炎症性肠病中焦虑、抑郁和双相情感障碍的纵向轨迹：一项基于人群的队列研究。
Longitudinal trajectories of anxiety, depression, and bipolar disorder in inflammatory bowel disease: a population-based cohort study.
作者信息
Bisgaard Tania H, Poulsen Gry, Allin Kristine H, Keefer Laurie, Ananthakrishnan Ashwin N, Jess Tine
机构信息
Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark.
Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
出版信息
EClinicalMedicine. 2023 May 5;59:101986. doi: 10.1016/j.eclinm.2023.101986. eCollection 2023 May.
BACKGROUND
Inflammatory bowel disease (IBD) is associated with psychiatric diseases, but it is unclear to what degree patients with IBD are affected over their lifetime. We aimed to longitudinally investigate the risk of anxiety, depression, and bipolar disorder before and after IBD diagnosis to understand the full burden of these diseases in patients with IBD.
METHODS
In this population based cohort study, we identified 22,103 patients diagnosed with IBD between January 1, 2003 and December 31, 2013 in the Danish National registers and 110,515 matched reference individuals from the general population. We calculated yearly prevalence of hospital contacts for anxiety, depression, and bipolar disorder and dispensed prescriptions for antidepressants from five years before to ten years after IBD diagnosis. We used logistic regression to calculate prevalence odds ratios (OR) for each outcome prior to IBD diagnosis, and Cox regression to calculate hazard ratios (HR) of new outcomes after IBD diagnosis.
FINDINGS
During >150,000 person years follow-up, patients with IBD had higher risk of anxiety (OR 1.4; 95% confidence interval (CI) 1.2-1.7) and depression (OR 1.4; 95% CI 1.3-1.6) starting at least five years before and continuing until at least ten years after IBD diagnosis (HR 1.3; 95% CI 1.1-1.5 for anxiety and HR 1.5; 95% CI 1.4-1.7 for depression). The risk was particularly high around IBD diagnosis and in patients diagnosed with IBD after the age of 40 years. We found no association between IBD and bipolar disorder.
INTERPRETATION
This population-based study suggests that anxiety and depression are clinically significant comorbidities of IBD both before and after IBD diagnosis, which warrant thorough evaluation and management, particularly around the time of IBD diagnosis.
FUNDING
The Danish National Research Foundation [DNRF148], the Lundbeck Foundation [R313-2019-857], and Aage og Johanne Louis-Hansens Fond [9688-3374 TJS].
背景
炎症性肠病（IBD）与精神疾病相关，但IBD患者一生受影响的程度尚不清楚。我们旨在纵向调查IBD诊断前后焦虑症、抑郁症和双相情感障碍的风险，以了解这些疾病在IBD患者中的全部负担。
方法
在这项基于人群的队列研究中，我们在丹麦国家登记处确定了2003年1月1日至2013年12月31日期间诊断为IBD的22103名患者，以及来自普通人群的110515名匹配的对照个体。我们计算了IBD诊断前五年至诊断后十年焦虑症、抑郁症和双相情感障碍的医院就诊年患病率以及抗抑郁药的处方量。我们使用逻辑回归计算IBD诊断前各结局的患病率比值比（OR），并使用Cox回归计算IBD诊断后新结局的风险比（HR）。
结果
在超过150000人年的随访期间，IBD患者在IBD诊断前至少五年开始并持续至诊断后至少十年，患焦虑症（OR 1.4；95%置信区间（CI）1.2 - 1.7）和抑郁症（OR 1.4；95% CI 1.3 - 1.6）的风险更高（焦虑症HR 1.3；95% CI 1.1 - 1.5，抑郁症HR 1.5；95% CI 1.4 - 1.7）。在IBD诊断前后以及40岁后诊断为IBD的患者中，风险尤其高。我们发现IBD与双相情感障碍之间无关联。
解读
这项基于人群的研究表明，焦虑症和抑郁症是IBD诊断前后具有临床意义的合并症，需要进行全面评估和管理，尤其是在IBD诊断前后。
资助
丹麦国家研究基金会[DNRF148]、伦贝克基金会[R313 - 2019 - 857]以及奥格和约翰娜·路易斯 - 汉森基金会[9688 - 3374 TJS]。
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