Predictors of depression in youth with Crohn disease.

摘要: Pediatric Crohn disease (CD) is a chronic, lifelong inflammatory bowel (IBD) that often involves an unpredictable cycle of flares and remissions. Symptoms can include abdominal pain, bloody diarrhea, weight loss, rectal bleeding (1). The patients with pediatric CD are at additional risk for the developmental problems, including growth retardation pubertal delay (2). In addition, this population also has high rate depression compared to community controls children other chronic illnesses (3). Several factors may contribute increased in IBD. It been shown activity interrelated (3,4). IBD-related morbidity through negative cognitive processing experience, which manifest as low self-esteem, feeling lack control over disease, or style, such rumination (5). Other related psychosocial stress associated coping physical illness decreased opportunities socialization (6). suggested be direct effect inflammation on brain (7,8). According hypothesis, some cases caused by systemic proinflammatory cytokines. One these cytokines, tumor necrosis factor-α (TNF-α), implicated both IBD (9,10). Basic clinical research already indicates TNF-α antagonism biological medications (eg, etanercept, adalimumab, infliximab) reduce depressive symptoms certain populations. For example, O’Connor et al (11) demonstrated mice pretreated etanercept resistant behavior following challenge immune-stimulator bacille Calmette-Guerin. Clinical randomized controlled trials have adalimumab yield significant improvements severity placebo (12,13). Notably, treated who experienced 75% greater reduction psoriasis area index score, even decrease (13). Another trial found psoriatic arthritis showed clinically relevant improvement mental component summary 36-Item Short-Form Health Survey treatment infliximab (14). Each illness; however, it unclear whether were more effects brain-based inflammation. This study cross-sectional examination relation between use CD. We hypothesized lower prevalence symptoms, would statistically when controlling potential mediators severity, sex, age, inflammation, steroid dose, socioeconomic status (SES). predictors was assessed, models constructed predict population.