By Will Boggs MD
NEW YORK (Reuters Health) - 12/7/2019
Depression in people with inflammatory bowel disease (IBD) is associated with less positive emotional-recognition bias, researchers from the U.K. report.
Depression is two to three times more common in people with IBD than in those without the disease, but the main causes of depression among people with IBD remain unclear, the team notes in Neurogastroenterology and Motility, online July 2.
For their study, Dr. Chris Dickens of the University of Exeter and colleagues recruited 120 adults with IBD (68 with Crohn's disease, 49 with ulcerative colitis, and 3 with unclassified IBD).
Overall, participants showed a positive bias in emotional recognition, meaning that they were better at recognizing happy expressions from images of people's eyes, and a negative bias in emotional memory, meaning that they were better at recalling negative scenes.
Emotional-recognition bias was less positive in people with active disease, whereas emotional memory was not significantly associated with disease activity.
Patients classified as depressed (based on Patient Health Questionnaire-9 scores of 10 or higher, indicating at least moderate depressive symptoms) were significantly more likely to be female, lack social support, have active IBD, not to be taking anti-TNF alpha inhibitors, have worse quality of life, and exhibit less positive bias on the emotional recognition task.
Depression was not associated with laboratory markers of inflammatory activity, emotional memory, or reinforcement learning related to reward or loss.
Depression was independently associated with less social support and greater disease activity in a multivariable logistic regression model. When disease activity was removed from the model, less positive emotional-recognition bias and less social support were the only variables significantly and independently associated with depression.
In a causal-steps approach, disease activity was associated with emotional recognition bias, and both disease activity and emotional-recognition bias predicted depression.
"Further research is required to investigate mechanisms underlying the development and maintenance of depression and, in particular, to test our hypotheses that that the association between disease activity/inflammation and depression might be mediated via emotional processing biases," the researchers note.
"Our findings raise the possibility that psychological interventions targeting emotional recognition biases among people with IBD could be used to treat or even prevent depression in high risk individuals, such as those with active IBD, and thereby possibly improve medical as well as psychological outcomes," they conclude.
Dr. Antonina Mikocka-Walus from Deakin University, in Burwood, Australia, who has researched various aspects of depression and its treatment in patients with IBD, told Reuters Health by email, "To me this study is problematic analytically and because of that I do not feel these results are an important scientific contribution. Causality simply cannot be examined in studies of this design."
"The methodological problems mean I cannot be sure these findings are meaningful to clinicians," she said.
Dr. Dickens did not respond to a request for comments.
Neurogastroenterol Motil 2019.