Impact of Mental Health Diagnoses on Hospitalizations in Ulcerative Colitis Patients

Abstract

Introduction: Psychological stress has been implicated in the etiopathogenesis and exacerbation of inflammatory bowel disease (IBD). Anxiety and depression are more common in patients with IBD, and available evidence suggests that IBD disease course is worse in depressed patients. The purpose of this study was to evaluate patient demographics, hospital characteristics, and patient outcomes in patients with ulcerative colitis (UC) and mental health diagnoses (MHD). Methods: We used ICD-9 diagnosis codes from the 2001-2010 National Hospital Discharge Survey to identify cases of UC both with and without MHD (anxiety, depression, schizophrenia, bipolar disorder, substance abuse, anorexia, bulimia, and post-traumatic stress disorder). Comparisons on demographics, hospital length of stay (LOS), and selected health system characteristics were made between those with and without MHD. SPSS was used for chi-square and t test analysis at alpha = 0.05. Results: 5,750 admissions with a diagnosis of UC were identified. Within this cohort, 437 (7.60%) had a MHD. The MHD cohort was younger (47.81 vs 51.36 years, p < 0.001) but showed no difference in gender (p=0.82) or racial distribution (p=0.61). There was no difference in regional distribution (p=0.31), but the MHD cohort was more likely to be admitted to smaller hospitals (p=0.007) under proprietary or government ownership (p < 0.001). There was a significant difference in principal form of payment, with the MHD cohort having a greater proportion of Medicaid patients (15.6% vs 6.5%) and a smaller proportion of HMO/PPO patients (16.2% vs 22.5%) (p < 0.001). The MHD cohort had a greater proportion of emergent admissions (61.8% vs 50.2%) and lesser proportion of elective admissions (15.3% vs 20.9%) (p < 0.001). The MHD cohort had a similar LOS (5.38 vs 5.80 days, p=0.64) but a lower mortality rate compared to the group without MHD (0.2% vs 1.5%, p=0.035). The MHD cohort also had a lower rate of bowel resection compared to the other group (2.3% vs 6.8%, p < 0.001).Figure 1Figure 2Figure 3Conclusion: Patients with MHD and UC were on average younger but otherwise no different in gender, racial, or regional demographics. While psychological factors have been implicated in the disease course and degree of severity in IBD, this study showed a lower all-cause mortality rate, a decreased rate of bowel resection, and no significant difference in hospital utilization/LOS. Factors contributing to these trends warrant further exploration as they appear to be linked to patient outcomes.