Department of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Department of Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Inflamm Bowel Dis. 2022 May 4;28(5):728-733. doi: 10.1093/ibd/izab162.
Studies of adults with Crohn's disease (CD) suggest that poor mental health precedes worsening disease activity. We evaluated whether depression and/or anxiety forecast worsening pediatric CD disease activity.
Through the Inflammatory Bowel Disease Partners Kids & Teens internet-based cohort, children with CD age 9 to 17 completed Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric measures and the short Crohn's disease activity index (sCDAI). Using general linear models, we examined how baseline PROMIS Pediatric anxiety and depressive symptom scores independently associate with subsequent sCDAI scores (average survey interval 6.4 months). Models included baseline PROMIS Pediatric anxiety and depressive symptoms scores, baseline sCDAI, sex, age, parental education, race/ethnicity, and prior IBD-related surgery. We performed a post hoc subanalysis of children in baseline remission (sCDAI <150) with otherwise identical models.
We analyzed 159 children with CD (mean age 14 years, 45% female, 84% in baseline remission). We found no association between baseline PROMIS Pediatric anxiety score and subsequent sCDAI (change in sCDAI for 3-point change in PROMIS Pediatric -0.89; 95% CI -4.81 to 3.03). Baseline PROMIS Pediatric depressive symptoms score was not associated with future sCDAI (change in sCDAI for 3-point change in PROMIS Pediatric <0.01; 95% CI -4.54 to 4.53). In a subanalysis of patients in remission at baseline, the lack of association remained.
We found that neither anxiety nor depressive symptoms associate with subsequent disease activity in pediatric CD. These findings contrast with adult IBD studies, thus underschoring the unique pathophysiology, natural history, and outcomes of pediatric CD.
研究成年人克罗恩病（CD）表明，心理健康状况不佳先于疾病活动恶化。我们评估了抑郁和/或焦虑是否预示着儿科 CD 疾病活动恶化。
通过炎症性肠病伙伴儿童和青少年的互联网队列，9 至 17 岁的 CD 患儿完成了患者报告的结果测量信息系统（PROMIS）儿科测量和短克罗恩病活动指数（sCDAI）。使用线性模型，我们检查了基线 PROMIS 儿科焦虑和抑郁症状评分如何独立与随后的 sCDAI 评分相关（平均调查间隔 6.4 个月）。模型包括基线 PROMIS 儿科焦虑和抑郁症状评分、基线 sCDAI、性别、年龄、父母教育程度、种族/民族和既往 IBD 相关手术。我们使用相同的模型对基线缓解（sCDAI<150）的儿童进行了事后亚分析。
我们分析了 159 名 CD 患儿（平均年龄 14 岁，45%为女性，84%在基线缓解）。我们发现基线 PROMIS 儿科焦虑评分与随后的 sCDAI 之间没有关联（PROMIS 儿科评分每增加 3 分，sCDAI 变化-0.89；95%CI-4.81 至 3.03）。基线 PROMIS 儿科抑郁症状评分与未来 sCDAI 无关（PROMIS 儿科评分每增加 3 分，sCDAI 变化<0.01；95%CI-4.54 至 4.53）。在基线缓解的患者亚分析中，这种关联仍然不存在。
我们发现，焦虑或抑郁症状均与儿科 CD 后的疾病活动无关。这些发现与成人 IBD 研究形成对比，从而突出了儿科 CD 的独特病理生理学、自然史和结局。
