Depression Symptoms in Pediatric IBD Can Be Predicted by Inflammatory Markers and Disease Activity

Depression Symptoms in Pediatric IBD Can Be Predicted by Inflammatory Markers and Disease Activity

Results from a study recently presented at the 2015 Advances in IBD Meeting showed that inflammatory markers and disease activity were predictors of anhedonia and somatic-affective symptoms in pediatric patients with inflammatory bowel disease (IBD). The presentation was titled “Inflammatory vs. Non-inflammatory Predictors of Specific Depressive Symptoms in a Large Pediatric Cohort With IBD” (abstract O-017).

“Rates of depression across all pediatric IBD [patients] range from 12% to 25%, and previous work in our group showed that nearly 20% of depressed youth with IBD have a somatic symptom-predominant phenotype of depression,” said Anne Levine, a medical student from University of Pittsburgh School of Medicine, during her presentation according to a news release. “It’s important to know that mood or affect itself can be associated with illness, and this has led to considerable debate over whether somatic symptoms truly represent depression or are simply a manifestation of [IBD]. With that debate in mind, we aimed to better understand the role that inflammation plays in somatic depression in this population. How much of somatic depression is and is not due to inflammation, and is it the whole story?”

Levine and her colleagues examined 550 patients with Crohn’s disease (51.8% males, and with a mean age of 14.4 years) from Boston Children’s Hospital and Children’s Hospital Pittsburgh. The Children’s Depressive Index was used to screen patients for depression.

Scores from the Pediatric Crohn’s Disease Activity Index (PCDAI) showed that 40.7% of the patients were in disease remission, 32.7% had mild disease, 6.4% had moderate disease, and 7.3% had severe disease. At study entry, 38.8% of the patients met criteria for depressive symptoms. Among them, 9.4% had previous surgery, 12.3% had an ostomy, and 28.1% were under treatment with corticosteroids. Depression symptom profiles included somatic-affective, anhedonia, low self-esteem, and suicidality.

The results revealed that females, patients under treatment with corticosteroids, patients with high PCDAI scores, with low hematocrit or low albumin, and with high erythrocyte sedimentation rate were at higher risk to develop somatic-affective symptoms.

The results further showed a positive association between anhedonia and high PCDAI subjective and objective lab scores, C-reactive protein, erythrocyte sedimentation rate, and corticosteroid use. Low self-esteem and suicidality correlated with the subjective PCDAI subscale, but did not correlated with inflammation markers.

“Inflammatory markers and disease activity are significant predictors of somatic-affective symptoms and anhedonia in youth with IBD,” concluded the research team.

“While we are still studying the exact nature or the relationship between inflammation and depression, we can make some suggestions here about treatment,” said Levine during her presentation. “Identifying depressive symptom clusters present in your patients with IBD can help guide treatment of comorbid IBD and depression. Previous work by our group has shown that patients with somatic affective symptoms can benefit from cognitive behavioral therapy.”

IBD is a term mainly used to describe two conditions: ulcerative colitis and Crohn’s disease. Both are long-term (chronic) conditions that involve inflammation of the gut (gastrointestinal tract). Ulcerative colitis only affects the colon (large intestine), while Crohn’s disease can affect all of the digestive system, from the mouth to the anus. In the United States, it is currently estimated that about 1-1.3 million people suffer from IBD.