Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2023; 11(4): 764-779
Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.764
Major depressive disorders in patients with inflammatory bowel disease and rheumatoid arthritis
Maryam Bilal Haider, Brinda Basida, Jasleen Kaur
Maryam Bilal Haider, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Sinai Grace Hospital, Detroit, MI 48235, United States
Brinda Basida, Department of Geriatrics, Rohde Island Hospital/Brown University, Providence, RI 02903, United States
Jasleen Kaur, Department of Rheumatology, St. Mary’s Ascension/Central Michigan University, Saginaw, MI 48601, United States
Author contributions: Haider MB, Basida B and Kaur J contributed equally to this work; Haider MB and Kaur J designed the research study; Kaur J and Basida B performed the research; Haider MB analyzed the data; Haider MB, Basida B and Kaur J wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: Data from this study used de-identified data from the National Inpatient Sample Database (NIS) 2000-2019. A publicly available all-payer inpatient care database in the United States. Institutional Review Board Approval Form or Document is not required.
Informed consent statement: Data from this study used de-identified data from the National Inpatient Sample Database. A publicly available all-payer inpatient care database in the United States. Informed patient consent is not required.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data that support the findings of this study are publicly available at https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp.
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: Maryam Bilal Haider, MD, Doctor, Department of Internal Medicine, Detroit Medical Center, Wayne State University, Sinai Grace Hospital, 6071 Outer Dr W, Detroit, MI 48235, United States. maryambilalhaider@yahoo.com
Received: September 21, 2022
Peer-review started: September 21, 2022
First decision: November 30, 2022
Revised: December 14, 2022
Accepted: January 12, 2023
Article in press: January 12, 2023
Published online: February 6, 2023
Processing time: 137 Days and 18.9 Hours
Abstract
BACKGROUND

Various immune-mediated inflammatory diseases consisting of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA), are found to have a substantial societal burden, increased healthcare costs, and progressive disability. Studies suggest that patients with vs without comorbid depression have a more significant disability, a lower likelihood of remission, and reduced adherence to therapy. Elevated interleukin (IL)-1β, tumor necrosis factor-α, and IL-6 contribute to developing depression by the impaired physiological responses to stress, resulting in increased pain, fever, fatigue, and lack thereof of interest, and thus poor long-term outcomes. This study emphasizes the timely recognition of the prevalence of major depressive disorder (MDD) in patients with RA and IBD combined, thus preventing disability.

AIM

To identify the prevalence level and temporal trends of depression in hospitalized IBD-RA patients.

METHODS

All adult hospitalized patients from January 2000 to December 2019 in the nationwide inpatient sample (NIS) were captured. The study population included all patients with a primary or secondary IBD-RA overlap disease using corresponding international classification of diseases (ICD)-9 and ICD-10 codes. IBD includes Crohn’s disease and ulcerative colitis. The study population was divided into IBD-RA without MDD (controls) and IBD-RA with MDD (cases). For group comparison between MDD vs no MDD, we used Student's t-test for continuous variables and Rao-Scott Chi-square tests for categorical variables. For univariate analyses, we used logistic regression, and for multivariate analysis, we used a weighted multi-level mixed-effects model. We attested all hypotheses with two-tailed significance level of 0.05 (P < 0.05 was considered significant). The outcome is to examine the temporal trends and prevalence of depression in patients with IBD-RA by gender, race, and age.

RESULTS

A total of 133315 records were identified with IBD-RA overlap, of which 26155 patients (19.62%) had MDD. Among the IBD-RA patients, those who had MDD were younger [mean age of 56 years (SD ± 15)] to IBD-RA without MDD patients with a P < 0.0001, more females (80% among cases vs 73% among controls) than males with a P < 0.0001, frequent in the white race (79% among cases vs 73% among controls) than black race. Over the 19 years, the number of patients with MDD in IBD-RA increased from 153 (the year 2000) to 2880 (the year 2019) in weighted NIS, representing a 1782% increase compared to the year 2000 with a P < 0.001. Factors associated with higher MDD included younger age, female gender, white race, alcohol, opioids, esophageal disorders, peptic ulcer disease, chronic pancreatitis, paralysis, dementia, menopausal disorders, obesity, nutritional deficiencies, diabetes mellitus with chronic complications, and osteoarthritis.

CONCLUSION

There is a rise in the prevalence of depression in younger patients with IBD-RA combined compared to their counterparts. These patients are also at higher risk for the increased cost of care and poor treatment compliance. It is crucial to educate the involved clinicians to identify the early signs and symptoms of depression in patients with IBD or RA or IBD-RA combined and treat them to have a better overall prognosis.

Keywords: Inflammatory bowel disease, Rheumatoid arthritis, Depression, Multimorbidity, Epidemiology, Demographics

Core Tip: Our study is a nationwide inpatient sample-based study of the two decades in which we aim to analyze inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) patients’ characteristics, temporal trends, sociodemographic characteristics, and predictors of major depressive disorders in the IBD-RA cohort. There is an increasing trend in the prevalence of IBD-RA, especially in younger patients. We believe this study will open the door for further research and educate the involved physicians to identify the early signs and symptoms of depression in patients with IBD or RA or IBD-RA combined and treat them or have them treated to have a better overall prognosis.