Similar risk of depression and anxiety following surgery or hospitalization for Crohn's disease and ulcerative colitis

Am J Gastroenterol. 2013 Apr;108(4):594-601. doi: 10.1038/ajg.2012.471. Epub 2013 Jan 22.


Objectives: Psychiatric comorbidity is common in Crohn's disease (CD) and ulcerative colitis (UC). Inflammatory bowel disease (IBD)-related surgery or hospitalizations represent major events in the natural history of the disease. The objective of this study is to examine whether there is a difference in the risk of psychiatric comorbidity following surgery in CD and UC.

Methods: We used a multi-institution cohort of IBD patients without a diagnosis code for anxiety or depression preceding their IBD-related surgery or hospitalization. Demographic-, disease-, and treatment-related variables were retrieved. Multivariate logistic regression analysis was performed to individually identify risk factors for depression and anxiety.

Results: Our study included a total of 707 CD and 530 UC patients who underwent bowel resection surgery and did not have depression before surgery. The risk of depression 5 years after surgery was 16% and 11% in CD and UC patients, respectively. We found no difference in the risk of depression following surgery in the CD and UC patients (adjusted odds ratio, 1.11; 95% confidence interval, 0.84-1.47). Female gender, comorbidity, immunosuppressant use, perianal disease, stoma surgery, and early surgery within 3 years of care predicted depression after CD surgery; only the female gender and comorbidity predicted depression in UC patients. Only 12% of the CD cohort had ≥4 risk factors for depression, but among them nearly 44% subsequently received a diagnosis code for depression.

Conclusions: IBD-related surgery or hospitalization is associated with a significant risk for depression and anxiety, with a similar magnitude of risk in both diseases.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / etiology*
  • Cohort Studies
  • Colitis, Ulcerative / complications
  • Colitis, Ulcerative / psychology
  • Colitis, Ulcerative / surgery*
  • Crohn Disease / complications
  • Crohn Disease / psychology
  • Crohn Disease / surgery*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / etiology*
  • Female
  • Hospitalization*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Risk Factors
  • Sex Factors