Krieg Andreas, Kolbe Ernst W, Kaspari Michael, Krieg Sarah, Loosen Sven H, Roderburg Christoph, Kostev Karel
Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Medical Campus OWL, University Hospital Herford, Ruhr University Bochum, Schwarzenmoorstr. 70, 32049, Herford, Germany.
Department of Inclusive Medicine, University Hospital Ostwestfalen-Lippe, Bielefeld University, 33617, Bielefeld, Germany.
Qual Life Res. 2025 Mar;34(3):701-709. doi: 10.1007/s11136-024-03863-1. Epub 2024 Dec 14.
Anal fissures and anorectal fistulas are diseases often associated with significant pain and prolonged discomfort, resulting in a significantly reduced quality of life (QoL). They are not only a surgical problem but also have a profound psychosocial impact and influence on QoL. The aim of this study was to investigate the incidence of depression in patients with these pathologies and to highlight the need to address the psychosocial aspects of these diseases.
Data from the Disease Analyzer database of approximately 3,000 general practitioners in Germany were retrospectively analyzed. The retrospective cohort study included patients aged ≥ 18 years diagnosed with anal fissure (n = 15,467) or anorectal fistula (n = 3,520) between January 2005 and December 2022 and propensity score matched individuals without these disorders (n = 94,935). The primary outcome was a diagnosis of depression within five years of the index date. Kaplan-Meier curves and Cox regression analyses were used to analyze the association between the two anorectal diseases and depression.
After 5 years of follow-up, 13.0% of patients with anal fissure and 12.3% of patients with anorectal fistula were diagnosed with depression, compared with 9.7-10.3% in the control group (p < 0.001). Cox regression analysis showed a significant association between both diseases and depression (anal fissure: HR: 1.31; 95% CI: 1.25-1.38; anorectal fistula: HR: 1.30; 95% CI: 1.17-1.44).
The results suggest that anal fissures or anorectal fistulas are significantly associated with a subsequent depression. This highlights the importance of multidisciplinary management that addresses both physical and psychosocial aspects to improve patient outcomes.
肛裂和肛瘘是常伴有剧痛和长期不适的疾病，会导致生活质量（QoL）显著下降。它们不仅是手术问题，还对心理社会产生深远影响并影响生活质量。本研究的目的是调查患有这些病症的患者中抑郁症的发病率，并强调解决这些疾病心理社会方面问题的必要性。
对来自德国约3000名全科医生的疾病分析仪数据库的数据进行回顾性分析。这项回顾性队列研究纳入了2005年1月至2022年12月期间诊断为肛裂（n = 15467）或肛瘘（n = 3520）的≥18岁患者，以及倾向得分匹配的无这些疾病的个体（n = 94935）。主要结局是在索引日期后五年内诊断为抑郁症。采用Kaplan-Meier曲线和Cox回归分析来分析这两种肛肠疾病与抑郁症之间的关联。
随访5年后，肛裂患者中有13.0%、肛瘘患者中有12.3%被诊断为抑郁症，而对照组为9.7%-10.3%（p < 0.001）。Cox回归分析显示这两种疾病与抑郁症之间均存在显著关联（肛裂：HR：1.31；95%CI：1.25-1.38；肛瘘：HR：1.30；95%CI：1.17-1.44）。
结果表明，肛裂或肛瘘与随后发生的抑郁症显著相关。这凸显了多学科管理的重要性，即要兼顾身体和心理社会方面以改善患者预后。
