Characteristics and Effect of Anxiety and Depression Trajectories in Inflammatory Bowel Disease

Abstract

INTRODUCTION:Symptoms of common mental disorders, such as anxiety or depression, are associated with adverse clinical outcomes in inflammatory bowel disease (IBD). We report trajectories of these symptoms in IBD, patient characteristics associated with different trajectories, and effects on healthcare utilization and prognosis.METHODS:We collected demographic, symptom, psychological, and quality-of-life data, with questionnaires at 3-month intervals, over 12 months of follow-up. We collected healthcare utilization and IBD outcomes through notes review. We compared characteristics of those with persistently normal or improving anxiety or depression scores with those with persistently abnormal or worsening scores and the number of flares, glucocorticosteroid prescriptions, escalations of therapy, hospitalizations, or intestinal resections due to IBD activity.RESULTS:Among 771 and 777 patients, respectively, worsening or persistently abnormal anxiety or depression scores were associated with increased antidepressant (28.6% vs 12.3% anxiety, 35.8% vs 10.1% depression, P < 0.001) and opiate use (19.0% vs 7.8% anxiety, P = 0.001 and 34.0% vs 7.4% depression, P < 0.001), compared with those with persistently normal or improving scores. These individuals were also more likely to have been diagnosed with IBD in the last 12 months (16.3% vs 5.0% anxiety, P = 0.001, and 15.1% vs 5.5% depression, P = 0.006), to have clinically active disease at baseline (57.1% vs 26.6% anxiety and 71.7% vs 29.1% depression, P < 0.001) and lower quality-of-life scores (P < 0.001). Individuals with worsening or persistently abnormal trajectories of anxiety or depression required significantly more outpatient appointments, radiological investigations, and endoscopic procedures for IBD-related symptoms.DISCUSSION:In this 12-month follow-up study, patients with IBD with worsening or persistently high anxiety or depression scores were higher utilizers of health care but were not at an increased risk of future adverse disease outcomes.

Psychiatric disorders comorbid with general medical illnesses and functional somatic disorders: The Lifelines cohort study

“…It was mentioned in the introduction that depression or other psychiatric disorders may precede the onset of inflammatory bowel disease, RA or diabetes [ 22 – 24 , 26 , 27 , 29 , 34 – 38 ]. It may also develop after the onset of all these conditions [ 20 , 22 , 24 – 27 , 30 , 39 , 40 ].…”

“…It was mentioned in the introduction that depression or other psychiatric disorders may precede the onset of inflammatory bowel disease, RA or diabetes [ 22 – 24 , 26 , 27 , 29 , 34 – 38 ]. It may also develop after the onset of all these conditions [ 20 , 22 , 24 – 27 , 30 , 39 , 40 ]. This bi-directional relationship has been shown also in the functional somatic syndromes and this has led some authors to imply that the relationship is causal in relation to IBS.…”

“…However, anxiety and depressive disorders are also frequent concomitants of general medical illnesses such as RA, Diabetes and IBD [17][18][19][20][21]. There is now some evidence that this relationship is also bidirectional with depression being a risk factor for these general medical illnesses as well as the other way round [22][23][24][25][26][27][28][29]. The relationship between psychiatric disorders and general medical disorders may be more similar to that between psychiatric disorders and functional somatic syndromes than previously considered.…”

Systematic review and meta‐analysis: Impact of depression on prognosis in inflammatory bowel disease

“…3 IBD patients often have psychological symptoms, such as depression and anxiety, which may be associated with the long disease course and daily life disorders in IBD. 4,5 A prospective cohort study based on UK biobank showed that IBD patients had a significantly higher risk of depression than non-IBD participants. 6 The prevalence of depression in UC patients is 24%, while the prevalence of depression in active UC patients is as high as 41.3%.…”