Symptoms of Depression and Anxiety Are Independently Associated With Clinical Recurrence of Inflammatory Bowel Disease

Abstract

In an analysis of a large cohort of subjects with IBD, we found a significant association between symptoms of depression or anxiety and clinical recurrence. Patients with IBD should therefore be screened for clinically relevant levels of depression and anxiety and referred to psychologists or psychiatrists for further evaluation and treatment.

Prevalence and Determinants of Job Stress in Patients with Inflammatory Bowel Disease

“…For instance, work engagement may lead to depressive and anxiety symptoms, 44 both of which have been shown to be increased in patients with IBD and to also adversely impact the course of the disease. 15,17 Having said that, it is sometimes difficult to differentiate the various psychosocial factors that may play a role in IBD because the term "stress" unfortunately is used in many studies in different ways; therefore, some authors advocate to improve the standardization of future studies with the term "perceived stress". 45 Although there is accumulating evidence that stress acts as a trigger for gastrointestinal inflammation in IBD, especially long-term perceived stress in UC 46 and depressive symptoms in CD, 47 there is no systematically designed study that investigated specific stressors, like job stress, as a possible trigger for disease activity and relapses in CD and UC/IC.…”

“…14 Psychosocial factors have been shown to negatively impact the course of IBD, particularly elevated levels of anxiety and depressive symptoms. [15][16][17] However, anxiety and depression may reflect one psychological dimension (i.e., negative affect) among many. For instance, although a recently published study found that job stress was not a major risk factor for incident CD or UC, 18 work-related stress still might influence the disease course.…”

Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

“…3). There was also no effect of psychological therapies on state 13,26,42 or trait 13,26,27 anxiety scores in three trials at either completion of therapy, or at final point of follow-up (webappendix pgs. 4-7).…”

“…6,7 In IBD, psychological co-morbidity, including anxiety, depression, somatisation, and perceived stress, is not only associated with active disease, but also ongoing symptoms in the absence of inflammation. [8][9][10][11][12] Although a temporal relationship between the presence of psychological co-morbidity and the onset of IBD activity has been suggested, 13 a causal relationship remains unproven. If this association is genuine, activation of the brain-gut axis, involving autonomic nervous system-mediated catecholamine release and hypothalamicpituitary-adrenal axis secretion of stress hormones, and the GI response to this, may contribute.…”

The Search for Causative Environmental Factors in Inflammatory Bowel Disease

“…This has been nicely shown for CD [46] . Other authors indicate that the same is true for UC [88] . Also in the SIBDCS, anxiety was shown to be a relevant risk factor for disease flares [89] .…”