Major depressive disorders in patients with inflammatory bowel disease and rheumatoid arthritis

doi:10.12998/wjcc.v11.i4.764

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Clin Cases. Feb 6, 2023; 11(4): 764-779
Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.764

Table 1 Comorbidities comparison in inflammatory bowel disease-rheumatoid arthritis overlap patients with and without major depressive disorders, national inpatient sample year 2000 to 2019

	IBD-RA without depressive disorders, weighted, n (%)	IBD-RA with depressive disorders, weighted, n (%)	P value
Liver disease, mild	6400 (5.97)	2130 (8.14)	< 0.0001^a
Liver disease, moderate to severe	786 (0.73)	230 (0.88)	0.2871^a
Peptic ulcer disease	1709 (1.59)	632 (2.41)	< 0.0001^a
Esophageal disorders	30712 (28.65)	10569 (40.40)	< 0.0001^a
Gastritis	3781 (3.52)	1124 (4.30)	0.0095^a
Diabetes mellitus with chronic complications	6367 (5.94)	2005 (7.66)	< 0.0001^a
Diabetes mellitus without chronic complications	14014 (13.07)	3533 (13.50)	0.4244^a
Hypertension	40782 (38.05)	10493 (40.12)	0.0080^a
Heart Failure	12798 (11.94)	2908 (11.11)	0.1176^a
Coronary artery disease	16644 (15.53)	3549 (13.57)	0.0007^a
Cardiac dysrhythmias	16114 (15.04)	3299 (12.61)	< 0.0001^a
Myocardial infarction	1316 (1.23)	224 (0.86)	0.0237^a
Stroke	1530 (1.42)	230 (0.88)	0.0018^a
Iron Deficiency Anemia	9298 (8.68)	2296 (8.78)	0.8167^a
Nutritional deficiencies	4062 (3.79)	1494 (5.71)	< 0.0001^a
Lipid Metabolism disorders	24990 (23.32)	7036 (26.90)	< 0.0001^a
Thyroid disorders	18029 (16.82)	5531 (21.15)	< 0.0001^a
Chronic Pancreatitis	1165 (1.09)	507 (1.94)	< 0.0001^a
Renal failure, moderate	8563 (7.99)	2132 (8.15)	0.7113^a
Renal failure, severe	2965 (2.77)	767 (2.93)	0.5434^a
Menopausal disorders	536 (0.50)	222 (0.84)	0.0033^a
Osteoporosis	11752 (10.97)	3544 (13.55)	< 0.0001^a
Osteoarthritis	15084 (14.07)	4562 (17.44)	< 0.0001^a
Obesity	11706 (10.92)	4062 (15.53)	<.0001¹
Weight Loss	1201 (1.12)	365 (1.39)	0.1101^a
Protein-calorie malnutrition	8479 (7.91)	2370 (9.06)	0.0085^a
Leukemia	558 (0.52)	134 (0.51)	0.9401^a
Lymphoma	838 (0.78)	181 (0.69)	0.5132^a
Metastatic cancer	1381 (1.29)	329 (1.26)	0.8524^a
Solid tumor without metastasis, malignant	3785 (2.84)	850 (0.64)	0.8524^a
Paralysis	1498 (1.40)	495 (1.89)	0.0114^a
Dementia	2291 (2.14)	886 (3.39)	< 0.0001^a
AIDS	212 (0.19)	45 (0.17)	0.6818^a
Smoking	32336 (30.17)	9893 (37.82)	< 0.0001^a
Alcohol	1747 (1.63)	950 (3.63)	< 0.0001^a
Opioids	3180 (2.97)	1797 (6.87)	< 0.0001^a

^aRao-Scott Chi-Square 2-tailed Test for the association of two Categorical Variables.

IBD-RA: Inflammatory bowel disease-rheumatoid arthritis; AIDS: Acquired immunodeficiency syndrome.

