For patients living with Crohn’s disease, feelings and thoughts associated with depression are linked to an increased presence of elevated disease activity (exacerbations), according to research presented at Digestive Disease Week 2014. The study is based on data from CCFA Partners, a groundbreaking research initiative sponsored by the Crohn’s & Colitis Foundation (CCFA).
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“Our study suggests that feelings of sadness and thoughts of helplessness, hopelessness, and worthlessness can affect the risk of disease flares, in people with Crohn’s disease,” comments lead author Lawrence S. Gaines, PhD, Associate Professor of Psychiatry and Medicine at Vanderbilt University. “For these patients, what they think about themselves may be related to a very real medical outcome.”
The study used data from CCFA Partners, an Internet-based study of patients with inflammatory bowel diseases (IBD). After giving informed consent, patients completed surveys providing information on their disease, how it’s being treated, and how it’s affecting their lives.
Respondents were also asked a few questions depressive thoughts and feelings—how often patients felt sad, helpless, hopeless, or worthless. These types of patient-reported outcomes are increasingly assessed to provide insights into how health issues are affecting patients’ lives.
The patients were followed up for one year to look for possible connections between depressive feelings and thoughts and elevated Crohn’s activity one year later. The study included approximately 3,150 adult patients with Crohn’s disease.
“We found a significant association between increased depression scores and the odds of active Crohn’s disease 12 months later,” says Dr Gaines. Even after adjustment for other potential risk factors, the link between depression and Crohn’s disease activity remained significant.
The association appeared stronger for patients with higher depression scores. In particular, for patients with higher scores for depressive thoughts and feelings, the proportion of patients having elevated disease activity scores was 50 percent higher than for those with lower depression scores.
In contrast, for patients with low depression scores risk the proportion having elevated activity was about 25 percent higher than for those with no depressive thoughts or feelings. This association was just under the cutoff point for statistical significance.
Patients with Crohn’s disease have inflammation of the intestinal tract, with disease flares, or exacerbations, causing attacks of symptoms and potential damage to the intestines. Minimizing the frequency of exacerbations is a major goal of disease management.
Crohn’s disease is a biological disease, not caused by psychological or emotional factors. (The same is true for ulcerative colitis, the other major form of IBD.) However, the risk of disease flare-ups may be increased during times of physical or emotional stress. Previous large-scale studies have suggested that depression may influence the course and severity of Crohn’s disease.
As a group, the study participants were mainly white, well-educated women. Dr. Gaines suggests that with this relatively healthy population, the study would be biased against showing a significant relationship. “It would be interesting to look for similar findings in a less-healthy group of patients with higher levels of depression,” he says.
The results provide the first evidence that depression-related thoughts and feelings are associated with likelihood of elevated Crohn’s disease activity one year later. From a research standpoint, Dr Gaines believes it would be of interest to look more deeply into what it means to be depression, and how patterns of depression are related to patterns of disease activity over time.
Meanwhile, professionals treating IBD should bear in mind that how patients feel about themselves may have a real impact on the course of their disease. Dr. Gaines adds, “Gastroenterologists should be asking patients about depression and how their disease is affecting the way they feel about their lives not just their disease.