Síndrome depressivo-ansiosa em pacientes com doença de Crohn

Abstract

Although psychological factors have been initially postulated as the key in the etiology of Crohn's Disease (CD), nowadays this hypothesis has been discarded, even though anxiety and depression disorders, can exacerbate or trigger activity of the disease. However, the prevalence of anxiety and depression syndromes in CD, as well as its possible factors associated with them are poorly defined. Objective: To evaluate the prevalence of the anxious-depressive-syndrome, as well as the possible risk factors, in patients with CD. Materials and Methods: 110 patients (55 men and 55 women) with a mean age of 38.2 years (range 18 to 64 years) with established diagnosis of CD were evaluated during the period of December 2005 to April 2007 for the presence of anxiety-depressive syndrome. Socio-demographic relevant data, clinical characteristics related to inflammatory bowel disease, and personal background were recorded. To assess the CD phenotype we used the Vienna´s Classification, while the activity of the CD was evaluated by the Activity Index in Crohn's Disease (AICD). Two instruments of self-assessment were used for the psychological evaluation of patients: the Beck Depression Inventory, and the anxiety subscale of the Hospital Anxiety and Depression Scale. The same questionnaires were applied in the control group of 110 patients (52 men and 58 women) with mean age of 39.9 years (range 18 to 65 years) attended in a general gastroenterology clinic for gastrointestinal cronic diseases (except CD). For comparative purposes, patients with CD were divided into groups: with and without depressive (DS) and / or anxiety syndrome (AS). Results: Patients with CD and the control group were similar with respect to sex, marital status, age, race, current employment, and alcohol consumption. Meanwhile, CD patient were more often smokers (p = 0.05) and had higher level of education (p <0.02). Depressive syndrome was significantly more often in CD patients that in the control group (25.4% vs. 8.2%, p <0.003), although the AS prevalence (33.6% vs. 22.7 %), and dysphoria (13.6% vs.6, 4%) were similars in both groups. Patients with CD and DS comorbidity were significantly more likely to present active disease in the inclusion when compared with the non-depressive patients (71.4% vs. 34.1%, respectively, p = 0.04). Additionally, the baseline score of the AICD was significantly higher in these (282 ± 113) than those without DS (138 ± 50, p = 0.001). In 37 patients with CD and AS comorbidity, there were clear trend of the predominance of women. Significantly more patients with AS had a depression family history when compared to patients without AS (56.7% vs. 16.4%, p = 0.002). Conclusion: Our results show that DS and / or AS are highly prevalent disorders in patients with CD. The activity of the CD was the main factor associated with the co-occurrence of DS, while depression family history proved to be a significantly factor associated with AS in these patients. The high prevalence of DS and / or AS found in patients with CD, along with the availability of effective treatment for these conditions, indicates that it is appropriate to recommend routine screening for DS / AS as part of improving the quality of care for subjects with CD .