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Stoma Formation in Crohn's Disease and the Likelihood of Antidepressant Use: A Population-Based Cohort Study

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  • Jonathan Blackwell, St George's University Hospitals NHS Foundation Trust, St. George's University of London, Imperial College London
  • ,
  • Sonia Saxena, Imperial College London
  • ,
  • Nishani Jayasooriya, St George's University Hospitals NHS Foundation Trust, St. George's University of London, Imperial College London
  • ,
  • Irene Petersen
  • Matthew Hotopf, King's College London, South London and Maudsley NHS Foundation Trust
  • ,
  • Hanna Creese, Imperial College London
  • ,
  • Alex Bottle, Imperial College London
  • ,
  • Richard C.G. Pollok, St George's University Hospitals NHS Foundation Trust, St. George's University of London, Imperial College London
  • ,
  • POP-IBD Study Group

Background & Aims: The impact of a temporary or permanent stoma on mental health in Crohn's Disease (CD) is unknown. The aim was to examine the association between intestinal surgery and stoma formation and subsequent antidepressant medication (ADM) use. Methods: Using the Clinical Practice Research Datalink, we identified individuals with CD who underwent intestinal surgery between 1998-2018. We excluded individuals with a prescription for an ADM in the 6 months before surgery. Individuals were stratified into three groups: no stoma, temporary stoma, and permanent stoma. We used Kaplan-Meier curves to examine initiation of ADM after intestinal surgery and Cox regression to identify risk factors for ADM use after intestinal surgery. Results: We identified 1,272 cases of CD undergoing their 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 ADM use was 26.4%, 33.4% and 37.3% respectively. Individuals with a permanent stoma were 71% more likely to receive an ADM than those with no stoma (HR 1.71, 95% CI 1.20-2.44). Individuals with a temporary stoma reversed within 12 months had a similar likelihood of ADM use to those without stoma formation (HR 0.99, 95% CI 0.64-1.53) whereas temporary stoma formation with late reversal after 12 months was associated with significantly greater likelihood of ADM use (HR 1.85, 95% CI 1.15-2.96). Conclusions: Permanent stomas and temporary stomas with late reversal surgery are associated with increased ADM use after intestinal surgery, likely associated with increased anxiety and depression.

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
Volume20
Issue4
Pages (from-to)e703-e710
Number of pages8
ISSN1542-3565
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Publisher Copyright:
© 2022 AGA Institute

    Research areas

  • Antidepressants, Crohn's Disease, Psychosomatic Medicine, Stoma

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