Abstract
Abstract Background Data regarding burden of depression and anxiety in pediatric-onset inflammatory bowel diseases (PIBD) are limited. We aimed to study the prevalence of depression and anxiety in a nationwide cohort of PIBD Methods Data were retrieved from the epi-IIRN, a nationwide cohort of the 4 Israeli Health Maintenance Organizations covering 98% of the population from 2005. We matched PIBD children to non-IBD controls for calculating time to depression/anxiety. Patients with depression/anxiety prior to IBD diagnosis were excluded. Poor disease course (PDC) was defined as IBD-related surgery, steroid-dependency, or need for more than one biologic class. A time-dependent Cox-proportional-hazard-ratio model was fit to examine predictors of the development of depression/anxiety over time. Inverse probability weights (IPW) were calculated to estimate the probability that an individual will develop depression at each time point within an individual follow up period Results In total, 4,960 PIBD cases were included [mean age 13.4±3.8 years; 3,304 (67%) with Crohn's disease (CD) and 1,656 (33%) ulcerative colitis (UC)], translating into 32,700 person-years of follow-up. These were individually matched to 4,806 non-IBD children. In a univariable Cox proportional regression model, PIBD was associated with overall anxiety/depression compared to controls (HR=1.9 95%CI 1.7-2.2). The probability of depression/anxiety was higher in PIBD patients vs controls at 3 (6% vs 2.5%) and 10 years (17.5% vs 10.2%; p<0.001, Figure 1). There were no differences in the probability of depression/anxiety between patients with UC and CD (HR=0.96 95%CI 0.81-1.1, p=0.62). In multivariable Cox proportional regression model in patients with CD; perianal disease [HR=1.5 (95%CI 1.3-2)], need for >1 biologic class, [HR=1.6 (95%CI 1.03-2.63)], and hospitalizations [HR=1.4 (95%CI 1.1-1.9)] were associated with developing anxiety/depression. Risk for anxiety/depression was lower among patients after CD related surgery compared with those who did not undergo surgery [HR 0.5 (95%CI 0.28-0.99)]. For patients with UC, steroid dependency was associated with anxiety/depression [HR 1.5, (95%CI 1.05-2.1)]. Figure 1 (Depression free survival probability) Conclusion Our study highlights the substantial burden of depression/anxiety in PIBD and identifies risk factors for these conditions. These findings emphasize the need for mental health monitoring and early intervention in this vulnerable population
Published Version
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