Table 2 Comparison of Patients’ demographics and hospital Characteristics of inflammatory bowel disease-rheumatoid arthritis overlap patients with and without depressive disorders, national inpatient sample year 2000 to 2019

	IBD-RA without MDD, weighted, n (%)	IBD-RA with MDD, weighted, n (%)	P value
Weighted total, n (%)	107160 (80.38)	26155 (19.62)
Sex			< 0.0001^a
Female	78088 (72.87)	21052 (80.49)
Male	29073 (27.13)	5103 (19.51)
Age (yr), mean ± SD	58.70 ± 16.89	56.36 ± 15.47	< 0.0001^b
Age groups (yr)			< 0.0001^c
< 18	319 (0.29)	25 (0.10)
18-44	22215 (20.73)	5887 (22.50)
45-64	40363 (37.67)	11544 (44.14)
65-84	39111 (36.50)	7902 (30.21)
≥ 85	5152 (4.81)	798 (3.05)
Ethnicity			< 0.0001^c
White	77818 (72.62)	20612 (78.80)
Black	10543 (9.83)	1850 (7.07)
Hispanic	4963 (4.63)	1045 (3.99)
Asian or Pacific Islander	741 (0.69)	94 (0.36)
Native American	500 (0.47)	91 (0.35)
Other	12596 (11.75)	2464 (9.42)
Primary payer status			< 0.0001^c
Medicare	59738 (55.75)	14522 (55.52)
Medicaid	10128 (9.45)	3257 (12.45)
Private	32808 (30.62)	7239 (27.68)
Self-Pay	2034 (1.89)	505 (1.93)
No charge	186 (0.17)	40 (0.15)
Other	2266 (2.11)	592 (2.26)
Median socioeconomic status by national quartiles			0.0008^c
0-25	24484 (22.85)	6111 (23.37)
25-50	26531 (24.75)	6690 (25.58)
50-75	27857 (26.00)	7171 (27.42)
75-100	26431 (24.66)	5876 (22.46)
Other	1857 (1.73)	307 (1.17)
Hospital bed size			0.0147^c
Small	16789 (15.67)	4496 (17.19)
Medium	28359 (26.46)	7067 (27.02)
Large	62012 (57.87)	14592 (55.79)
Location/teaching status of the hospital			< 0.0001^c
Rural	10398 (9.70)	2299 (8.79)
Urban nonteaching	36576 (34.13)	7801 (29.83)
Urban teaching	60186 (56.17)	16055 (61.38)
Hospital region			< 0.0001^c
Northeast	21819 (20.36)	4601 (17.59)
Midwest or North Central	27596 (25.75)	7636 (29.19)
South	40204 (37.52)	9583 (36.64)
West	17541 (16.36)	4335 (16.57)
Discharge outcomes
Routine Discharge	69143 (64.52)	16289 (62.28)	< 0.0031^a
Transfer to Short-term Hospital	2240 (2.09)	475 (1.82)	0.2013^a
Transfer to other facilities	16349 (15.26)	4612 (17.63)	< 0.0001^a
HHC	17635 (16.45)	4536 (17.34)	0.1373^a
In-hospital mortality	1792 (1.67%)	243 (0.93%)	< 0.0001^a
Length of stay (days), mean ± SD	5.49 ± 5.75	5.65 ± 5.79	0.0738^a
Total charges (USD), mean ± SD	43881 ± 61300	45157 ± 60859	0.1762^a

^aTwo-sample Student t-test, 2-tailed for comparing means of two Continuous Variables.

^bRao-Scott Chi-Square 2-tailed Test for the association of two Categorical Variables.

^cRao-Scott Chi-square, 2-tailed Test for two by n table. Statistical significance illustrates that the two groups differ.

IBD-RA: Inflammatory bowel disease-rheumatoid arthritis; HHC: Home health care.

