Depression, Anxiety Symptoms Linked to Poor IBD Outcomes and Steroid Response

Patients with irritable bowel disease (IBD) who experience symptoms of anxiety or depression are at an increased risk of poorer disease outcomes including resistance to steroid therapy.¹

According to new research from a team of China-based investigators, anxiety and/or depression symptoms were significantly associated with worsened outcomes in IBD management. The findings call for expanded research into the correlation between psychiatric wellness and systemic improvement in IBD care.

Led by Shihao Duan, of the department of gastroenterology at West China Hospital, Sichuan University, investigators sought to explore the impact of anxiety and depression on the efficacy of medications for IBD, as well as disease-related outcomes. They noted the well-understood and frequent association between anxiety, depression and IBD in affected patients.

Indeed, prior research has even shown links implicating IBD’s effect on patients as a potential driver of anxiety or depression—rather than vice versa. “These findings…suggest that negative cognitive biases associated with IBD activity may lead to the development of depression in people with IBD,” investigators wrote in a cross-sectional analysis in 2019.²

Another study from Japan in 2022 reported an association between worsened clinical course of ulcerative colitis and depression, with suggestion the link between increased disease activity and depression may be causative.³

The China investigation team conducted a prospective, longitudinal, observational study using the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depressive symptoms in patients with IBD. They used logistic regression analyses to assess the link between anxiety and depression and patient response to IBD medication.

IBD-related poor outcomes—defined as urgent disease-related hospitalization or surgery, or death—were analyzed via Kaplan-Meier survival analysis and Cox regression modeling.

The study’s total population included 325 patients with IBD. They were primarily treated with anti-tumor necrosis factor (TNF) agents (n = 147 [45.2%]). Another 118 patients (36.3%) were treated with corticosteroids; 88 (27.1%) were treated with azathioprine or 6-mercaptopurine.

Resistance to steroid therapy among IBD patients was observed to be significantly associated with symptoms of anxiety or depression; investigators observed no such association in nonresponse to anti-TNFs nor azathioprine or 6-mercaptopurine. The team additionally observed a significant link between anxiety and depression symptoms and the 3 components of poor IBD-related outcomes.

The association was significant enough for investigators to conclude that coexisting with anxiety or depression symptoms was an independent influencing factor of steroid resistance and poor disease outcomes among patients with IBD.

“IBD patients with anxiety or depression symptoms were at a higher risk of developing steroid resistance and IBD-related poor outcome,” Duan and colleagues wrote. “Future studies are needed to explore whether interventions for anxiety and depression will improve their response to medications and change their prognosis.”

References

1. ^{Duan S, Yang Y, Cao Y, Chen P, Liang C, Zhang Y. Symptoms of anxiety and depression associated with steroid efficacy and clinical outcomes in patients with inflammatory bowel disease. Front Psychiatry. 2023;14:1029467. Published 2023 Jul 21. doi:10.3389/fpsyt.2023.1029467}
2. ^{Walter K. Investigators Gain Insight into High Depression Rates for IBD Patients. HCPLive. Published August 12, 2019. https://www.hcplive.com/view/investigators-insight-depression-rates-ibd-patients}
3. ^{Walter K. Depression Results in Worse Clinical Course for IBD Patients. HCPLive. Published November 16, 2022. https://www.hcplive.com/view/depression-results-worse-clinical-course-ibd-patients}