Depression, Anxiety Mostly Unrelated to Inflammatory Bowel Disease

New research shows patients with inflammatory bowel disease (IBD) are not significantly linked to most psychiatric symptoms, including depression, anxiety, and stress.

A team, led by Thomas C. Mules, Christchurch Hospital, Canterbury District Health Board, Canterbury, New Zealand, correlated objective measures of disease activity with psychological symptoms for patients with IBD.

Previous research shows patients with IBD are more likely to suffer from the symptoms of psychological illnesses, including depression, anxiety, and stress.

“The presence of psychological illness has negative impacts on the quality of life and IBD-related outcomes,” the authors wrote. “Successful treatment of psychological illness can improve QoL and health-related outcomes making diagnosis and implementation of treatment extremely important.”

The Study

In the study, the investigators examined adult patients with IBD who underwent ileocolonoscopies. The team collected different data points on demographics, psychological symptoms, including depression, anxiety, and stress, disease activity, including symptoms, biomarkers, endoscopy, and quality of life.

Each participant completed symptom, psychological health, and quality of life questionnaires. The investigators also collected stool samples for biomarker analysis in the week prior to their ileocolonoscopy.

The investigators also collected stool samples at the 6-month follow-up appointment and each participant answered the same questionnaires.

The investigators used one-way ANOVA and multivariable analyses to examine the associations between disease activity and symptoms of psychological illness. They also identified other predictors of mental illness and reduced quality of life.

The study included 172 patients, 107 of which have Crohn’s disease and 65 patients with ulcerative colitis.

No Link

The investigators did not find a significant link between objective disease activity, whether it is endoscopic scores, fecal calprotectin, or C-reactive protein and depression, anxiety, or stress scores (P >0.05 for all comparisons).

On the other hand, gastrointestinal symptoms were significantly associated with depression, anxiety, and stress in patients with either IBD disorder (P <0.05).

After implementing the multivariable analysis, only the gastrointestinal symptoms were significantly linked to the severe symptoms of depression (OR, 20.78; 95% CI, 6.71-92.37; P <0.001) and anxiety (OR, 4.26; 95% CI, 1.70-12.25; P = 0.004).

There were also trends found depending on the treatment used for IBD.

Both anti-TNF and corticosteroid use, along with the presence of severe depressive, moderate–severe stress and gastrointestinal symptoms, and endoscopically active IBD were associated with a reduced quality of life (P <0.05) and longer duration of IBD predicted an improvement in quality of life (P <0.05).

Quality of life improvements are a key goal for clinicians, with several modifiable factors identified during the study that could be of benefit to patients with IBD.

“Objective measures of disease activity are not associated with symptoms of psychological illness in patients with IBD,” the authors wrote. “Clinicians should consider underlying mental illness in patients with IBD with active gastrointestinal symptoms.”

The study, “The impact of disease activity on psychological symptoms and quality of life in patients with inflammatory bowel disease—results from the Stress, Anxiety and Depression with Disease Activity (SADD) Study,” was published online in Alimentary Pharmacology & Therapeutics.