Table 3 Univariate and multivariate analyses of demographics and comorbidities associated with major depressive disorders in the inflammatory bowel disease-rheumatoid arthritis cohort, national inpatient sample year 2000 to 2019

Variables	Univariate analysis		Multivariate analysis
Variables	Unadjusted odds ratio¹ (95%CI)	P value	Adjusted odds ratio² (95%CI)	P value
Gender, Female vs Male	1.533 (1.424–1.651)	< 0.0001	1.518 (1.463-1.575)	< 0.0001
Age groups (yr)
< 18	0.380 (0.153–0.944)	0.0371	0.793 (0.523-1.203)	0.2842
18-44	1.320 (1.214-1.434)	< 0.0001	1.888 (1.790-1.991)	< 0.0001
45-64	1.418 (1.321-1.521)	< 0.0001	1.693 (1.625-1.764)	< 0.0001
65-84	Reference	NA	Reference	NA
≥ 85	0.773 (0.649-0.920)	0.0037	0.749 (0.688-0.814)	< 0.0001
Race
White	1.500 (1.338-1.682)	< 0.0001	1.830 (1.728-1.939)	< 0.0001
Black	Reference	NA	Reference	NA
Hispanic	1.193 (0.993-1.434)	0.0598	1.391 (1.272-1.521)	< 0.0001
Asian or Pacific Islander	0.720 (0.441-1.174)	0.1876	0.856 (0.679-1.078)	0.1876
Native American	1.029 (0.616-1.720)	0.9120	0.937 (0.733-1.198)	0.6120
Other	1.109 (0.959-1.282)	0.1627	1.456 (1.351-1.568)	< 0.0001
Primary payer status
Medicare	Reference	NA	Reference	NA
Medicaid	1.327 (1.205-1.462)	< 0.0001	1.043 (0.99-1.10)	0.1148
Private	0.911 (0.850-0.977)	0.0085	0.774 (0.744-0.805)	< 0.0001
Self-Pay	1.035 (0.831-1.289)	0.7616	0.892 (0.800-0.994)	0.0382
No charge	0.853 (0.398-1.827)	0.6825	0.698 (0.485-1.005)	0.0555
Other	1.069 (0.871-1.311)	0.5255	0.974 (0.88-1.077)	0.5930
Median socioeconomic status by national quartiles
0-25	Reference	NA	Reference	NA
25-50	1.006 (0.923-1.097)	0.8836	1.031 (0.988-1.075)	0.1595
50-75	1.026 (0.943-1.117)	0.5455	1.071 (1.025-1.118)	0.0019
75-100	0.890 (0.814-0.972)	0.0095	0.998 (0.952-1.045)	0.9323
Other	0.664 (0.505-0.873)	0.0034	0.697 (0.61-0.795)	< 0.0001
Hospital bed size
Small	Reference	NA	Reference	NA
Medium	1.061 (0.967-1.164)	0.2109	0.956 (0.913-1.002)	0.0585
Large	0.936 (0.873-1.005)	0.0669	0.926 (0.888-0.966)	0.0004
Location/teaching status of the hospital
Rural	Reference	NA	Reference	NA
Urban nonteaching	1.028 (0.917-1.152)	0.6376	0.994 (0.938-1.054)	0.8450
Urban teaching	1.253 (1.172-1.339)	< 0.0001	1.235 (1.168-1.306)	< 0.0001
Hospital region
Northeast	Reference	NA	Reference	NA
Midwest or North Central	1.312 (1.199-1.437)	< 0.0001	1.223 (1.162-1.286)	< 0.0001
South	1.124 (1.031-1.225)	0.0078	1.083 (1.032-1.137)	0.0015
West	1.179 (1.065-1.306)	0.0015	1.148 (1.085-1.213)	< 0.0001
Comorbidities
Liver disease, mild	1.401 (1.251-1.569)	< 0.0001	1.156 (1.091-1.224)	< 0.0001
Liver disease, moderate to severe	1.206 (0.867-1.677)	0.2655	0.976 (0.827-1.152)	0.7708
Peptic ulcer disease	1.532 (1.247-1.881)	< 0.0001	1.254 (1.133-1.387)	< 0.0001
Esophageal disorders	1.684 (1.582-1.792)	< 0.0001	1.528 (1.481-1.576)	< 0.0001
