Department of Clinical Pharmacology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
College of Acupuncture Moxibustion and Tuina, Nanjing University of Chinese Medicine, Nanjing, China.
J Gastroenterol Hepatol. 2024 Aug;39(8):1476-1488. doi: 10.1111/jgh.16568. Epub 2024 Apr 24.
Depression is highly prevalent in patients with inflammatory bowel disease (IBD), which may affect the prognosis of IBD. This aimed to investigate the impact of depression on prognosis in IBD.
A systematic literature search was performed in four databases (Medline, Embase, Web of Science, and PsycINFO) up to December 31, 2023. Studies were included if they investigated the impact of depression on prognosis in IBD. The primary outcome was flare in IBD, and secondary outcomes were hospitalization, readmission, emergency visits, surgery, and escalation of medical therapy. Relative risks (RRs) were utilized to estimate the risk in each of the above prognostic indicators.
Fourteen cohort and 10 case-control studies matched our entry criteria, comprising 630 408 patients with IBD. Twenty-two of included studies were considered to have a low risk of bias. Depression was found to significantly increase the risk of flare (RR = 1.37, 95% CI 1.16-1.63), hospitalization (RR = 1.11, 95% CI 1.00-1.23), readmission (RR = 1.32, 95% CI 1.04-1.67), emergency visits (RR = 1.33, 95% CI 1.12-1.59), surgery (1.38, 95% CI 1.08-1.76), and escalation of medical therapy (RR = 1.38, 95% CI 1.13-1.69) in IBD. Of note, patients with depression in ulcerative colitis had significant differences in readmission (RR = 1.38, 95% CI 1.19-1.60) and escalation of medical therapy (RR = 1.78, 95% CI 1.55-2.04). Additionally, the association was observed in patients with Crohn's disease in terms of flare (RR = 1.47, 95% CI 1.08-2.01) and hospitalization (RR = 1.20, 95% CI 1.03-1.40).
Current evidence suggested that depression could significantly increase the risk of poor prognosis worsening in patients with IBD. However, the association varied in IBD subtypes.
炎症性肠病（IBD）患者中抑郁的发病率很高，这可能会影响 IBD 的预后。本研究旨在探讨抑郁对 IBD 预后的影响。
在 2023 年 12 月 31 日前，我们在四个数据库（Medline、Embase、Web of Science 和 PsycINFO）中进行了系统文献检索，纳入了研究抑郁对 IBD 预后影响的研究。主要结局为 IBD 复发，次要结局为住院、再入院、急诊就诊、手术和医疗治疗升级。采用相对风险（RR）来估计每种预后指标的风险。
符合纳入标准的队列研究有 14 项，病例对照研究有 10 项，共纳入 630408 例 IBD 患者。22 项纳入研究被认为存在低偏倚风险。结果显示，抑郁显著增加了 IBD 复发（RR=1.37，95%CI 1.16-1.63）、住院（RR=1.11，95%CI 1.00-1.23）、再入院（RR=1.32，95%CI 1.04-1.67）、急诊就诊（RR=1.33，95%CI 1.12-1.59）、手术（RR=1.38，95%CI 1.08-1.76）和医疗治疗升级（RR=1.38，95%CI 1.13-1.69）的风险。值得注意的是，溃疡性结肠炎患者的再入院（RR=1.38，95%CI 1.19-1.60）和医疗治疗升级（RR=1.78，95%CI 1.55-2.04）存在显著差异。此外，在克罗恩病患者中，也观察到了复发（RR=1.47，95%CI 1.08-2.01）和住院（RR=1.20，95%CI 1.03-1.40）的风险增加。
目前的证据表明，抑郁显著增加了 IBD 患者不良预后恶化的风险。然而，这种关联在 IBD 亚型中存在差异。
