Prognostic Significance of Concurrent Mental Health Diagnosis in Southwestern Ohio Veteran IBD Population

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 aim of this study is to describe the effect of concurrent mental health diagnosis (MHD) on IBD disease course, severity and prognosis in our local veteran IBD population. Methods: This was a retrospective study of all Veterans with IBD seen at Dayton VA Medical Center between January 2004 and June 2011. MHD, IBD related emergency room visits, hospitalizations and medication use were recorded. Relevant demographic and clinical data was obtained from electronic chart review. Results: 231 patients, 123 Crohn's disease (CD) and 108 ulcerative colitis (UC), were included in this study. 38 (35%) UC and 53 (43%) CD patients had a MHD. Average duration of IBD was 18.4 years (SD= 12.6) in CD and 16.8 years (SD= 11.3) in UC patients. Sixty percent of the CD patients with MHD had at least one IBD related ED visit compared to 28% patients without MHD (p= 0.0003). Seventy percent of CD patients with MHD had at least one hospitalization compared to 42% without MHD (p=0.002). Anti-TNF use was higher in the CD patients with MHD compared to those without MHD (40% vs. 30%; p=0.29) There was no difference in CD related bowel surgeries in CD patients with and without MHD (43% vs. 43%; p=0.992). Forty two percent of the UC patients with MHD had at least one IBD related ED visit compared to 19% without MHD (p= 0.008). Fifty seven percent of UC patients with MHD had at least one hospitalization compared to 47% without MHD (p=0.038). Anti-TNF use was higher in the UC patients with MHD compared to those without MHD (11% vs. 3%; p=0.1). There was no difference in UC related bowel surgeries in patients with and without MHD (42% vs. 33%; p=0.337). Conclusion: Concurrent MHD in local veteran IBD population is associated with more frequent IBDspecific emergency department visits and increased hospitalizations but not with an increase in anti-TNF use and bowel related surgeries. These findings suggest that maladaptive disease coping strategies in veteran IBD patients with MHD result in increased health care utilization, but concurrent MHD does not necessarily indicate more aggressive IBD disease course.