{MP Test LMU} Double whammy: Depression and IBD increase hospital readmission, death

Individuals with comorbid depression and inflammatory bowel disease (IBD) are at increased risks for hospital readmission and mortality at 30 days after readmission as shown in a retrospective observational study presented at CCC 2024.

The readmission risk substantially increased at 90 days. The leading readmission diagnoses were sepsis, hypertension, chronic kidney failure with heart failure, complications of renal disease, chronic obstructive pulmonary disease, pneumonia, urinary tract infection, type 1 diabetes with ketoacidosis, and acute depressive episodes.

Reporting the findings at CCC 2024, Dr Neethi Dasu, a gastroenterologist at Beth Israel Lahey Health in Burlington, Massachusetts, US, said studies are showing that people with either manifestation of IBD are vulnerable to experiencing mental health conditions that predate the gastrointestinal disorder. “Conversely, a pre-existing mental health disorder such as depression may impact the disease process and course of IBD.”

She described the complexity of the interaction between depression and IBD as a fertile ground for investigations. However, she noted the dearth of studies looking at the effects of depression on patients with IBD.

In the current study, Dasu and her team drew on data from the US National Readmissions Database from 2016 to 2019. International Classification of Diseases (ICD)-10 codes – a global standard for classifying and coding mortality and morbidity data – were used to identify individuals with IBD (Crohn’s disease [CD], ulcerative colitis [UC]) and depression. [CCC 2024, abstract P100]

Mortality and 30- and 90-day readmission rates were the primary endpoints whereas index admission mortality, hospital length of stay, and total hospitalization cost at 30 and 90 days were the secondary endpoints. The top 10 readmission diagnoses in each subgroup were also identified.

At 30 days, the readmission rate was 5.2 percent (p<0.01) in those with CD and depression whereas the mortality rate was 2.8 percent (p<0.01).  At 90 days, the readmission rate further increased to 8.4 percent (p<0.01).

Hospital length of stay and hospitalization cost for both 30- and 90-day readmissions (p<0.01). were comparable to index admission.

A similar trend was seen for UC and depression, with mean age at readmission essentially the same at 51.4 years. The readmission rate was 5 percent (p<0.01) and the mortality rate was 2.6 percent (p<0.01) at 30 days. Both increased significantly at 90 days  (readmission rate 8.1 percent, mortality rate 2.9 percent; p<0.01 for both).

As in those with CD and depression, the duration of hospital stay and hospitalization cost for 30- and 90-day readmissions (p<0.01 for all) were similar to index admission.

Clinical implications

“Patients with comorbid depression and either UC or CD had elevated readmission rates and mortality risk following readmission,” said Dasu. “This highlights the importance of routinely screening for depression and managing mental health, as well as acknowledging its impact on patients with co-occurring diseases such as IBD, as an integral part of comprehensive care.”