Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. May 19, 2024; 14(5): 715-725
Published online May 19, 2024. doi: 10.5498/wjp.v14.i5.715
Prevalence and risk factors of depression among patients with perianal fistulizing Crohn’s disease
Jing Li, Wing-Yi Ng, Li-Chao Qiao, Fen Yuan, Xing Lan, Li-Bei Zhu, Bo-Lin Yang, Zhong-Qiu Wang
Jing Li, Fen Yuan, Xing Lan, Zhong-Qiu Wang, Department of Radiology, Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Wing-Yi Ng, Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Li-Chao Qiao, Li-Bei Zhu, Bo-Lin Yang, Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Co-first authors: Jing Li and Wing-Yi Ng.
Co-corresponding authors: Bo-Lin Yang and Zhong-Qiu Wang.
Author contributions: Li J and Ng WY contributed equally to design the studies, writing, and statistical analysis, and should be considered as co-first authors; Wang ZQ and Yang BL contributed to project, manuscript writing, review, and revision; Yuan F and Lan X generated figures and tables according to the analysis; Qiao LC and Zhu LB performed subject and data collection; all authors were involved in the critical review of the results and have contributed to, read, and approved the final version of the manuscript. The reasons for designating Wang ZQ and Yang BL as co-corresponding authors are listed below: The research was conducted as a joint undertaking, with the shared authorship status accurately representing the equal distribution of duties and workload involved in the study and the preparation of the manuscript. This arrangement facilitates efficient communication and handling of matters after submission, thereby elevating the overall quality and dependability of our study. By naming these researchers as co-corresponding authors, we acknowledge and celebrate their equitable input, as well as the collaborative and team-oriented essence of the study. In essence, we assure that specifying Wang ZQ and Yang BL as co-corresponding authors is appropriate for our submission, as it accurately embodies our team's collaborative ethos, balanced contributions, and diversity.
Supported by Developing Program for High-level Academic Talent in Jiangsu Hospital of Chinese Medicine, No. y2021rc03; and Postgraduate Research and Innovation Program of Jiangsu Province, China, No. KYCX23_2172.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Nanjing University of Chinese Medicine (2020NL-170-02).
Informed consent statement: All study participants or their legal guardians provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhong-Qiu Wang, PhD, Professor, Department of Radiology, Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China. zhongqiuwang0815@163.com
Received: January 26, 2024
Revised: April 10, 2024
Accepted: April 17, 2024
Published online: May 19, 2024
Processing time: 110 Days and 14.5 Hours
Abstract
BACKGROUND

Psychological distress, especially depression, associated with perianal fistulizing Crohn’s disease (PFCD) is widespread and refractory. However, there is a surprising paucity of studies to date that have sought to identify the prevalence and risk factors of depression associated with PFCD.

AIM

To estimate the prevalence of depressive symptoms and investigate the depression-related risk factors in patients with PFCD.

METHODS

The study was conducted in the form of survey and clinical data collection via questionnaire and specialized medical staff. Depressive symptoms, life quality, and fatigue severity of patients with PFCD were assessed by Patient Health Questionnaire-9, Inflammatory Bowel Disease Patient Quality of Life Questionnaire (IBDQ), and Inflammatory Bowel Disease (IBD) Fatigue Patient Self-assessment Scale. The basic demographic information, overall disease features, perianal clinical information, and laboratory inflammation indicators were also gathered. Multivariate regression analysis was ultimately used to ascertain the risk factors of depression associated with PFCD.

RESULTS

A total of 123 patients with PFCD were involved, and 56.91% were suffering from depression. According to multivariate logistic regression analysis, Perianal Disease Activity Index (PDAI) score [odds ratio (OR) = 0.69, 95% confidence interval (CI): 0.50 to 0.95], IBDQ score (OR = 0.93, 95%CI: 0.88 to 0.97), modified Van Assche index (OR = 1.24, 95%CI: 1.01 to 1.53), and IBD Fatigue score (OR = 1.72, 95%CI: 1.23 to 2.42) were independent risk factors of depression-related prevalence among patients with PFCD (P < 0.05). Multiple linear regression analysis revealed that the increasing perianal modified Van Assche index (β value = 0.166, 95%CI: 0.02 to 0.31) and decreasing IBDQ score (β value = -0.116, 95%CI: -0.14 to -0.09) were independently associated with the severity of depression (P < 0.05).

CONCLUSION

Depressive symptoms in PFCD patients have significantly high prevalence. PDAI score, modified Van Assche index, quality of life, and fatigue severity were the main independent risk factors.

Keywords: Crohn’s disease; Fistula; Depression; Inflammatory bowel diseases; Risk factors

Core Tip: Perianal fistulizing Crohn’s disease (PFCD) is the most prominent, invasive and common lesion among the phenotypes of Crohn’s disease (CD). Due to the unique disease experience of PFCD patients, they suffer from severe clinical and psychological consequences like depression. However, there is a lack of studies focusing on the risk factors of depression within specific disease types of CD. In this study, we analyzed the prevalence and risk factors of PFCD with depression, which could assist professionals in early identification and medical intervention in patients with PFCD.