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P290. Biological predictors of depression in IBD: Preliminary results of the ISA study

B.J. Baig

University of Edinburgh, Edinburgh, United Kingdom

Background and Aim: IBD is associated with affective disorders such as anxiety and depression. Co morbid depression and IBD leads to increased symptom reporting, health care usage, surgery and hospital stay but up to 60% of those with depression will not be detected. Corticosteroids are known to cause psychiatric side-effects and could be an independent risk factor for depressive illness. Recent studies show that depression is associated with raised CRP and IL6, thus Depression and IBD may co occur as a result of immunological changes. We hypothesize that there are demographic, clinical, medication and immunological predictors of affective disorders in IBD.

Methods: The IBD, Steroids and Affective Disorder (ISA) study is a cross-sectional association study. The Edinburgh IBD Cohort of 1400 patients, have been extensively phenotyped for 10 years and genotyped. From November 2008 – November 2010, patients attending the IBD clinics in Edinburgh were invited to undergo psychiatric and gastroenterological phenotyping. The assessment consisted of:

  • Disease activity (Modified Harvey Bradshaw/Colitis Activity index),
  • Blood and faecal inflammatory markers (CRP, ESR, Calprotectin),
  • Medication history (present and past year)
  • Past psychiatric history (diagnosis, medication and health service usage),
  • Medication Adherence Rating Scale (MARS)
  • Altman Self Rated Mania Scale
  • Hospital Anxiety Depression Scale (HADS). Patients scoring above 12 in the HADS were given a telephone interview with the Scheduled Clinical Interview for DSM (SCID) to establish psychiatric diagnosis.

Results: The 612 patients consenting to assessment represented 72% of all IBD clinic attendees during the time period. 236 (42.7%) patients scored 12 or above on the HADS questionnaire (range 0–35/42) representing significant psychological distress. 45% of patients stated they had previously suffered from a depressive or anxiety illness. 27.8% of patients were on systemic corticosteroids either at the time of assessment or during the previous year. When controlling for disease severity, 37% of those on steroids had a past history of depression compared to 17% of those not on steroids (p < 0.05). Affective symptoms were correlated with CRP, ESR and Faecal Calprotectin.

Conclusion: Affective illness is common in the IBD population, and correlates with biomarkers of disease activity. Systemic corticosteroids are associated with a history of depression. The use of psychiatric screening tools in clinics may be useful in detecting untreated psychiatric illness.