郁症状（aHR：3.30，P<0.001）。D 型和抑郁症状的组合进一步增加了发生活动性病的风险（aHR：3.98，q<0.001）。然而，D 型相关的抑郁症状似乎是这种效应的主要贡献者，因为在校正抑郁症状的模型中，D 型的预测能力大大降低（aHR：1.32，CI：0.97-1.79，q=0.292）。
IBD 患者中 D 型人格的患病率与一般人群相当。D 型与抑郁症状密切相关，与 IBD 预后有适度的独立关联。
