The Prevalence of Depression and Its Association with Opioid Exposure in IBD Patients

Abstract

Introduction: According to the World Health Organization, depression has a lifetime prevalence of 17% in the general population, and 16 million people are afflicted in the United States alone. It is a common comorbidity in chronic diseases such as chronic obstructive pulmonary disease (COPD) (25% prevalence) and heart failure (22% prevalence). The presence of depression is a major determinant of health related quality of life (HR-QOL) in patients with inflammatory bowel disease (IBD). IBD patients have a higher rate of opioid usage than the general population. Opioid usage is associated with an increased rate of depression. The role of this study is to assess the prevalence of depression in IBD patients and the association of lifetime opioid exposure to depression. Methods: An automated data extraction was performed on patients enrolled in a tertiary medical center's IBD program. Data from 792 patients was obtained and analyzed. Antidepressant usage was used as a marker for a diagnosis of depression. The charts of patients prescribed antidepressants were reviewed to confirm that the antidepressant was given for a diagnosis of depression and not some other indication such as chronic pain. A patient was deemed to have used opioids if they had ever been prescribed opioids for any disease process. The primary endpoints were assessed with the Fisher's Exact Test. Results: The prevalence of depression among the IBD Program patients was 28% (24.9-31.3%; 95% CI). The prevalence of depression in IBD patients was significantly higher compared to the general population. When compared to chronic diseases such as COPD and heart failure, the prevalence is similar, 28% compared to 25% and 22%. 67% of patients in the IBD program had been prescribed opioids. There was a statistically significant (p < 0.0001) associated between depression and opioid exposure in IBD patients. Conclusion: The patients enrolled in the IBD Program were more likely to be depressed than the general population. The rates of depression were similar to patients with other chronic diseases such as heart failure and COPD. There is an association between opioid exposure and depression when compared to opioid naïve patients in this single tertiary medical center's IBD Program. Routine depression screening should be performed for all patients and opioids should be avoided if possible.