Analysis Of The Changes And Risk Factors Of Depression In Crohn’s Disease With Perianal Fistula Before And After Treatment

BACKGROUND:Crohn’s disease(CD)is a chronic inflammatory bowel disease of unknown origin.The incidence of Crohn’s disease in China has increased year by year.The incurable,recurrent,disabling and other characteristics of the disease have severely affected the patients’ psychology.Nearly a third of CD patients are associated with perianal lesions,of which perianal fistula is the most common type.Because perianal fistula Crohn’s disease(PFCD)is a high risk factor for CD disability or severe CD,the recurrence of the disease greatly affects the patients’ physical,psychological and daily life,making the patients’ psychological problems more serious,and may even appear suicidal.At present,the research on depression status of patients with Crohn’s disease perianal fistula is mostly based on cross-sectional studies in western countries.There are few reports on this aspect in China,especially the related research on the changes in depression status and influencing factors of patients after treatment.OBJECTIVE:To understand the depression status of PFCD patients and analyze the influencing factors related to the formation of depression.A controlled study was compared with the depressive state after treatment(12-month treatment period),and the factors that caused the change of depressive state after treatment were analyzed.METHODS:This study is a prospective cohort study.From October 2017 to December 2018,126 patients with perianal fistula of Crohn’s disease who underwent diagnosis and treatment in in the anorectal department of the Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Provincial Hospital of Chinese Medicine)were eligible.The PHQ-9 scale was used to assess the depression status of patients at the time of enrollment and after treatment(12 months of treatment period).Changes in depression status before and after one-year treatment were assessed using the Wilcoxon rank test.The t-test was used to analyze the formation factors of patients’ depression.A univariate and multivariate analysis was used to determine the factors that affect depression in patients with Crohn’s disease perianal fistula after treatment.RESULTS:①Among the 126 PFCD patients included in the study,70.6%were men,the average age of the patients was 28.4 years,and the average course of disease was 39.8 months.All patients had perianal lesions.At the time of enrollment,the overall depression rate was 45.2%.Patients with active perianal disease(p<0.001)and severe anal incontinence(p<0.001)are more likely to develop depression.Depression levels were higher in women(P=0.039)and those with simplified CDAI>4(p<0.001).②After 12 months of treatment,the overall depression rate in PFCD patients was 39.7%,the number of patients with moderate-severe depression was lower than before(17.4%vs 10.3%),and the number of patients without depression was increased(54.8%vs 60.3%),but statistics did not show a significant difference in depression levels before and after treatment(P＝0.063).③ The Univariate and multivariate analyses results indicated that the increase in the number of hospitalizations(OR=1.245,95%CI 1.002-1.547)and the decline in quality of life(OR=21.493,95%CI 2.897-159.477)were risk factors for exacerbation of depression in PFCD patients after 12 months of treatment.CONCLUSION:Crohn’s patients with perianal fistula did not show statistically significant changes in overall depression after 12 months of treatment.Females,patients with anal incontinence,active luminal and perianal disease have higher levels of depression.Increasing the number of hospitalizations and decreasing quality of life can lead to increased levels of depression in patients.