P235 Major Depression in patients with Crohn's disease and its relationship with clinical activity and disease’s phenotype.

Facanali, C.(1);Sousa Freitas Queiroz, N.(1);Facanali, M.R.(1);Rodrigues Boarini, L.(1); Amuratti Gonçalves, J.L.(1);Rodrigues Borba, M.(1);Nahas, S.C.(1);Sobrado, C.W.(1);

(1)University of São Paulo School of Medicine, Department of Gastroenterology and Division of Colorectal Surgery, Sao Paulo, Brazil


Crohn's disease (CD) has a considerable impact on quality of life and contributes to the onset of depressive symptoms¹. It has been demonstrated that depression is more prevalent in inflammatory bowel disease (IBD) patients compared to the general population². However, whether depression affects IBD course or the onset of IBD triggers psychological disorders remains to be elucidated. The aim of the study is to estimate the prevalence of major depression in patients with CD and to evaluate its relationship with the clinical activity and phenotype of the disease.


From November 2019 to February 2020, 283 patients with CD were evaluated using the Patient Heath Questionnaire-9 (PHQ-9). Major depression (MD) was defined by PHQ-9 ≥ 10 (0-4: absent depressive symptoms / 5-9: mild depressive symptoms / 10-14: moderate depressive symptoms / 14- 27: severe depressive symptoms). Data regarding socio-demographic characteristics, disease phenotype, clinical activity were prospective collected. Disease phenotype was characterized according to the Montreal classification and clinical activity was assessed using the Harvey-Bradshaw index (HBI). Statistical tests were performed with a 5% significance level.


The prevalence of MD in CD patients was 41.7% (Table 1). Female patients were more susceptible to MD (Table 2). Other socio-demographic characteristics did not increase the risk of MD. Disease activity was significantly associated with an increased risk of MD (Odds Ratio [OR] 795.97, 95% confidence interval [CI] 133.7-4738.78, p <0.001) (Table 2). Regarding disease phenotype, the stenosing and penetrating behaviour were associated with a lower risk of MD (OR 0.8, 95%CI 0.01-.5 and OR 0.03, 95%CI 0.00-0.18), respectively, as compared with the inflammatory behaviour. No association was observed between location of the disease and MD.


Our study shows a high prevalence of MD among CD patients, which is significantly affected by disease phenotype and clinical activity. Given that the ultimate therapeutic goals for CD should include restoration of quality of life, this study shed light on the need of the inclusion of psychological assessment besides the objective measures of disease activity as an integral part of IBD care.