For many years people have wondered if psychological problems have a role in causing Crohn’s disease (CD) and Ulcerative Colitis (UC). This has always been difficult to prove although sometimes events are very suggestive. There was once a young woman for example, who had very well controlled UC and who, whilst walking along the street shopping was struck by a heavy metal pulley dropped by a builder from scaffolding above. She had a nasty cut on her head which need stitching. The following day her UC relapsed and remained resistant to medical treatment so that several months later she underwent surgery and had an ileo-anal pouch constructed. She was successful in sueing the builder concerned for a large sum of money.
The difficulty in linking stress/shock and IBD has always been that of course the development of an unpleasant chronic disorder, such as IBD inevitably makes many patients anxious and or depressed and it is difficult to decide which is the chicken and which is the egg. It was very interesting therefore to read a paper which appeared in Clinical Gastroenterolgy and Hepatology in Jan 2013, in which it was possible to link depression and the onset of IBD in a prospective study. The Nurses Health Study is a program which is carried out in Massachusetts. 238,386 female registered nurses aged 30-55 were recruited in 1976 and again in 1989 and were followed up regularly observing changes in their health and assessing them regularly to see if they showed signs of any specific diseases. In this group depressive symptoms were assessed by a recognized symptom score on 6 occasions between 1992 and 2001. Of 152,461 assessed for depression, 203 later developed UC and 170 CD. The frequency of which they became unwell was compared with non depressed controls from the same group of nurses. The risk for developing UC was found not to be increased but the risk of developing CD was just over twice as high in those women who showed evidence of depression before they developed CD.
Thus it looks as if being depressed could carry an increased risk of developing CD and indeed the authors suggest that treating depression could reduce risk of disease relapse and possibly, in individuals with genetic susceptibilty reduce the risk of disease onset. However, such a finding is perhaps over optimistic when one considers that of 16,986 women who met the definition of depression only 170 developed CD. Although sudden shocks are recognized by many physicians as sometimes leading to relapses of IBD, the role of depression in the production of CD can be seen to be relatively small.
Ref: Ananthakrishnan AN et al Clin Gast Hepatol 2013 11 57-62
This article was first published on the original crohns.org.uk blog. Research has moved on since, so please check current advice with your IBD team.