Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study

Abstract

BackgroundImmune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood.ObjectiveThe objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants.MethodsBetween November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations.ResultsThe final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001).ConclusionsThis paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.

The association of fatigue, pain, depression and anxiety with work and activity impairment in immune mediated inflammatory diseases

“…The sample size for the present study was determined based on a power analysis for the two principal longitudinal study objectives. Details of the sample size calculation and comprehensive protocol information is available elsewhere [ 43 ].…”

Diabetes and anxiety adversely affect cognition in multiple sclerosis

“…The source population was participants in a longitudinal study of the effects of psychiatric comorbidity on immune-mediated inflammatory diseases (the 'IMID' study) that recruited 255 persons with definite MS (Polman et al, 2011) from the province-wide Winnipeg MS Clinic (Marrie et al, 2018). The present study enrolled a subgroup of 111 IMID study participants aged ≥18 years, with adequate knowledge of the English language who underwent a study visit between September 2016 and July 2017.…”

“…As described in detail elsewhere (Marrie et al, 2018), participants completed questionnaires, and underwent standardized clinical assessments conducted by trained personnel.…”

Factors associated with perceived need for mental health care in multiple sclerosis

“…As part of a larger cohort study assessing psychiatric comorbidities in patients with chronic immune-inflammatory diseases (Marrie et al, 2018), we recruited 255 participants with neurologist-confirmed diagnoses of MS (Poser et al, 1983;McDonald et al, 2001;Polman et al, 2005;Polman et al, 2011), from the Winnipeg MS Clinic, the only clinic specializing in MS care in the province of Manitoba, Canada. Recruitment took place by telephone, mail or in clinic.…”

“…Recruitment took place by telephone, mail or in clinic. All participants were aged 18 years and older, residing in Manitoba, able to provide informed consent and willing to participate in the cohort study for three years (Marrie et al, 2018). Ethics approval was obtained from the University of Manitoba Health Research Ethics Board.…”