- Email: [email protected]
Self-Report is not a Sensitive Method of Assessing Depression in Patients with Inflammatory Bowel Disease
consider administering a PHQ-8 scale as part of their care for IBD patients in order to capture those who are at greater risk for worsening disease over time.
AGA Abstracts
reported working full-time (n=1695, 51.4%), with others working part-time (n=412, 12.5%), not currently working (n=316, 9.6%), working at home or as a student (n=246, 7.5%), and being disabled (n=259, 7.9%) or retired (n=368, 11.2%). To assess factors associated with work status, we compared those who were working (either full-time or part-time) to those who were not currently working (for reasons other than being students, disabled or retired). Participants who reported they were not currently working were more likely than those who reported they were currently working (either full- or part-time) to worry about inability to pay medical bills (b=-.320, t(1)=14.905, p<.001), have delayed healthcare (b=-.286, t(1)= 4.703, p=.030), and have visited the ER more frequently in the past year(b=.286, t(1)= 24.451, p<.001). Factors associated with respondents reporting they were disabled included 1) Crohn's as opposed to ulcerative colitis (UC) (b=.844, t(1)=19.538, p<.001), 2) longer IBD duration (b=-.478, t(1)=58.168, p<.001), 3) male gender (b=-.408, t(1)=5.818, p=.016), 4) more self-reported severe IBD (b=-.837, t(1)=46.526, p<.001), 5) more physician-reported severe IBD (b=-.773, t(1)=37.122, p<.001), 6) flares in the past 12 months (b=-.960, t(1)= 21.068, p<.001), and 7) annual income <$50,000 (b=-.973, t(1)=26.276, p<.001). Conclusions: IBD patients are more likely to report being disabled if they have Crohn's disease, longer disease duration, are male and have lower income. Identifying these risks can allow for identification of patient groups who may benefit from targeted care interventions.
Figure 1: Kaplan-Meier curve for Crohn's disease patients comparing the time to a composite endpoint for worsening disease, based on Harvey-Bradshaw Index, surgery, hospitalization, new biologic or steroid prescription, at follow up for those with and without depression as defined by the personal health questionnaire (PHQ-8) depression scale Caption: Log-rank test: <0.01
Figure 1. Participant's work status, separated by self-reported disease severity. Participants who reported they were disabled, as opposed to not currently working for other reasons, were more likely to report severe disease.
Figure 2: Kaplan-Meier curve for ulcerative colitis patients comparing the time to a composite endpoint for worsening disease, based on Simple Clinical Colitis Activity Index, surgery, hospitalization, new biologic or steroid prescription, at follow up for those with and without depression as defined by the personal health questionnaire (PHQ-8) depression scale Caption: Log-rank test: p = 0.03
Mo1840 Figure 2. Respondents who reported they were disabled, as opposed to not working for other reasons, were more likely to have reported a flare in the past 12 months.
