Abstract
Both depression and anxiety are comorbidities of inflammatory bowel disease (IBD). Though previous studies have proposed a relationship between depression, anxiety and IBD, causality and directionality are unknown. We used a novel computerized adaptive testing technology to screen IBD patients for depression and anxiety and compared the screening results to disease activity.
Consecutive patients at our tertiary IBD clinic were asked to complete the validated CAT-MH™ survey (Adaptive Testing Technologies, Chicago, IL); we then reviewed disease and patient characteristics. Clinical remission status was determined by the senior author, blinded to the CAT-MH results. Simple statistics were performed.
100 patients (57 women, 81 Caucasian, 63 Crohn’s disease) participated in the study, 58 of whom had no previous history of psychiatric disorders. We identified 42 patients with depression (40 mild, 2 moderate). Of those with mild depression, 25/40 (62.5%) were previously undiagnosed; of those with moderate depression, 1/2 (50%) were previously undiagnosed. 27 subjects tested positive for anxiety (21 mild, 6 moderate). 11/21 (52.38%) of mild anxiety cases and 3/6 (50%) of moderate anxiety cases were previously undiagnosed. 1 of the 100 patients was positive for suicidal ideation in the past month. Sex, race, type of IBD, smoking status, IBD-related surgical history, and number of discontinued medications were not statistically significant factors in depression or anxiety by proportion of patients or severity score. Clinically active disease status was found to be positively associated with depression severity score (p=0.002, 95% CI 4.3–19.5) and anxiety severity score (p=0.019, 95% CI 1.4–16.0) (Table 1). Of the 30 patients who had clinically active disease, 18 (60%) were positive for depression and 12 (40%) were positive for anxiety. Of the 70 patients in clinical remission, 24 (34%) were positive for depression and 15 (21%) were positive for anxiety (Figure 1). Patients with active disease have a significantly greater relative risk for having depression (RR 1.8, 95% CI 1.1–2.7) and an almost significantly greater relative risk of having anxiety (RR 1.9, 95% CI 0.99–3.5).
Proportion of patients with depression and anxiety based on disease activity.
Average severity scores for factors thought to contribute to depression and anxiety.
Using a novel screening tool for depression and anxiety in IBD patients, we identified a positive correlation between clinically active disease status and the presence of depression and anxiety. Our results show that regardless of past surgical and therapeutic IBD history, patients in clinical remission are less likely to have these mental health conditions than those with active disease. Gastroenterologists should consider patients with clinically active disease at higher risk for psychological co-morbidities, and include such screening in their routine care. Further research will explore directionality between disease activity and psychological outcomes.
