Prevalence of Fatigue and Unrecognized Depression in Patients with Inflammatory Bowel Disease in Remission under Immunosuppressants and Biologicals

Abstract

Background: Although highly prevalent among inflammatory bowel disease (IBD) patients, fatigue remains an unmet clinical need. The aim was to describe the prevalence of fatigue in an IBD population in remission and identify factors associated with fatigue. Methods: IBD patients in clinical and biochemical remission under treatment with immunomodulators or biologicals were included. Fatigue, physical tiredness and depression were assessed using the fatigue Visual Analogue Scale (fVAS), the Shortened Fatigue Questionnaire (SFQ) and the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR), respectively. Relevant clinical and biochemical parameters were included in regression analyses to identify factors associated with physical fatigue. Results: In total, 157 IBD patients were included. Up to 45.9% of patients reported fatigue, physical tiredness was observed in 51% and depression in 10.8%. The majority of patients with subclinical depression were fatigued. Female sex (OR = 4.17 [1.55–6.78], p = 0.002) was independently associated with physical fatigue. Transferrin saturation (OR = −0.11 [−0.22–−0.007], p = 0.037) and treatment with adalimumab (compared to infliximab, OR = −3.65 [−7.21–−0.08], p = 0.045) entailed a lower risk of fatigue. Conclusion: Fatigue is observed in about half of IBD patients in remission and can be a symptom of underlying undetected depression. Sex, transferrin saturation and medication were identified as independent risk factors.

Fatigue Is Associated with Anxiety and Lower Health-Related Quality of Life in Patients with Inflammatory Bowel Disease in Remission

“…Female sex is a well-known factor associated with fatigue [ 14 , 24 , 25 , 28 , 29 , 33 ]. Similar to general population, in our group of patients, fatigue was strongly associated with female sex.…”

“…In the univariate analysis, t test, Chi-squared test and Fisher’s exact test were used to determine whether there were significant differences between patients presenting with fatigue and those without fatigue. Variables were selected taking into account the pre-existing data in the literature [ 6 , 10 , 11 , 14 , 15 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

Fatigue in patients with inflammatory bowel disease—strongly influenced by depression and not identifiable through laboratory testing: a cross-sectional survey study

“…Depression and fatigue have common behavioral, affective and cognitive characteristics; furthermore, they may even share similar causal pathways [ 7 , 46 , 51 ]. Truyens et al [ 52 ] suspected fatigue to be a symptom of underlying undetected depression. This hypothesis was supported by our study, in which 100% of patients with conspicuous values on the HADS-D scale had fatigue.…”

“…Severe IBD has been shown to impact psychology and is associated with new-onset depression [ 53 ]. Conversely, depression can negatively affect the course of IBD [ 52 , 54 – 56 ]. Hence identifying and appropriately addressing depression in patients with IBD are crucial.…”

Unraveling the fatigue puzzle: insights into the pathogenesis and management of IBD-related fatigue including the role of the gut-brain axis

“…While one study identified disease chronicity as a factor contributing to fatigue ( 31 ) another study observed lower fatigue levels in patients with longer disease duration ( 97 ). Finally, one study showed no significant relationship between disease duration and fatigue ( 44 ).…”