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Impact of Depressive Mood on Relapse in Patients With Inflammatory Bowel Disease: A Prospective 18-Month Follow-Up Study

From the Department of Medicine IV, Division of Gastroenterology and Hepatology (C.D., A.O. W.M., M.B., W.T., A.G., G.M.), Department of Physical Medicine and Rehabilitation (C.M.), and Department of Epidemiology, Institute of Tumor Biology (T.W.), University Hospital of Vienna, Vienna, Austria.

Address correspondence and reprint requests to Dr. Clemens Dejaco, Division of Gastroenterology and Hepatology, Department of Internal Medicine IV, University Hospital, AKH, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: clemens.dejaco{at}akh-wien.ac.at

OBJECTIVE: There is evidence of an interaction between psychological factors and activity of inflammatory bowel disease (IBD). We examined the influence of depressive mood and associated anxiety on the course of IBD over a period of 18 months in a cohort of patients after an episode of active disease.

METHODS: In this prospective, longitudinal, observational study, 60 patients (37 women and 23 men) with clinically inactive IBD (Crohn disease, n = 47, 78%; ulcerative colitis, n = 13, 22%) were enrolled after a flare of disease. Psychological status, health-related quality of life (HRQOL), and disease activity were evaluated at baseline and then every 3 months for a period of 18 months by means of clinical and biological parameters, the Beck Depression Inventory (BDI), the Spielberger State-Trait Anxiety Inventory, the Inflammatory Bowel Disease Questionnaire, the Perceived Stress Questionnaire, and the Rating Form of Inflammatory Bowel Disease Patients Concerns.

RESULTS: At baseline, depression (BDI 13 points) was found in 17 of 60 (28%) patients. Thirty-two patients (59%) experienced at least one relapse during the 18 months of follow-up. Regression analysis showed a significant correlation between BDI scores at baseline and the total number of relapses after 12 (p < .01) and 18 months (p < .01) of follow-up. Furthermore, depression scores at baseline correlated with the time until the first recurrence of the disease (p < .05). Anxiety and low HRQOL were also related with more frequent relapses during follow-up (p < .05 and p < .01, respectively).

CONCLUSIONS: Psychological factors such as a depressive mood associated with anxiety and impaired HRQOL may exert a negative influence on the course of IBD. Therefore, assessment and management of psychological distress should be included in clinical treatment of patients with IBD.

Key Words: inflammatory bowel disease, • depressive mood, • anxiety, • disease activity, • health-related quality of life.

Abbreviations: BDI = Beck Depression Inventory;; CAI = colitis activity index;; CD = Crohn disease;; CDAI = Crohn disease activity index;; ESR = erythrocyte sedimentation rate;; HRQOL = health-related quality of life;; IBD = inflammatory bowel disease;; IBDQ = Inflammatory Bowel Disease Questionnaire;; PSQ = Perceived Stress Questionnaire;; RFIPC = Rating Form of Inflammatory Bowel Disease Patient Concerns;; STAI = Spielberger State-Trait Anxiety Inventory;; UC = ulcerative colitis.

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