Posted May 21st, 2010 in Recent News.
CHICAGO — Depression is common in children with Crohn’s disease who complain of abdominal pain even when their disease appears minimal or inactive, a researcher said here.
Among 500 pediatric Crohn’s disease patients, scores on the Children’s Depression Rating Scale (CDRS) correlated significantly with abdominal pain with a r value of 0.42 (P<0.001), reported Arvind Srinath, MD, of Children's Hospital of Pittsburgh, at Digestive Disease Week.
Srinath said it would make sense to screen children with inflammatory bowel disease for depression.
He said the study was prompted by observations that many children with IBD report severe abdominal pain even when they show few objective signs of disease activity.
In a preliminary study, Srinath said, 23% of 139 children with Crohn's disease reporting abdominal pain had mild or inactive disease, according to measures such as erythrocyte sedimentation rate, albumin, and stool frequency.
Moreover, when abdominal pain was removed from the Pediatric Crohn's Disease Activity Index (PCDAI), the proportion with scores indicating active disease fell from 29% to 3%.
He and colleagues therefore conducted a larger study that examined children's psychological status in more detail along with objective disease parameters.
Among the 500 children included, 116 (23%) were found to be depressed according to CDRS scores. The mean age in this group was 14 and they were evenly divided between boys and girls.
In addition to depression, other correlates of pain in univariate analysis included anxiety symptoms, diarrhea, albumin levels, and overall PCDAI scores.
Both depression and anxiety were significantly correlated with pain frequency and pain severity, Srinath reported.
In a hierarchical regression analysis that controlled for IBD-related inflammatory biomarkers, a model including anxiety, depression and diarrhea accounted for about 26% to 30% of the variance in total abdominal pain, pain intensity, and pain frequency.
But only the severity of depression made a "unique significant contribution" to explaining the variance in the model, Srinath said.
He acknowledged that, in at least some cases, the depression may result from living with a "devastating diagnosis" that disrupts sleep, embarrasses patients at school, and is indeed painful.
Consequently, the study findings could also be interpreted as suggesting that the objective measures of disease activity are inadequate, Srinath said.
Nevertheless, he said, screening for depression in children with IBD and treating it should be considered, he said.
At a press briefing on the study, DDW session moderator Robynne Chutkan, MD, of Georgetown University in Washington, D.C., echoed his comment.
"It's so important to screen for that," she said. "As physicians, sometimes we have this sort of 'Don't ask, don't tell' policy, and I think you really have to ask some pointed questions of the children, if they're old enough, or of the parents."
Srinath pointed out that asking about sleep, negative thoughts, and other depressive symptoms only takes two or three minutes and can be very revealing.
Moreover, both he and Chutkan said cognitive behavioral therapy, rather than antidepressant drugs, should be tried first in depressed IBD patients.
Srinath said his group planned a randomized trial later this year to formally test the efficacy of cognitive behavioral therapy in children with IBD and depression.
Source: Primary source: Digestive Disease Week
Source reference: Srinath A, et al “Predictors of abdominal pain in depressed pediatric Crohn’s disease patients” DDW 2011; Abstract 453.