N002 What are the factors related to depression in patients with ulcerative colitis in Japan?
A. Kawakami*1, M. Tanaka2, N. Yamamoto-Mitani3, M. Naganuma4, S. Maeda5, R. Kunisaki1
1Yokohama City University Medical Centre, Inflammatory Bowel Disease Centre, Yokohama, Japan, 2Mahidol University, Faculty of Medicine Ramathibodi Hospital, Ramathibodi School of Nursing, Bangkok, Thailand, 3The University of Tokyo, School of Health Sciences and Nursing, Tokyo, Japan, 4Keio University, Division of Gastroenterology and Hepatology, Tokyo, Japan, 5Yokohama City University Graduate School of Medicine, Department of Gastroenterology, Yokohama, Japan
Depression in patients with ulcerative colitis (UC) has been reported to have a prevalence of 12%–26% and can be a serious risk factor for disease exacerbation. Thus, elucidating the factors related to depressive symptoms is important for its treatment. Although previous studies have evaluated the extent to which psychological problems predict the onset of inflammatory bowel disease, little is known about the factors related to depression in patients with UC. Thus, we investigated the prevalence of depression and its related factors in Japanese outpatients with UC.
A cross-sectional study was undertaken in outpatients with UC. The patients completed a self-administered questionnaire, and medical information was obtained from medical records. Symptoms of depression were measured using the Japanese version of the Hospital Anxiety and Depression scale (HAD). A higher score indicates a greater tendency towards depression, and a score below 8 indicates depression. The validity and reliability of the scale have been previously confirmed. The rate of depression was calculated, and a logistic regression model was applied to assess the relationship between depression and other factors, including disease factors, medication characteristics, abdominal symptoms and sociodemographic characteristics.
Of 241 patients with UC, 38 (15.8%) patients were classified as depressed, 23 (9.5%) patients were prescribed oral corticosteroids, and 38 (15.8%) were prescribed medication for psychological problems. We included the following factors in a multivariate logistic regression analysis: prescription of corticosteroids, physician–patient rapport, symptoms of anxiety, adherence to medication, and length of current remission. The analyses showed that patients with depression were prescribed corticosteroids (odds ratio [OR] = 3.29; 95% confidence interval [CI] = 1.07–9.80), had lower physician–patient rapport (OR = 0.91; 95% CI = 0.86–0.97) and experienced symptoms of anxiety (OR = 10.80; 95% CI = 4.65–25.10).
The rate of depression in patients with UC in the present study was similar to the results obtained in previous investigations of UC and is approximately twice the rate that is observed in the general population. We identified additional factors that were significantly associated with depression. The results suggest that patients with these factors require increased support to reduce depression. Strategies to improve depression should particularly target and support patients with symptoms of anxiety, as anxiety showed a significant effect on depression in this study. Further investigations are essential to develop reasonable, tailored programs to reduce depressive symptoms.