S949 Risk of Depression and Its Impact on Patients With Inflammatory Bowel Disease: A Population-Based Nationwide Cohort Study

Introduction: Studies have shown that patients with inflammatory bowel disease (IBD) experience high levels of depression, anxiety, and loneliness and this has been linked with lower health-related quality of life scores, regardless of disease activity. The primary aim of our study were to evaluate major depressive disorder (MDD) outcomes in adult patients with IBD and to ascertain the risk of IBD complications in patients with MDD. Methods: We performed a retrospective analysis in the IBM Explorys database (1999-2021), a national, de-identified clinical database of over 72 million unique patients from 300 hospitals across the United States. Patient populations were identified using SNOMED and ICD codes. IBD patients were identified by diagnosis of either UC or CD who had a gastroenterology provider plus any one IBD medication. MDD patients were identified by diagnosis of major depressive order plus any anti-depressant medication or class. Patients with diseases that have been associated with depression were excluded from the study. Control group included non-IBD patients who developed MDD. MDD complications evaluated are as follows: self-harm, suicidal thoughts, recurrent major depression, severe major depression and electroconvulsive therapy. IBD outcomes evaluated were as follows: Disease flare (intravenous steroids), biologic therapy, colon cancer, strictures, fistula, pouchitis, osteoporosis, malnutrition and IBD surgery. These outcomes were compared in IBD patients with MDD and those without. Odds ratio with 95% CI were calculated to assess risk of MDD and its complications in UC or CD compared to control cohort. We also compared risk of IBD complications in patients with and without MDD. Results: A total of 11,360 patients (10.22%) with IBD developed MDD, of which 4440 (9.08%) were UC and 6920 (11.12%) were CD. Patients with CD (OR 3.2; CI 3.13-3.29) and UC (OR 2.56; CI 2.48-2.64) were at a higher risk for MDD compared to control cohort. IBD patients with MDD were more at risk of having recurrent major depressive disorder and severe major depression (Table 1). UC patients with MDD were noted to be at increased risk of flare, pouchitis, osteoporosis and malnutrition (Figure 1). CD patients with MDD were at increased risk of flare and malnutrition (Figure 1). Conclusion: Our findings highlight the complex interplay between IBD and MDD. Addressing mental health in IBD clinics may significantly impact the patient’s quality of life, natural course of disease, and prevent IBD related complications.Table 1.: Depression outcomes in patients with inflammatory bowel disease (IBD). Odds ratios with 95% confidence intervals were calculated to evaluate risk of each outcome between patients with IBD patients with depression and non-IBD patients with depressionFigure 1.: Odds ratio with 95% confidence intervals (CI) for outcomes in patients with inflammatory bowel disease (IBD) with major depressive disorder (MDD) compared to patients with IBD without MDD.