RESILIENCE IS ASSOCIATED WITH LOWER RATES OF DEPRESSION AND ANXIETY, AND HIGHER QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE PATIENTS Priya Sehgal, Elizabeth Abrahams, Ryan C. Ungaro, Marla Dubinsky, Laurie Keefer
Mo1839
Background: Resilience, known as "grit" or one's ability to overcome adversity, is a psychological strength that varies across the population, but can be improved with intervention. Resilience has not yet been examined in IBD and may have relevance to outcomes, including serving as a buffer against depression, impaired quality of life (QOL) or poor disease control. This study aims to identify links between resilience and depression, anxiety, QOL and disease activity in IBD. Methods: Consecutive patients at a tertiary IBD Center were included. Remission was defined as Harvey Bradshaw Index (HBI) <5 for Crohn's disease and Simple Colitis Activity Index (SCAI) <2.5 for UC. Patients completed Connor-Davidson Resilience (CD-RISC; 10-50, low resilience <35), Patient Health Questionnaire-9 (PHQ-9; 0-27, >10 = depression), Generalized Anxiety Disorder 7-item (GAD-7; 0-21, >10 =anxiety) and NIH PROMIS-Global Health QOL. The CD-RISC is a widely used measure and directly correlated with post-traumatic stress disorder and depression. Linear regression was used to identify associations between resilience and depression, anxiety, QOL and disease activity. An independent sample t-test was used to evaluate mean HBI scores between patients with and without depression. Chi-square analyses comparing low and high resilience with remission and depression status were also performed. Results: 113 patients (56% female) with IBD participated; mean age = 38 years +/- 15, 61% Crohn's disease. Mean disease activity scores were 4.70 (HBI; CD) and 3.00 (SCAI; UC). 48% were in clinical remission. Mean resilience was 40.1 (+/- 6.2). 16% of patients scored in the low (<35) resilience range. Mean depression was low at 4.1 (+/-4.3) and mean anxiety was also low at 2.9 (+/- 4.1). 12% of patients had clinical levels of depression and 7% had clinical anxiety. Clinical depression was more commonly seen in Crohn's patients with active disease (t = -2.77, p = 0.008), but this was not seen in UC (t = -1.74, p = 0.09). Lower resilience was associated with higher levels of depression (R2 = -0.57, p<0.001) and anxiety (R2= -0.39, p=0.013), and patients with low resilience were also more likely to have clinically significant depression [χ2 = 13.85, p<0.001] but not anxiety. Higher resilience predicted higher global health QOL (R2 = 1.31, p=0.004). Resilience was not associated with disease activity. Conclusion: This is the first study to measure resilience in IBD patients. The cohort exhibited normal levels of resilience, but when present, low resilience was associated with depression, anxiety and poor QOL. Crohn's patients with clinical depression had significantly elevated disease activity. Resilience did not buffer this relationship, but future studies, with a larger patient population, should examine the longitudinal effect of resilience on disease activity.
SELF-REPORT IS NOT A SENSITIVE METHOD OF ASSESSING DEPRESSION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE Bharati Kochar, Edward L. Barnes, Kelly C. Cushing, Joseph Galanko, Christopher Martin, Laura H. Raffals, Millie D. Long, Robert Sandler Background: Depression is prevalent in inflammatory bowel disease (IBD) patients. The impact of depression on disease course is not well studied. It is also not known how IBD providers should assess depression in practice. Methods: We used data from the prospective Sinai-Helmsley Alliance for Research Excellence (SHARE) cohort to assess methods of reporting depression and the effects of depression at baseline on markers of disease activity at follow up. Depression was defined as a personal health questionnaire (PHQ-8) depression scale of ≥5. Relapse was defined as short Crohn's disease activity index (sCDAI) score >150 or a simple clinical colitis activity index (SCCAI) score >2. A composite endpoint for worsening disease included biologic or steroid initiation, hospitalization, surgery or relapse by disease activity score. We calculated risk ratios (RR) and also performed survival analysis. Results: There were 2,798 Crohn's disease (CD) patients with a mean disease duration of 13 years and mean follow up of 22 months. There were 1,516 ulcerative colitis (UC) patients with a mean disease duration of 10 years and mean follow up of 24 months. Based on disease activity indices, 64% of CD patients and 45% of UC patients were in remission at baseline. When surveyed, 20% of CD and 14% of UC patients reported being depressed. However, by PHQ-8, 38% of CD and 32% of UC patients were depressed (p<0.01). In this population, self-reported depression had a specificity of 90%, but