Outcomes of Inflammatory Bowel Disease in Hospitalized Patients With Generalized Anxiety Disorder

Abstract

BackgroundThe development of inflammatory bowel disease (IBD), which encompasses ulcerative colitis and Crohn's disease, is multifactorial. Stress from anxiety is a risk factor for IBD. Generalized anxiety disorder (GAD) is twice as likely in IBD patients. This study explores the outcomes of patients hospitalized for IBD with comorbid GAD. MethodsA retrospective analysis utilizing the 2014 USA National Inpatient Sample database was performed to assess the outcomes of hospitalized IBD patients with and without GAD. The outcomes analyzed were sepsis, acute hepatic failure, hypotension/shock, acute respiratory failure, acute deep vein thrombosis, acute renal failure, intestinal obstruction, myocardial infarction, ileus, inpatient mortality, colectomy, intestinal abscess, intestinal perforation, and megacolon. A multivariate logistic regression analysis was employed to explore whether GAD is a risk factor for these outcomes. ResultsAmong 28,173 IBD hospitalized patients in the study, GAD was a comorbid diagnosis in 3,400 of those patients. IBD patients with coexisting GAD were found to be at increased risk for acute hepatic failure (adjusted odds ratio (aOR) 1.80, p = 0.006), sepsis (aOR 1.33, p < 0.001), acute respiratory failure (aOR 1.24, p = 0.018), inpatient mortality (aOR 1.87, p < 0.001), intestinal abscess (aOR 2.35, p = 0.013), and intestinal perforation (aOR 1.44, p = 0.019). The aORs for the remaining outcomes were not statistically significant. ConclusionsIn hospitalized IBD patients, GAD is a risk factor for sepsis, acute hepatic failure, acute respiratory failure, intestinal abscess, intestinal perforation, and inpatient mortality. IBD and GAD are becoming increasingly common, which will likely lead to a larger number of complications among inpatients with these comorbidities.

Depressive and Anxiety Disorders in Patients with Inflammatory Bowel Diseases: Are There Any Gender Differences?

“…The study with the largest sample reported the greatest prevalence of depressive disorders in female inpatients (68%) [ 32 ]. Similar data were reported for anxiety disorders [ 32 , 34 ]. Taken as a whole, the different authors agree that patients with IBD have a higher probability to develop affective disorders compared with the general population and that female gender represents a risk factor.…”

“…Most of the included studies had a retrospective design [ 29 , 30 , 31 , 32 , 33 , 34 ], three were cross-sectional [ 35 , 36 , 37 ], and three were prospective [ 38 , 39 , 40 ].…”

“…The methods used to assess anxiety and depressive disorders differed across the studies; most used the HADS [ 35 , 37 , 38 , 39 , 40 ] or the ICD criteria [ 29 , 30 , 31 , 32 , 33 , 34 ], only Al-Aamri et al assessed depression using PHQ-9 [ 36 ].…”

“…A recent retrospective study from the USA reported a high prevalence (12.0%) of generalized anxiety disorder (GAD) in IBD inpatients, with females having a higher risk than males [ 34 ]. Similar results were found by a recent American study on anxiety disorders [ 32 ].…”

“…This implies that female patients may need to be treated with different drugs and require specific monitoring and a targeted multidisciplinary approach. Individualized treatment for women is even more important as the presence of affective disorders is associated with a poorer prognosis in IBD [ 34 ] and quality of life [ 38 ]. Healthcare professionals should regularly assess the mental health of their patients, both during visits and remotely [ 85 ], in light of the availability of easily used tools and the detrimental effects of poor psychological wellbeing on the course of illness [ 86 ].…”