Gaines Lawrence S, Kappelman Michael D, Schwartz David A, Horst Sara N, Beaulieu Dawn B, Scoville Elizabeth S, Dalal Robin L, Pabla Baldeep S, Slaughter James C
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Crohns Colitis 360. 2023 Dec 23;6(1):otad080. doi: 10.1093/crocol/otad080. eCollection 2024 Jan.
Longitudinal research reveals a unidirectional relationship between a nonsomatic symptom of depression, a negative view of the self, and later reported Crohn's disease (CD) activity. We evaluated whether health behaviors mediated this association using a longitudinal design.
We studied 3304 adult volunteers with a self-reported diagnosis of CD who completed a baseline survey that included demographics, CD activity, a symptom-specific index of depression, and measures of physical activity, smoking, and sleep quality. Crohn's disease status and the cognitive index of depression were also measured 6 and 12 months after the baseline evaluation. We specified single-mediator and multiple-mediator models to elucidate the depression-disease activity relationship.
Among 2395 females and 909 males, we found a significant mediation effect for activity level ( < .001) after adjusting for age, sex, and body mass index. There was no evidence that sleep quality and smoking are significant single mediators. When we considered multiple mediation models, smoking and less activity partially mediate the depression-CD association.
Smoking and lower levels of physical activity are potential mediators of the unidirectional association between a nonsomatic symptom of depression-a negative view of the self-and patient-reported CD activity. Evaluating and treating specific symptoms of depression may reduce the frequency of CD exacerbations.
纵向研究揭示了抑郁的非躯体症状、对自我的负面看法与后来报告的克罗恩病（CD）活动之间存在单向关系。我们采用纵向设计评估健康行为是否介导了这种关联。
我们研究了3304名自我报告诊断为CD的成年志愿者，他们完成了一项基线调查，包括人口统计学信息、CD活动情况、抑郁症状特异性指数以及身体活动、吸烟和睡眠质量的测量指标。在基线评估后的6个月和12个月，还测量了克罗恩病状态和抑郁认知指数。我们指定了单中介模型和多中介模型来阐明抑郁与疾病活动之间的关系。
在2395名女性和909名男性中，在调整年龄、性别和体重指数后，我们发现活动水平存在显著的中介效应（<0.001）。没有证据表明睡眠质量和吸烟是显著的单中介因素。当我们考虑多中介模型时，吸烟和较少的活动部分介导了抑郁与CD之间的关联。
吸烟和较低水平的身体活动可能是抑郁的非躯体症状（对自我的负面看法）与患者报告的CD活动之间单向关联的潜在中介因素。评估和治疗抑郁的特定症状可能会降低CD病情加重的频率。
