Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients.

Abstract

Patients with inflammatory bowel disease (IBD) are diagnosed with anxiety/depression at higher rates than the general population. We aimed to determine the frequency of anxiety/depression among IBD patients and the temporal association with abdominal surgery and stoma formation. We conducted a retrospective cohort study in adult patients with IBD using difference-in-difference methodology and a large commercial claims database (2003-2016). Outcomes were anxiety/depression diagnoses before and after major abdominal surgery or stoma formation. We identified 10481 IBD patients who underwent major abdominal surgery, 18.8% of whom underwent stoma formation, and 41924 nonsurgical age- and sex-matched IBD controls who were assigned random index dates. Rates of anxiety and depression increased among all cohorts (P<0.001). Surgical patients had higher odds of anxiety [one surgery, adjusted OR 6.90 (95% CI 6.11-7.79), P<0.001; two or more surgeries, 7.53 (5.99-9.46), P<0.001] and depression [one surgery, 6.15 (5.57-6.80), P<0.001; two or more surgeries, 6.88 (5.66-8.36), P<0.001] than nonsurgical controls. Undergoing multiple surgeries was associated with a significant increase in depression from 'pre' to 'post' time periods [1.43 (1.18-1.73), P<0.001]. Amongst surgical patients, stoma formation was independently associated with anxiety [1.40 (1.17-1.68), P<0.001] and depression [1.23 (1.05-1.45), P=0.01]. New ostomates experienced a greater increase in postoperative anxiety [1.24 (1.05-1.47), P=0.01] and depression [1.19 (1.03-1.45), P=0.01] than other surgical patients. IBD patients who undergo surgery have higher rates of anxiety and depression than nonsurgical patients. Rates of anxiety and depression increase following surgery. Stoma formation represents an additional risk factor. These findings suggest the need for perioperative psychosocial support services.