P-019 YI Risk Factors for Suicidality Amongst Depressed IBD Patients

Abstract

Background: Depression is common in patients with inflammatory bowel disease (IBD) but suicidal ideation (SI) is often not assessed. The aim of our study is to determine factors that increase the risk for SI amongst depressed IBD patients. Methods: We conducted a cross-sectional observational study of consecutive adult patients presenting to a tertiary care IBD clinic over an 18-month period. All included patients had colonoscopy-confirmed IBD. Patients were screened for depression using patient health questionnaire (PHQ-9). Item-9 of PHQ9 measures self-reported SI on a scale of 0 to 3. From the total sample, patients with at least moderate depression (PHQ9 >10) with no SI were compared to IBD patients with SI. IBD disease activity was measured by Harvey-Bradshaw Crohn's Disease Index (HBCDI) or Ulcerative Colitis Activity Index (UCAI). Quality of Life (QOL) was measured using Short IBD Questionnaire (SIBDQ). Demographic data including age, gender, race, IBD type and social history (alcohol, illicit drugs, smoking) were obtained from electronic medical records. Other data including ESR, CRP, pain level, recent intestinal surgery, presence of ostomy, current medications including biologics, steroids, narcotics, selective serotonin reuptake inhibitors (SSRI), serotonin noradrenergic reuptake inhibitors (SNRI), bupropion, and tricyclic antidepressant (TCA) and childhood diagnosis of IBD were also recorded. Patients with SI were compared to patients with at least moderate depression (PHQ9 >10) but without suicidality using independent t-test for continuous variables and chi square (Fisher exact test) for categorical variables. Results: A total of 1352 consecutive outpatient IBD patients were screened for depression over an 18-month period. Of these patients, 71 were suicidal based on Item-9 of the PHQ9. Of the remaining 1281 patients (without SI), the complete medical information from the EMR for the first 502 patients was collected and served as a representative sub-sample of the entire non-SI sample. Of these 502 patients, 81 patients were selected on the criteria of having PHQ9 >10. Of the 71 patients with SI, 90% were moderately depressed. Suicidal IBD patients (n = 71) had significantly higher depressive severity, were more male (55% versus 33%), more belonging to a minority (18% versus 6%), had more surgery in the past year (9% versus 31%), and were more likely to be on an SSRI (38% versus 22%) compared to non-suicidal and at least moderately depressed patients. Less current use of biologics (42% versus 58%), higher current steroid use (41% versus 10%), and having an ostomy ever (28% versus 16%) were more likely to be encountered in the suicidal patients at a trend statistical level compared to the non-suicidal patients. The other variables probed, including IBD activity and inflammatory biomarkers were not significantly different between the 2 groups. Conclusions: In at least moderately depressed IBD patients, demographic factors and variables associated with a poorer course of IBD are associated with a greater risk of becoming suicidal. Current IBD activity, acute pain, or inflammation does not seem to increase risk for suicidality. Depressed patients on SSRIs and steroids need more careful monitoring for SI.