Editorial: anxiety and depression in inflammatory bowel disease

Abstract

Anxiety and depression are common comorbidities in patients with inflammatory bowel disease (IBD), with 19% of patients reporting symptoms of anxiety and 21% of depression, as compared to 9% and 13%, respectively, in healthy controls. Analysing 28 studies (n = 8107) published between 1994-2017, they 7 showed the pooled prevalence of anxiety symptoms to be 16.4% (95% CI: 6.8%-27.3%), of anxiety disorders to be 4.2% (95% CI: 3.6%-4.8%), of depressive symptoms to be 15.0% (95% CI: 6.4%-24.8%), and of depressive disorders to be 3.4% (95% CI: 0%-9.3%).Except for anxiety disorders, significant heterogeneity was noted among the studies, and there were fewer studies reporting disorders as opposed to symptoms, which is consistent with previous systematic reviews. 1,8Reporting anxiety/depression symptoms and disorders separately is a strength of the present review. The differences between the two are frequently ignored both in practice and in academic papers.Symptoms are derived from screening measures such as the Child Depression Inventory, while disorders are typically established during a psychological or psychiatric interview, which is more costly and time-consuming, and thus less often used in research. Symptoms are common but, as shown, 7 are not disorders in most cases. This is a reassuring finding for clinicians. Nevertheless, the symptoms of anxiety and depression are a sign that there is a need for psychological support and, if this can be provided, there is a good chance they will not escalate to a diagnoseable psychological disorder.As the rates of anxiety and depression are lower in children than in adults, 1,7,8 paediatric IBD clinics may be ideally situated to provide biopsychosocial integrated care which could offer support not only for IBD symptoms and non-intestinal inflammatory issues but also, holistically, for overall wellbeing. Studies on psychological therapy, while limited in number, show higher efficacy in children with IBD than adults, 9 further supporting early psychological interventions in IBD. While the impact of anxiety/depression on disease course in paediatric IBD was outside the scope of the recent review,

Editorial: anxiety and depression in inflammatory bowel disease – authors’ reply

“…We thank Mikocka‐Walus and Knowles for their editorial about our systematic review and meta‐analysis on anxiety and depression in children and adolescents with inflammatory bowel disease (IBD) . Indeed, anxiety and depression are common in IBD, and the bidirectional relationship between anxiety/depression and intestinal inflammation can be explained in terms of the “brain‐gut‐axis” .…”