Gastritis	1.236 (1.063-1.436)	0.0059	1.096 (1.018-1.18)	0.0145
Diabetes mellitus with chronic complications	1.326 (1.181-1.489)	< 0.0001	1.201 (1.131-1.274)	< 0.0001
Diabetes mellitus without chronic complications	1.033 (0.946-1.128)	0.4688	1.064 (1.018-1.113)	0.0059
Hypertension	1.082 (1.018-1.151)	0.0115	1.091 (1.055-1.128)	< 0.0001
Heart Failure	0.922 (0.839-1.014)	0.0943	1.005 (0.955-1.058)	0.8505
Coronary artery disease	0.858 (0.787-0.936)	0.0005	0.901 (0.861-0.944)	< 0.0001
Cardiac dysrhythmias	0.811 (0.742-0.887	< 0.0001	0.884 (0.844-0.925)	< 0.0001
Myocardial infarction	0.703 (0.512-0.965)	0.0295	0.684 (0.587-0.797)	< 0.0001
Stroke	0.604 (0.443-0.825)	0.0015	0.564 (0.484-0.656)	< 0.0001
Iron Deficiency Anemia	1.009 (0.908-1.122)	0.8635	1.017 (0.966-1.071)	0.5143
Nutritional deficiencies	1.539 (1.344-1.762)	< 0.0001	1.282 (1.199-1.37)	< 0.0001
Lipid Metabolism disorders	1.210 (1.130-1.296)	< 0.0001	1.192 (1.15-1.237)	< 0.0001
Thyroid disorders	1.327 (1.231-1.430)	< 0.0001	1.247 (1.201-1.295)	< 0.0001
Chronic Pancreatitis	1.788 (1.415-2.259)	< 0.0001	1.356 (1.207-1.524)	< 0.0001
Renal failure, moderate	1.026 (0.919-1.145)	0.6530	1.04 (0.981-1.102)	0.1839
Renal failure, severe	1.072 (0.897-1.282)	0.4445	1.117 (1.02-1.223)	0.0172
Menopausal disorders	1.716 (1.211-2.432)	0.0024	1.433 (1.206-1.702)	< 0.0001
Osteoporosis	1.280 (1.171-1.399)	< 0.0001	1.21 (1.157-1.265)	< 0.0001
Osteoarthritis	1.287 (1.187-1.395)	< 0.0001	1.215 (1.167-1.264)	< 0.0001
Obesity	1.500 (1.377-1.635)	< 0.0001	1.228 (1.176-1.283)	< 0.0001
Weight Loss	1.253 (0.964-1.628	0.0913	1.212 (1.067-1.378)	0.0032
Protein-calorie malnutrition	1.162 (1.045-1.291)	0.0054	1.103 (1.047-1.162)	0.0002
Leukemia	0.980 (0.643-1.492)	0.9237	1.05 (0.856-1.288)	0.6351
Lymphoma	0.875 (0.610-1.255)	0.4685	1.014 (0.852-1.207)	0.8744
Metastatic cancer	0.975 (0.744-1.277)	0.8532	1.095 (0.948-1.265)	0.2168
Solid tumor without metastasis, malignant	0.917 (0.775-1.085)	0.3140	0.944 (0.863-1.034)	0.2131
Paralysis	1.391 (1.110-1.744)	0.0042	1.48 (1.32-1.659)	< 0.0001
Dementia	1.601 (1.344-1.908)	< 0.0001	2.082 (1.906-2.274)	< 0.0001
AIDS	0.866 (0.422-1.776)	0.6938	0.826 (0.58-1.178)	0.2847
Smoking	1.410 (1.325-1.502)	< 0.0001	1.231 (1.193-1.271)	< 0.0001
Alcohol	2.296 (1.922-2.743)	< 0.0001	2.109 (1.927-2.308)	< 0.0001
Opioids	2.430 (2.128-2.774)	< 0.0001	2.009 (1.882-2.145)	< 0.0001

¹Univariate analysis is performed with logistic regression.

²Multivariate analysis is performed with weighted multi-level mixed effect models.

NA: No application; AIDS: Acquired immunodeficiency syndrome.

Citation: Haider MB, Basida B, Kaur J. Major depressive disorders in patients with inflammatory bowel disease and rheumatoid arthritis. World J Clin Cases 2023; 11(4): 764-779
URL: https://www.wjgnet.com/2307-8960/full/v11/i4/764.htm
DOI: https://dx.doi.org/10.12998/wjcc.v11.i4.764