P212 Diagnostic approach to monogenic inflammatory bowel disease in clinical practice: a 10-year multi-centric experience (original) (raw)

Risk factors of anxiety and depression in inflammatory bowel disease

Inflammatory Bowel Diseases, 2012

Background: Little is known in inflammatory bowel disease (IBD) regarding risk factors for psychological distress. The aim of this work was to study the disease characteristics and socioeconomic factors associated with anxiety and depression in IBD. patients with IBD (1450 were members of the Association Francois Aupetit, French association of IBD patients) answered a questionnaire about psychological and socioeconomic factors and adherence to treatment. In this study we focused the analysis on the characteristics of IBD (type, location, severity, treatment) and socioeconomic factors (professional, educational, and marital status and Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES] score of socioeconomic deprivation; score established in medical centers in France; http://www.cetaf.asso.fr) associated with depression and anxiety. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Comparison between groups according to the existence of depression or anxiety was carried out using univariate and multivariate analysis.

Performance of administrative case definitions for depression and anxiety in inflammatory bowel disease

Journal of Psychosomatic Research, 2016

Objectives: Comorbid depression and anxiety are common in inflammatory bowel disease (IBD), but few population-based estimates of the burden of depression and anxiety exist. Methods to support population-based studies are needed. We aimed to test the performance of administrative case definitions for depression and anxiety in IBD and to understand what the prevalence estimated using such definitions reflects. Methods: We linked administrative (health claims) data from the province of Manitoba, Canada with clinical data for 266 persons in the Manitoba IBD Cohort Study. We compared the performance of administrative case definitions for depression and anxiety with (a) diagnoses of depression and anxiety as identified based on the Composite International Diagnostic Interview (CIDI), which identifies disorders meeting formal diagnostic criteria, and (b) participant report of physician-diagnosed depression or anxiety. Results: Administrative definitions for depression showed moderate agreement with the CIDI (κ = 0.39-0.42). Agreement was higher with participant report of physician-diagnosed depression (κ = 0.54). The lifetime prevalence of depression was 29.3% based on the CIDI, 17.7% based on participant report of physician-diagnosed depression, and 21.8-22.5% based on administrative data. Compared to the CIDI, administrative definitions for anxiety showed fair agreement (κ = 0.21-0.25). The lifetime prevalence of anxiety was 31.2% based on the CIDI, 9.7% based on participant report of physiciandiagnosed anxiety, and 24.4-31.9% based on administrative data. Conclusions: Administrative data may be used for population-level surveillance of depression and anxiety in IBD, although they will not capture undiagnosed or untreated cases.

Symptoms of anxiety and depression are independently associated with inflammatory bowel disease-related disability

Digestive and Liver Disease, 2017

Background: Inflammatory bowel disease(IBD) frequently results in disability. The relevance of psychological effects in causing disability, and whether disability occurs similarly in non-Western cohorts is as yet unknown. Aim: We assessed the relationship between symptoms of anxiety and depression, quality of life and disability in a Singaporean IBD cohort and their predictors. Methods: Cross-sectional study. We assessed consecutive IBD subjects' IBD-Disability Index (IBD-DI), Hospital Anxiety and Depression Scale(HADS), and IBD questionnaire(IBDQ). Clinical and demographic variables were collected. Non-parametric statistical analyses were 2 performed. Independent predictors of disability were identified through multivariate logistic regression. Results: 200 consecutive subjects were recruited (males: 69%; median age: 43.8(±15.4) years; 95 had Crohn's disease(CD), 105 had ulcerative colitis(UC); median IBD duration: 10.8(±9.0) years.) 27% of the cohort had anxiety and/ or depression, which worsened disability (IBD-DI:-9(±14) with anxiety vs 6(±13) without anxiety, P<0.001;-12(±16) with depression vs 5(±13) without depression, P<0.001). Age at diagnosis, use of prednisolone, stricturing CD and active IBD were significant predictors of disability. IBDQ strongly correlated with IBD-DI(rs=0.82, P<0.01). Conclusion: Symptoms of anxiety and depression were common in this Asian cohort of IBD and were strongly associated with IBD-related disability. Recognizing psychological issues contributing to disability in IBD is important to ensure holistic care and appropriate treatment.