a sensitivity of 31% compared to depression defined by PHQ-8. CD patients with a PHQ-8 consistent with depression at baseline were at significantly increased risk for the composite endpoint for worsening disease (RR: 1.9; 95% confidence interval (CI):1.7-2.3). UC patients with a PHQ8 consistent with depression at baseline were also at increased risk for the composite endpoint for worsening disease (RR: 1.3; 95%CI:0.9-1.8). Similar trends were seen when assessing a composite endpoint without including disease activity indices. Survival analyses revealed that CD and UC patients with a PHQ-8 consistent with depression at baseline developed the composite endpoint for worsening disease sooner than those who were not depressed by PHQ-8 (Figures 1 & 2). Conclusions: In IBD patients, depression at baseline is associated with higher risks for worsening disease at follow up. Asking patients whether they are depressed is not a sensitive way to assess depression in this population. Providers should
S-797
AGA Abstracts
AGA Abstracts
reported working full-time (n=1695, 51.4%), with others working part-time (n=412, 12.5%), not currently working (n=316, 9.6%), working at home or as a student (n=246, 7.5%), and being disabled (n=259, 7.9%) or retired (n=368, 11.2%). To assess factors associated with work status, we compared those who were working (either full-time or part-time) to those who were not currently working (for reasons other than being students, disabled or retired). Participants who reported they were not currently working were more likely than those who reported they were currently working (either full- or part-time) to worry about inability to pay medical bills (b=-.320, t(1)=14.905, p<.001), have delayed healthcare (b=-.286, t(1)= 4.703, p=.030), and have visited the ER more frequently in the past year(b=.286, t(1)= 24.451, p<.001). Factors associated with respondents reporting they were disabled included 1) Crohn's as opposed to ulcerative colitis (UC) (b=.844, t(1)=19.538, p<.001), 2) longer IBD duration (b=-.478, t(1)=58.168, p<.001), 3) male gender (b=-.408, t(1)=5.818, p=.016), 4) more self-reported severe IBD (b=-.837, t(1)=46.526, p<.001), 5) more physician-reported severe IBD (b=-.773, t(1)=37.122, p<.001), 6) flares in the past 12 months (b=-.960, t(1)= 21.068, p<.001), and 7) annual income <$50,000 (b=-.973, t(1)=26.276, p<.001). Conclusions: IBD patients are more likely to report being disabled if they have Crohn's disease, longer disease duration, are male and have lower income. Identifying these risks can allow for identification of patient groups who may benefit from targeted care interventions.
Figure 1: Kaplan-Meier curve for Crohn's disease patients comparing the time to a composite endpoint for worsening disease, based on Harvey-Bradshaw Index, surgery, hospitalization, new biologic or steroid prescription, at follow up for those with and without depression as defined by the personal health questionnaire (PHQ-8) depression scale Caption: Log-rank test: <0.01
Figure 1. Participant's work status, separated by self-reported disease severity. Participants who reported they were disabled, as opposed to not currently working for other reasons, were more likely to report severe disease.
Figure 2: Kaplan-Meier curve for ulcerative colitis patients comparing the time to a composite endpoint for worsening disease, based on Simple Clinical Colitis Activity Index, surgery, hospitalization, new biologic or steroid prescription, at follow up for those with and without depression as defined by the personal health questionnaire (PHQ-8) depression scale Caption: Log-rank test: p = 0.03
Mo1840 Figure 2. Respondents who reported they were disabled, as opposed to not working for other reasons, were more likely to have reported a flare in the past 12 months.
RESILIENCE IS ASSOCIATED WITH LOWER RATES OF DEPRESSION AND ANXIETY, AND HIGHER QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE PATIENTS Priya Sehgal, Elizabeth Abrahams, Ryan C. Ungaro, Marla Dubinsky, Laurie Keefer
Mo1839
Background: Resilience, known as "grit" or one's ability to overcome adversity, is a psychological strength that varies across the population, but can be improved with intervention. Resilience has not yet been examined in IBD and may have relevance to outcomes, including serving as a buffer against depression, impaired quality of life (QOL) or poor disease control. This study aims to identify links between resilience and depression, anxiety, QOL and disease activity in IBD. Methods: Consecutive patients at a tertiary IBD Center were included. Remission was defined as Harvey Bradshaw Index (HBI) <5 for Crohn's disease and Simple Colitis Activity Index (SCAI) <2.5 for UC. Patients completed Connor-Davidson Resilience (CD-RISC; 10-50, low resilience <35), Patient Health Questionnaire-9 (PHQ-9; 0-27, >10 = depression), Generalized Anxiety Disorder 7-item (GAD-7; 0-21, >10 =anxiety) and NIH PROMIS-Global Health QOL. The CD-RISC is a widely used measure and directly correlated with post-traumatic stress disorder and depression. Linear regression was used to identify associations between resilience and depression, anxiety, QOL and disease activity. An independent sample t-test was used to evaluate mean HBI scores between patients with and without depression. Chi-square analyses comparing low and high resilience with remission and depression status were also performed. Results: 113 patients (56% female) with IBD participated; mean age = 38 years +/- 15, 61% Crohn's disease. Mean disease activity scores were 4.70 (HBI; CD) and 3.00 (SCAI; UC). 48% were in clinical remission. Mean resilience was 40.1 (+/- 6.2). 16% of patients scored in the low (<35) resilience range. Mean depression was low at 4.1 (+/-4.3) and mean anxiety was also low at 2.9 (+/- 4.1). 12% of patients had clinical levels of depression and 7% had clinical anxiety. Clinical depression was more commonly seen in Crohn's patients with active disease (t = -2.77, p = 0.008), but this was not seen in UC (t = -1.74, p = 0.09). Lower resilience was associated with higher levels of depression (R2 = -0.57, p<0.001) and anxiety (R2= -0.39, p=0.013), and patients with low resilience were also more likely to have clinically significant depression [χ2 = 13.85, p<0.001] but not anxiety. Higher resilience predicted higher global health QOL (R2 = 1.31, p=0.004). Resilience was not associated with disease activity. Conclusion: This is the first study to measure resilience in IBD patients. The cohort exhibited normal levels of resilience, but when present, low resilience was associated with depression, anxiety and poor QOL. Crohn's patients with clinical depression had significantly elevated disease activity. Resilience did not buffer this relationship, but future studies, with a larger patient population, should examine the longitudinal effect of resilience on disease activity.
SELF-REPORT IS NOT A SENSITIVE METHOD OF ASSESSING DEPRESSION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE Bharati Kochar, Edward L. Barnes, Kelly C. Cushing, Joseph Galanko, Christopher Martin, Laura H. Raffals, Millie D. Long, Robert Sandler Background: Depression is prevalent in inflammatory bowel disease (IBD) patients. The impact of depression on disease course is not well studied. It is also not known how IBD providers should assess depression in practice. Methods: We used data from the prospective Sinai-Helmsley Alliance for Research Excellence (SHARE) cohort to assess methods of reporting depression and the effects of depression at baseline on markers of disease activity at follow up. Depression was defined as a personal health questionnaire (PHQ-8) depression scale of ≥5. Relapse was defined as short Crohn's disease activity index (sCDAI) score >150 or a simple clinical colitis activity index (SCCAI) score >2. A composite endpoint for worsening disease included biologic or steroid initiation, hospitalization, surgery or relapse by disease activity score. We calculated risk ratios (RR) and also performed survival analysis. Results: There were 2,798 Crohn's disease (CD) patients with a mean disease duration of 13 years and mean follow up of 22 months. There were 1,516 ulcerative colitis (UC) patients with a mean disease duration of 10 years and mean follow up of 24 months. Based on disease activity indices, 64% of CD patients and 45% of UC patients were in remission at baseline. When surveyed, 20% of CD and 14% of UC patients reported being depressed. However, by PHQ-8, 38% of CD and 32% of UC patients were depressed (p<0.01). In this population, self-reported depression had a specificity of 90%, but a sensitivity of 31% compared to depression defined by PHQ-8. CD patients with a PHQ-8 consistent with depression at baseline were at significantly increased risk for the composite endpoint for worsening disease (RR: 1.9; 95% confidence interval (CI):1.7-2.3). UC patients with a PHQ8 consistent with depression at baseline were also at increased risk for the composite endpoint for worsening disease (RR: 1.3; 95%CI:0.9-1.8). Similar trends were seen when assessing a composite endpoint without including disease activity indices. Survival analyses revealed that CD and UC patients with a PHQ-8 consistent with depression at baseline developed the composite endpoint for worsening disease sooner than those who were not depressed by PHQ-8 (Figures 1 & 2). Conclusions: In IBD patients, depression at baseline is associated with higher risks for worsening disease at follow up. Asking patients whether they are depressed is not a sensitive way to assess depression in this population. Providers should
S-797
AGA Abstracts