The incidence of new mental health disorders after acute pancreatitis: A large, propensity-matched, observational study

Komal Khoja; Omar Sadiq; Phillip R Chisholm; Kulwinder S Dua; Srivats Madhavan; Zachary L Smith

doi:10.1016/j.pan.2023.01.008

The incidence of new mental health disorders after acute pancreatitis: A large, propensity-matched, observational study

Pancreatology. 2023 Mar;23(2):163-170. doi: 10.1016/j.pan.2023.01.008. Epub 2023 Jan 18.

Authors

Komal Khoja¹, Omar Sadiq¹, Phillip R Chisholm¹, Kulwinder S Dua¹, Srivats Madhavan¹, Zachary L Smith²

Affiliations

¹ Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.
² Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: zsmith@mcw.edu.

PMID: 36710225
DOI: 10.1016/j.pan.2023.01.008

Abstract

Introduction: The prevalence of acute pancreatitis (AP) and mental health disorders (MHDs) are rising. While the association between chronic pancreatitis (CP) and MHDs is established, it is unknown whether there is a risk of MHDs after an index episode of AP. The aim of this study was to evaluate the incidence of MHDs and pharmacotherapy use after an episode of AP.

Methods: This was a large observational study using the TriNetX research network, an electronic health record dataset containing inpatient and outpatient data from more than 50 healthcare organizations. Patients with AP from 2015-2020 were identified. Four cohorts were created: acute necrotizing pancreatitis (ANP), acute pancreatitis without necrosis (AP-WON), acute appendicitis, and healthy controls without pancreatitis. The cohorts were matched by age, sex, race, ethnicity, and nicotine and alcohol use. The primary outcome was new composite MHDs at one-year. Secondary outcomes included stratified MHDs, psychiatric medication use, opioid analgesic use, and all-cause mortality.

Results: The ANP, AP-WON, appendicitis, and healthy control cohorts contained 11,806, 177,266, 27,187, and 561,833 patients, respectively. Patients with AP-WON had significantly higher rates of composite MHDs compared with those hospitalized for appendicitis (9.7% vs 4.7%, HR 1.9, 95% CI 1.7-1.9). This association was augmented when comparing ANP to appendicitis (12.8% vs 5.2%, HR 2.4, 95% CI 2.1-2.7). All secondary outcomes were observed at significantly higher rates in the AP-WON cohort when compared to appendicitis. Again, these associations were augmented comparing ANP to appendicitis.

Conclusion: Compared with controls, patients with AP had significantly higher rates of new MHDs and their associated pharmacotherapies at one-year, suggesting that a single episode of AP may independently place patients at risk for developing MHDs irrespective of whether they go on to develop CP.

Keywords: Acute pancreatitis; Depression; Mental health; Opiates; Pain.

Publication types

Observational Study

MeSH terms

Acute Disease
Appendicitis* / complications
Humans
Incidence
Mental Health
Opioid-Related Disorders* / complications
Pancreatitis, Chronic* / complications