The bidirectional effects of hemorrhoids, depression, and anxiety: a prospective cohort study in the UK Biobank.

BACKGROUND

This study examines the bidirectional association between hemorrhoidal disease and mental health conditions, specifically depression and anxiety. While a plausible connection exists, research on their interplay is limited.

METHODS

Using data from the UK Biobank (until March 2024), this prospective study analyzed two cohorts: 48,620 participants in the hemorrhoids-to-mental disorder cohort and 87,310 in the mental disorder-to-hemorrhoids cohort. Analyses were adjusted for multiple sociodemographic, lifestyle, and clinical covariates, including age, sex, ethnicity, BMI, smoking status, alcohol consumption, socioeconomic indicators, and comorbidities. We employed time-varying Cox proportional hazards models in conjunction with propensity score matching to estimate associations, assessing risk within 5 years, within 10 years, and over long-term follow-up.

RESULTS

Fully adjusted models revealed significant associations between hemorrhoidal disease and mental disorders. A diagnosis of hemorrhoidal disease was associated with a higher risk of subsequent depression (HR, 1.56 [95% CI, 1.46-1.66]) and anxiety (HR, 1.55 [95% CI, 1.46-1.66]). Conversely, a diagnosis of depression was associated with an increased risk of subsequent hemorrhoidal disease (HR, 1.14 [95% CI, 1.09-1.19]), as was a diagnosis of anxiety (HR, 1.46 [95% CI, 1.38-1.54]).

CONCLUSION

This study identifies a significant bidirectional association between hemorrhoidal disease and mental health conditions. Notably, the interaction between smoking and anxiety highlights a subgroup at elevated risk that may benefit from closer clinical attention. These findings support an integrated care perspective that considers both gastrointestinal and mental health conditions, while acknowledging that causal inferences cannot be definitively established from observational data.