Anxiety / depression & IBD outcomes

September 7, 2022

Issue 17

Clinical Question

Do anxiety and depression predict longitudinal IBD outcomes?

Editor’s Bottom Line

Anxiety and depression predict an unfavourable course of IBD. Attention to mental health is an important component of comprehensive IBD care.

Reference

Fairbrass KM, Gracie DJ, Ford AC. Relative Contribution of Disease Activity and Psychological Health to Prognosis of Inflammatory Bowel Disease During 6.5 Years of Longitudinal Follow-Up. Gastroenterology. 2022 Jul;163(1):190–203.e5. https://www.gastrojournal.org/article/fulltext

Synopsis

Between 2014 and 2021, British researchers documented demographic and clinical characteristics as well as anxiety and depression scores for 718 adults with IBD, accruing a mean 6.5 years of follow up. The patient population was divided into four groups: those with or without clinical activity at baseline who did or did not have symptoms of anxiety or depression. Anxiety and depression symptoms were assessed using validated questionnaires.

In multivariate analyses, those in clinical remission with anxiety or depression symptoms had a higher risk of a combined measure of corticosteroid use or clinical relapse, compared with patients in clinical remission at baseline who did not have symptoms of anxiety or depression (Hazard Ratio [HR], 1.57; 95% Confidence Interval [CI], 1.08–2.27). Similarly, individuals with normal levels of fecal calprotectin (FC) at baseline and symptoms of depression or anxiety were at a higher risk of subsequently requiring corticosteroids or experiencing relapse, compared to those with normal FC levels at baseline and no symptoms of depression or anxiety (HR, 1.67; 95% CI, 1.07–2.62).

Patients with clinical activity at baseline along with symptoms of depression or anxiety also had significantly higher rates of medical therapy escalation due to uncontrolled IBD activity (HR, 1.65; 95% CI, 1.14–2.4) and a higher risk of death during follow-up (HR, 4.99; 95% CI, 1.8–13.88), compared to those in clinical remission at baseline and without depression or anxiety symptoms.

Details

Study Design: Longitudinal cohort

Funding: The Leeds Teaching Hospitals Charitable Foundation and Tillotts Pharma UK Ltd.

Allocation: Not applicable

Setting: Single center

Level of Evidence: 1b