Anxiety But Not Depression Predicts Poor Outcomes in Inflammatory Bowel Disease

Inflammatory Bowel Diseases, 2019

Background and Aims: Patients with inflammatory bowel disease (IBD) have high rates of psychiatric comorbidities, but it is not clear whether those with comorbidities are at higher risk of poor outcomes. We aimed to determine whether patients with IBD who have co-existing anxiety and/or depression are more likely to have poor IBD-related outcomes compared with IBD patients without anxiety and/or depression. Methods: This was a prospective longitudinal follow-up study in Ontario, Canada, from 2008 to 2016. Patients were asked to complete questionnaires at the time of initial assessment, including the Hospital Anxiety and Depression Scale (HADS). We selected a number of clinical variables at the time of presentation and tested their ability to predict subsequent poor IBD-related outcomes, such as IBD-related hospitalization, emergency room visits, and recurrent courses of corticosteroids over the duration of follow-up. Logistic regression was used for multivariate analysis. Results: Four hundred fourteen IBD patients completed the baseline questionnaire. Among them, 125 had anxiety and/or depression at baseline. Factors that predicted poor IBD-related outcomes during longitudinal follow-up included increased severity of disease at initial presentation, prior IBD-related surgery, longer duration of follow-up, and elevated C-reactive protein at time of initial presentation. After adjustment for potential covariates, IBD patients with abnormal anxiety subscores had poor IBD-related outcomes compared with those without elevated anxiety subscores (odds ratio [OR] 3.36, 95% CI, 1.51-7.48). No difference in IBD-related outcomes were observed in those with abnormal depression subscores compared with those without elevated depression scores (OR 0.43, 95% CI, 0.14-1.32). Conclusions: Severe disease, anxiety, and previous IBD-related surgery predict poor IBD-related outcomes in patients in the future. Closer monitoring with regular follow-up may be appropriate for patients with these risk factors.

Psychometric properties of the original Inflammatory Bowel Disease Questionnaire, a Spanish version

Gastroenterología y Hepatología, 2007

BACKGROUND: The Inflammatory Bowel Disease Questionnaire (IBDQ) was developed by Guyatt et al. (1989) and it is the most widely used health-related quality of life instrument for patients with Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study was to assess the psychometric properties of a Spanish version of the original IBDQ by examining the instrument's underlying factor structure, the internal and external validity, and the internal consistency reliability MATERIAL AND METHOD: One hundred and forty seven patients (76 CD, 71 UC) completed the Spanish version of the IBDQ, the Hospital Anxiety and Depression Scale (HADS) and the Temperament and Character Inventory (TCI). Clinical activity was assessed by the CDAI and the Truelove-Witts indexo RESULTS: The confirmatory factor analysis of the IBDQ failed to reproduce the original four-factor structure proposed by Guyatt et al. We found that the Spanish version of the IBDQ consists also of four underlying factors, but the content of each factor and the items included were slightly different. Psychometric testing of the IBDQ revealed that the questionnaire has an acceptable internal and external validity, and a high internal reliability. CONCLUSION: Although confirmatory factor analyses failed to reproduce the original psychometric structure of IBDQ, it seems that the Spanish version of this instrument proved to be valid and reliable for assessing health related quality of life in inflammatory bowel disease patients.

Burden of comorbid anxiety and depression in patients with inflammatory bowel disease: a systematic literature review

Expert Review of Gastroenterology & Hepatology

Introduction Patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, often have comorbid anxiety and depression that affects their quality of life (QoL) and management of their IBD. Areas covered A systematic literature review (SLR) was conducted to identify articles and conference abstracts on comorbid anxiety and depression in IBD patients using MEDLINE ® and Embase ® (January 2003 − June 2018). The impact of these psychological comorbidities on QoL and economic burden was examined. Non-pharmacologic interventions and disease-specific unmet clinical needs associated with these comorbidities were also evaluated. Expert opinion There is evidence that individual and group-based cognitive behavioral therapy can reduce rates of anxiety and depression in adults and adolescents with IBD. Patients with IBD and anxiety or depression had an increased risk of hospitalization, emergency department visits, readmission, and used outpatient services more often than people without these conditions. Several disease-specific unmet clinical needs for IBD patients were identified. These included lack of reimbursement for mentalhealth care, inconsistent screening for psychological comorbidities and patients not consulting mentalhealth professionals when needed. IBD patients may benefit from integrated medical and psychological treatment, and should be considered for behavioral treatment. Plain Language Summary Background People with IBD may have mental-health conditions, such as anxiety and depression. These conditions can affect people's quality of life and how they manage their IBD. What did this review look at? We found 79 publications on anxiety or depression in people with IBD, published between January 2003 and June 2018.In people with IBD and anxiety or depression, researchers looked at:the impact on health-related quality of life and healthcare utilization, including access to and reimbursement for mental-health services how effective interventions that do not involve the use of medicines were (known as non-pharmacologic therapy). What were the main findings from this review? People with IBD and anxiety or depression were more likely to be admitted to hospital and visit emergency departments than people without these conditions.Access to mental-health care varied and some people with IBD were not screened for depression. Individual and group-based talking therapy (known as cognitive behavioral therapy) reduced rates of anxiety and depression in some people with IBD. What were the main conclusions from this review? We found evidence that people with IBD and anxiety or depression may benefit from certain nonpharmacologic interventions. However, many people with IBD and anxiety or depression did not have access to mental-health services.Healthcare professionals should address gaps in patient care to improve outcomes in people with IBD and anxiety or depression. See Additional file 1 for an infographic plain language summary.

