Permanent stomas and temporary stomas with late reversal surgery were found to be associated with increased use of antidepressant medication after intestinal surgery for Crohn disease, according to the results of a study published in Clinical Gastroenterology and Hepatology.1 The increased medication use was correlated with increased anxiety and depression following the surgery.
Stoma formation is known to be associated with an increased risk for both anxiety and depression compared with stoma-sparing surgery for Crohn disease,2 but whether this applies to both permanent and temporary stomas is unknown. Therefore, a team of researchers in the United Kingdom designed a nationally representative, population-based cohort study to test the hypothesis that both permanent and temporary stomas are associated with an increased likelihood of antidepressant medication use in patients having undergone intestinal surgery for Crohn disease.
The researchers identified 1272 patients with Crohn disease undergoing a first intestinal surgery; of these, 871 (68.5%) had no stoma, 191 (15.0%) had a temporary stoma, and 210 (16.5%) had a permanent stoma. The 10-year cumulative incidence of antidepressant medication use was 26.4%, 33.4%, and 37.3%, respectively. Individuals with a permanent stoma were 71% more likely to receive an antidepressant medication than those with no stoma. Individuals with a temporary stoma reversed within 12 months had a similar likelihood of antidepressant medication use as those without stoma formation, whereas temporary stoma formation with late reversal after 12 months was associated with significantly greater likelihood of antidepressant medication use.
The authors concluded that, “Permanent stoma formation and temporary stomas with late reversal are associated with significantly increased rates of [antidepressant medication] use after intestinal surgery, which is likely to be indicative of anxiety and depression.” They added, “Clinicians should be vigilant regarding the higher rate of anxiety and depression in this patient group and consider applying approaches to integrate mental and physical healthcare provision.”
1. Blackwell J, Saxena S, Jayasooriya N, et al; POP-IBD study group. Stoma formation in Crohn’s disease and the likelihood of antidepressant use: a population-based cohort study. Clin Gastroenterol Hepatol. Published online December 24, 2020. doi:10.1016/j.cgh.2020.12.026
2. Ananthakrishnan AN, Gainer VS, Cai T, et al. Similar risk of depression and anxiety following 7 surgery or hospitalization for Crohn’s disease and ulcerative colitis. Am J Gastroenterol. 2013;108(4):594-601. doi:10.1038/ajg.2012.471