Inflammatory bowel disease and anxiety: links, risks, and challenges faced (original) (raw)
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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.
Influences and Impact of Anxiety and Depression in the Setting of Inflammatory Bowel Disease
Inflammatory bowel diseases, 2018
Individuals with inflammatory bowel disease (IBD) are at increased risk of developing anxiety or depression (A&D). Crohn's disease (CD) and ulcerative colitis (UC) with comorbid A&D are both more challenging to manage. IBD providers need to better understand the causes and impact of A&D in order to improve care for IBD patients. We sought to identify clinical factors that influence development of A&D and healthcare utilization in IBD. This is a retrospective analysis using an IBD natural history registry from a single tertiary care referral center. Presence of A&D was determined based upon responses to the Hospital Anxiety and Depression Scale. Demographic and clinical factors were abstracted to evaluate for significant associations. Four hundred thirty-two IBD patients (132 UC, 256 CD, and 44 indeterminate colitis) were included in this study. One hundred ninety-two (44.4%) had anxiety or depression or both, and most were female (59.4%, P < 0.05). History of surgery (P < ...
BMC research notes, 2016
Depression and anxiety are common in inflammatory bowel disease (IBD) and can affect disease outcomes, including quality of life and success of disease treatment. Successful management of psychiatric comorbidities may improve outcomes, though the effectiveness of existing treatments in IBD is unknown. We searched multiple online databases from inception until March 25, 2015, without restrictions on language, date, or location of publication. We included controlled clinical trials conducted in persons with IBD and depression or anxiety. Two independent reviewers reviewed all abstracts and full-text articles and extracted information including trial and participant characteristics. We also assessed the risk of bias. Of 768 unique abstracts, we included one trial of pharmacological anxiety treatment in IBD (48 participants), which found an improvement in anxiety symptoms (p < 0.001). There was a high risk of bias in this trial. We found no controlled clinical trials on the treatment...
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.
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.
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)
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)
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...