Inflammatory Bowel Disease: Impact on Scores of Quality of Life, Depression and Anxiety in Patients Attending a Tertiary Care Center in Brazil

Arquivos de Gastroenterologia, 2018

BACKGROUND: Inflammatory bowel disease frequently affects patients at working age, compromising their quality of life in several levels: physical, psychological, familial and social. Few studies have evaluated the impact of Inflammatory bowel disease on quality of life, anxiety and depression in Brazilian patients. OBJECTIVE: Evaluate quality of life and its correlation with psychological aspects of patients with inflammatory bowel disease through the Inflammatory Bowel Disease Questionnaire and Hospital Anxiety and Depression Scale. METHODS: Cross-sectional study; Inflammatory Bowel Disease Questionnaire, Short Form-36 and Hospital Anxiety and Depression Scale were applied to consecutive outpatients in a tertiary referral center for inflammatory bowel disease. Harvey-Bradshaw Index and Truelove scores were used to evaluate Crohn’s disease and ulcerative colitis activity. Sample calculation: 113 patients for a significance level of 5%, power of 90% and a correlation coefficient of a...

Assessment of Comorbid Depression and Anxiety in Inflammatory Bowel Disease Using Adaptive Testing Technology

Crohn's & Colitis 360, 2021

Background Depression and anxiety are comorbidities of inflammatory bowel disease (IBD), and it is now recommended to screen IBD patients for these conditions. We screened patients using a novel computerized adaptive testing technology and compared the screening results to measures of disease activity. Methods 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 based on clinical, laboratory, endoscopy, and imaging results. Statistical methods included Fisher exact test and Pearson chi-square tests to assess association. Univariable and multivariable analyses were performed. Results We included 134 patients, of which 34 (25.3%) screened positive for depression and 18 (13.4%) screened positive for anxiety. We identified 19 (55.9%) and 10 (55.5%) patients who were previously undiagnosed for depression...

Controversies surrounding the comorbidity of depression and anxiety in inflammatory bowel disease patients

Inflammatory Bowel Diseases, 2007

Psychological disorders are highly prevalent in patients with inflammatory bowel disease (IBD). Anxiety and depression are known to independently affect quality of life and may additionally impair quality of life in IBD over and above the IBD itself. Some researchers have further proposed that anxiety and depression may influence the clinical course of IBD. However, despite the potential for anxiety and depression to play an important role in the clinical picture of IBD, there is little prospective well-controlled research in this area. Probably because of this lack of clear data, researchers dispute the actual role of these psychological disorders in IBD, with a number of conflicting opinions expressed. This article reports on a review of the literature in this field. Herein we discuss the five main areas of controversy regarding IBD and the specific psychological comorbidities of depression and anxiety: 1) the relative rate of cooccurrence of these psychological disorders with IBD; 2) the cooccurrence of these psychological disorders with particular phase of IBD; 3) the cooccurrence of these psychological disorders with the specific type of IBD; 4) the rate of these psychological comorbidities compared both to healthy subjects and to other disease states; and 5) the timing of onset of psychological comorbidity with respect to onset of IBD. Methodological weaknesses of the reviewed studies make it impossible to resolve these controversies. However, the results clearly show that anxiety/depression and IBD frequently interact. Given the long-term illness burden patients with IBD face, further prospective, appropriately controlled studies are needed to adequately answer the question of the precise interplay between anxiety/depression and IBD. (Inflamm Bowel Dis 2007;13:225-234)

Psychological factors associated with inflammatory bowel disease

British Medical Bulletin, 2021

BackgroundBoth depression and anxiety are identified as significant experiences in inflammatory bowel disease (IBD); whether these are a consequence of the disease or an active contributor to the disease remains controversial. This review aimed to identify and critique recent evidence regarding mental health in IBD.Sources of dataPubmedⓇ, OvidⓇ, EmbaseⓇ, EBSCO PsychInfo and Google-Scholar were searched within the last 5 years (2016–2020).Areas of agreementOverall, both depression and anxiety affect disease activity, relapse and healthcare utilization.Areas of controversyThere is some controversy on whether depression and anxiety affect IBD outcomes differently depending on IBD subtype.Growing pointsThe data support the need for depression and anxiety assessment to be incorporated in the routine management of IBD patients; prompt psychiatric and psychological management may ultimately reduce disease activity, relapses and healthcare costs.Areas timely for developing researchMore long...