The role of depression in ulcerative colitis and Crohn’s disease.




J Epidemiol Community Health

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Ulcerative colitis is one of two forms of inflammatory bowel disease (IBD), the other form being Crohn's disease. Unfortunately, the cause of this form of IBD remains unknown, but diagnosis is still possible through excluding other possible conditions and by a full review of the symptoms. Ulcerative colitis is a condition in which the moist tissue layer that lines the colon and rectum, called the mucosa, has become inflamed. In some instances, a short segment of the lower section of the small intestine called the terminal ileum may also be inflamed. Unlike Crohn's disease, the deeper longitudinal muscular layers, and regional lymph nodes are usually not involved.

Crohn's disease is an inflammatory condition; the delicate mucous membrane lining the intestinal wall becomes inflamed and ulcerated in spots called "skip lesions." The intestinal lining looks somewhat like an old cobblestone street, with lesions spaced between normal tissue. The inflammation can penetrate the bowel wall, leading to the development of abscesses and deep cracks. Even worse, these cracks may lengthen, forming complete openings from the inside of the intestine to the outside called "fistulas." The intestinal wall eventually becomes hardened and inflexible. In later stages of the disease, the intestine may become obstructed. Though it can strike anywhere along the GI tract from the mouth to the anus, Crohn's disease usually affects the endmost portion of the small intestine, called the "ileum."

A study conducted at the University of Oxford examined whether anxiety or depression co-exists with inflammatory bowel diseases or not. The researchers retrieved their data from a database of hospital linked record abstracts. Both depression and anxiety preceded ulcerative colitis (UC) more than predictions from the control population’s experience. The links were strongest when the mental condition was diagnosed right before the ulcerative colitis was diagnosed, or when the depression was diagnosed 5 or more years before the UC. Anxiety followed diagnosis of UC, but depression did not. Neither depression nor anxiety occurred before diagnosis of Crohn’s disease, but afterwards, they were significantly more common, especially the 1st year after diagnosis. The authors concluded that the two mental disorders that occur one year or less before diagnosis of an inflammatory bowel disease, may be early symptoms of the undiagnosed condition.1


1. Kurina LM. Depression and anxiety in people with inflammatory bowel disease. J Epidemiol Community Health. Oct 2001; 55(10):716-20.