Systematic review with meta‐analysis: anxiety and depression in children and adolescents with inflammatory bowel disease

Alizadeh-Tabari

2019

Aliment Pharmacol Ther

269

195

Background: Irritable bowel syndrome (IBS) is a common and potential disabling functional gastrointestinal disorder. Studies have revealed a possible association between IBS and psychological problems, such as anxiety and depression. Existing systematic reviews have addressed only the levels of anxiety or depression in patients with IBS. Aim:To investigate systematically the prevalence of anxiety or depression in IBS patients Methods: A literature search was conducted using the related keywords from the bibliographic databases of Embase, PubMed, Scopus, Web of Science and POPLINE published until 1 January 2019 with no language restriction. Studies reporting the prevalence of anxiety/depressive symptoms/disorders in adult (≥15 years) IBS patients were evaluated. The pooled prevalence, odds ratio (OR) and 95% CI were calculated using stata software.Results: A total of 14 926 articles were initially screened, and finally 73 papers were included. The prevalence rates of anxiety symptoms and disorders in IBS patients were 39.1% (95% CI: 32.4-45.8) and 23% (95% CI: 17.2-28.8) respectively. The ORs for anxiety symptoms and disorders in IBS patients compared with healthy subjects were 3.11 (95% CI: 2.43-3.98) and 2.52 (95% CI: 1.99-3.20) respectively. The prevalence estimates of depressive symptoms and disorders in IBS patients were 28.8% (95% CI: 23.6-34) and 23.3% (95% CI: 17.2-29.4) respectively. The ORs for depressive symptoms and disorders in IBS patients compared to healthy subjects were 3.04 (95% CI: 2.37-3.91) and 2.72 (95% CI: 2.45-3.02) respectively. Conclusion: Patients with IBS have a three-fold increased odds of either anxiety or depression, compared to healthy subjects. | 133 ZAMANI et Al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information will be found online in the Supporting Information section at the end of the article. How to cite this article: Zamani M, Alizadeh-Tabari S, Zamani V. Systematic review with meta-analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2019;50:132-143. https ://

Section: Methodsmentioning

confidence: 99%

Systematic review with meta‐analysis: the prevalence of anxiety and depression in patients with irritable bowel syndrome

Alizadeh-Tabari

2019

Aliment Pharmacol Ther

269

195

“…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, are not disorders in most cases. This is a reassuring finding for clinicians.…”

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confidence: 72%

“…While paediatric IBD is now becoming fairly common, much less systematic knowledge is available on anxiety and depression in children with IBD than in adults. The excellent systematic review with meta‐analysis by Stapersma et al is therefore timely …”

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confidence: 99%

“…Analysing 28 studies (n = 8107) published between 1994‐2017, they 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 …”

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confidence: 99%

“…As the rates of anxiety and depression are lower in children than in adults, 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, further supporting early psychological interventions in IBD.…”

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confidence: 99%

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Editorial: anxiety and depression in inflammatory bowel disease

Mikocka‐Walus

Knowles

2018

Aliment Pharmacol Ther

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,

Efficacy of Motivational Interviewing to Improve Utilization of Mental Health Services Among Youths With Chronic Medical Conditions

et al. 2021

IMPORTANCE Despite the high prevalence of anxiety and depression in youths with chronic medical conditions (CMCs), physicians encounter substantial barriers in motivating these patients to access mental health care services. OBJECTIVE To determine the efficacy of motivational interviewing (MI) training for pediatricians in increasing youths' use of mental health care. DESIGN, SETTING, AND PARTICIPANTS The COACH-MI (Chronic Conditions in Adolescents: Implementation and Evaluation of Patient-Centered Collaborative Healthcare-Motivational Interviewing) study was a single-center cluster randomized clinical trial at the University Children's Hospital specialized outpatient clinics in Düsseldorf, Germany. Treating pediatricians were cluster randomized to a 2-day MI workshop or treatment as usual (TAU). Patient recruitment and MI conversations occurred between April 2018 and May 2020 with 6-month follow-up and 1-year rescreening. Participants were youths aged 12 to 20 years with CMCs and comorbid symptoms of anxiety and depression; they were advised by their MI-trained or untrained physicians to access psychological counseling services. Statistical analysis was performed from October 2020 to April 2021. INTERVENTIONS MI physicians were trained through a 2-day, certified MI training course; they recommended use of mental health care services during routine clinical appointments. MAIN OUTCOMES AND MEASURESThe primary outcome of uptake of mental health care services within the 6-month follow-up was analyzed using a logistic mixed model, adjusted for the data's cluster structure. Uptake of mental health services was defined as making at least 1 appointment by the 6-month follow-up. RESULTS Among 164 youths with CMCs and conspicuous anxiety or depression screening, 97 (59%) were female, 94 (57%) had MI, and 70 (43%) had TAU; the mean (SD) age was 15.2 (1.9) years.Compared with patients receiving TAU, the difference in mental health care use at 6 months among patients whose physicians had undergone MI training was not statistically significant (odds ratio [OR], 1.96; 95% CI, 0.98-3.92; P = .06). The effect was moderated by the subjective burden of disease (F 2,158 = 3.42; P = .04). Counseling with an MI-trained physician also led to lower anxiety symptom scores at 1-year rescreening (F 1,130 = 4.11; P = .045). MI training was associated with longer conversations between patients and physicians (30.3 [16.7] minutes vs 16.8 [12.5] minutes; P < .001), and conversation length significantly influenced uptake rates across conditions (OR, 1.03; 95% CI, 1.01-1.06; P = .005).