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Original research
Depression in individuals who subsequently develop inflammatory bowel disease: a population-based nested case–control study
  1. Jonathan Blackwell1,
  2. Sonia Saxena2,
  3. Irene Petersen3,4,
  4. Matthew Hotopf5,6,
  5. Hanna Creese2,
  6. Alex Bottle2,7,
  7. Christopher Alexakis8,
  8. Richard C Pollok1,9
  9. POP-IBD study group
  1. 1Gastroenterology, St George's University of London, London, UK
  2. 2School of Primary Care and Public Health, Imperial College, London, UK
  3. 3Department of Primary Care and Population Health, University College London, London, UK
  4. 4Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
  5. 5Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  6. 6South London and Maudsley NHS Foundation Trust, London, UK
  7. 7Dr Foster Unit, School of Primary Care and Public Health, Imperial College, London, UK
  8. 8Gastroenterology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
  9. 9Institute of Infection and Immunity, University of London St George's, London, UK
  1. Correspondence to Dr Richard C Pollok, Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK; richard.pollok{at}nhs.net

Abstract

Objective Depression is a potential risk factor for developing IBD. This association may be related to GI symptoms occurring before diagnosis. We aimed to determine whether depression, adjusted for pre-existing GI symptoms, is associated with subsequent IBD.

Design We conducted a nested case–control study using the Clinical Practice Research Datalink identifying incident cases of UC and Crohn’s disease (CD) from 1998 to 2016. Controls without IBD were matched for age and sex. We measured exposure to prevalent depression 4.5–5.5 years before IBD diagnosis. We created two sub-groups with prevalent depression based on whether individuals had reported GI symptoms before the onset of depression. We used conditional logistic regression to derive ORs for the risk of IBD depending on depression status.

Results We identified 10 829 UC cases, 4531 CD cases and 15 360 controls. There was an excess of prevalent depression 5 years before IBD diagnosis relative to controls (UC: 3.7% vs 2.7%, CD 3.7% vs 2.9%). Individuals with GI symptoms prior to the diagnosis of depression had increased adjusted risks of developing UC and CD compared with those without depression (UC: OR 1.47, 95% CI 1.21 to 1.79; CD: OR 1.41, 95% CI 1.04 to 1.92). Individuals with depression alone had similar risks of UC and CD to those without depression (UC: OR 1.13, 95% CI 0.99 to 1.29; CD: OR 1.12, 95% CI 0.91 to 1.38).

Conclusions Depression, in the absence of prior GI symptoms, is not associated with subsequent development of IBD. However, depression with GI symptoms should prompt investigation for IBD.

  • psychosomatic medicine
  • inflammatory bowel disease
  • psychophysiology
  • crohn's disease
  • ulcerative colitis
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  • Correction notice This article has been corrected since it published Online First. Author affiliations have been updated and the corresponding author has been changed to Professor Pollok.

  • Contributors The POP-IBD study group is a collaboration between St George’s, University of London, Imperial College London, University College London and King’s College London, conducting population-based studies in the field of Inflammatory Bowel Disease. JB, SS, RCP, CA, IP and MH conceived and designed this study. JB prepared the data and carried out statistical analysis overseen by HC, IP and AB. JB and SS contributed equally to this project and are joint first authors. All authors contributed to the development of the analysis, interpreting data and preparing the manuscript. SS will act as the guarantor for the article.

  • Funding This work was supported by the Living with IBD Research Programme at Crohn’s & Colitis UK (grant number: SP2018/3). This funding source had no role in the design or execution of this study or in the analysis and interpretation of the data. The views expressed are those of the authors and not necessarily those of Crohn’s & Colitis UK. RCP received support by a Wellcome Trust Institute Strategic Support Fund (ISSF) grant. SS is funded by the National Institute for Health Research (NIHR) School for Public Health. Research (SPHR) and NIHR Northwest London Applied Research Collaboration (ARC). The School for Public Health Imperial College London is also grateful for support from the Imperial NIHR Biomedical Research Centre. MH acknowledges support from the National Institute of Health Research Biomedical Research Centre at the Maudsley, and is an NIHR Senior Investigator. The Dr Foster Unit at Imperial is affiliated with the National Institute of Health Research (NIHR) Imperial Patient Safety Translational Research Centre and is part-funded by Dr Foster Limited, a wholly owned subsidiary of Telstra Health. The NIHR Imperial Patient Safety Translational Centre is a partnership between the Imperial College Healthcare NHS Trust and Imperial College London. The Dr Foster Unit at Imperial College is grateful for support from the NIHR Biomedical Research Centre funding scheme.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval We obtained ethical and scientific approval for our study from the Independent Scientific Advisory Committee (ISAC Protocol number: 15_018R).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Data were obtained from CPRD GOLD.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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