Increased Risk of Anxiety and Depression in Patients with Inflammatory Bowel Disease: A Nationwide Population-based Study in Korea

Abstract

Background/Aims: Inflammatory bowel disease (IBD) may be associated with psychological disorders. The aim of this study was to investigate the risk of anxiety and depression in patients with IBD. Methods: We conducted a retrospective study using claim data from the National Healthcare Insurance service (NHIS) in Korea. The patients with Crohns disease (CD) and ulcerative colitis (UC) were identified through both ICD-10 codes and the rare/intractable disease registration program codes which provide co-payment reduction of up to 90% in Korea. We compared 15,569 IBD patients with 46,707 non-IBD controls matched by age and sex with a ratio of 1:3. Cases with newly diagnosed anxiety and depression were identified through ICD-10 codes in the study population, respectively. The Kaplan–Meier method was used to estimate the cumulative probability of anxiety and depression in IBD patients. Results: During the mean follow-up of 6 years, IBD patients experienced anxiety and depression more frequently than non-IBD controls, respectively (anxiety: 12.2% vs. 8.7%, p<0.001

depression: 8.0% vs. 4.7%, p<0.001). In patients with CD, incidence rate (per 1,000 person-years) of anxiety was 19.51, compared to 13.26 in controls (hazard ratio [HR], 1.63

95% confidence interval [CI], 1.40-1.89

p<0.001), and incidence rate of depression was 12.79, compared to 6.6 in controls (HR, 2.09

95% CI, 1.73-2.52

p<0.001). In patients with UC, incidence rate (per 1,000 person-years) of anxiety was 28.9, compared to 19.87 in controls (HR, 1.60

95% CI, 1.44-1.77

p<0.001), and incidence rate of depression was 16.49, compared to 9.23 per in controls (HR, 2.00

95% CI, 1.74-2.30

p<0.001). The impact of CD on developing depression was more pronounced in male gender (adjusted HR, 1.58

95% CI, 1.41-1.76) than in female (adjusted HR, 1.21

95% CI, 1.00-1.47

p=0.025 by interaction analysis). Conclusion: The risk of anxiety and depression increased in the patients with IBD, respectively. Patients with IBD would be monitored carefully for the development of mood disorders.