Crohn Disease Risk in Women Elevated by Depressive Symptoms

The presence of depressive symptoms in women increases the risk of Crohn disease, according to data from the Nurses’ Health Study. Researchers in the Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, concluded that psychological factors might contribute to the development of Crohn disease.

The study results were reported in the January 2013 issue of Clinical Gastroenterology and Hepatology.¹

Ananthakrishnan and associates analyzed data from 152,461 women aged 29 to 72 years enrolled in the Nurses’ Health Study I (a prospective cohort) and II. They used the Mental Health Index (MHI)-5, a validated 5-item subscale of the 36-item Short-Form Health Survey, to assess self-reported depressive symptoms, and they confirmed self-reported Crohn disease or ulcerative colitis through blinded record review by 2 gastroenterologists. A diagnosis of Crohn disease or ulcerative colitis was assigned on the basis of the typical clinical presentation for 4 weeks or longer and established typical findings on endoscopic, histological, radiological, or surgical evaluation consistent with a diagnosis of Crohn disease or ulcerative colitis.

Depressive symptoms were associated with a 2-fold increase in risk of Crohn disease. On the basis of the recent MHI-5 administered within 4 years, a significant linear increase in the risk of Crohn disease according to decreasing MHI-5 score was observed. The risk was increased in women with recent depressive symptoms (MHI-5 scores lower than 52) compared with women with recent MHI-5 scores of 86 to 100. Baseline depressive symptoms also were associated with Crohn disease. Depressive symptoms did not increase the risk of ulcerative colitis.

The authors noted that their findings lend support to a biopsychosocial model of inflammatory bowel disease pathogenesis in which the risk of disease is influenced by psychosocial factors. They suggested that preliminary animal and human studies show that managing depression through administration of antidepressants or through improvement in coping mechanisms could reduce the risk of disease relapse.

References
1. Ananthakrishnan AN, Khalili H, Pan A, et al. Association between depressive symptoms and incidence of Crohn’s disease and ulcerative colitis: results from the Nurses’ Health Study. Clin Gastroenterol Hepatol. 2013;11:57-62.