The Impact of Anxiety and Depression on Patients with Inflammatory Bowel Diseases

Acknowledgement: This article is a summary of “Influences and Impact of Anxiety and Depression in the Setting of Inflammatory Bowel Disease” recently published in Inflammatory Bowel Diseases by Seyedehsan Navabi, MD, Venkata Subhash Gorrepati, MD, MPH, Sanjay Yadav, MD, Jaykrishna Chintanaboina, MD,  Sarah Maher, MD,  Peter Demuth,  Benjamin Stern, MD,  August Stuart, Andrew Tinsley, MD,  Kofi Clarke, MD, Emmanuelle D Williams, MD, and Matthew D Coates, MD, PHD. This summary article was written by Catherine Soto, Director, Patient Education & Support at the Crohn’s & Colitis Foundation.

People with inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are at increased risk of developing anxiety and/or depression. Some research has found that anxiety and depression are two to three times more likely to occur in IBD patients, compared with the general population. ^{[1],[2],[3],[4],[5],[6],[7]}

It is important for doctors, and other healthcare professionals to understand how IBD and anxiety and depression can affect each other. It is important to address this relationship between mental health and IBD because:

1. Managing IBD can be even more challenging when patients have anxiety and depression.
2. IBD patients who also experience anxiety and depression are more likely to report having symptoms, even with no inflammation.
3. Anxiety and depression in IBD patients may heighten disease flares or other complications and lower the likelihood that a treatment will be successful. ^[8]
4. IBD patients with anxiety and depression tend to show lower scores when asked to report on or rate their quality of life. ^{[9],[10],[11],[12],[13],[14]}

While IBD is a chronic condition, not all patients develop anxiety or depression. This has brought many researchers to try to understand why anxiety and depression occur among certain patients. Are there specific medical factors that can be connected to having anxiety and/or depression? How might these medical factors affect how a patient is using the healthcare system in the management of their disease?  

A study was performed at Pennsylvania State University Hershey Medical Center looking at the data of patients who consented to be included in the Intestinal Diseases Natural History Database. The study was done as a retrospective analysis, a type of scientific approach that looks back at existing information in order to identify patterns or learn more about an issue or question. The data from this study was filtered to review patients seen between January 2015 and August 2016. The two objectives were to:

1. Identify any medical information that could help us understand what types of patient experiences are more likely to be associated with anxiety and depression.
2. Determine how anxiety and depression may affect a patient’s experience of symptoms, and their use of healthcare.

The results

Researchers looked closely at the data of 432 IBD patients within the Intestinal Diseases Natural History Database at the Pennsylvania State College of Medicine in Hershey, PA. Of these patients, approximately 44 percent were found to have significant scores on a scale for anxiety or depression, with a majority of them (59 percent) female. About 20 percent had both anxiety and depression. The medical factors that were associated with having anxiety or depression included:

• Smoking
• Extra-intestinal manifestations (symptoms outside of the gastrointestinal tract)
• Previous surgery (or surgeries)

In addition, IBD patients with anxiety and/or depression showed these connections:

• Had more imaging studies (such as x-rays, scans, endoscopies)
• Visited the emergency room more often
• Were more often hospitalized
• Were on corticosteroids more frequently
• Were taking a biologic (example: anti-TNF)

The study also found that patients with anxiety and/or depression reported their symptoms to be more severe compared to those that did not have anxiety or depression. Symptoms such as abdominal pain, fatigue, fecal urgency, excess gas, and blood in the stool, were more commonly reported. In addition, the level of inflammation shown through endoscopy was also scored higher among IBD patients with anxiety and depression.

This retrospective analysis highlights the importance of addressing mental health, specifically anxiety and depression as it relates to the patient’s disease management. Those who had anxiety and/or depression symptoms demonstrated higher likelihood of disease-related complications, and experienced a greater burden of their disease. There is a need to improve the access to mental health professionals and resources which could help reduce the risk of complications, flares, progression of IBD, and help improve a patient’s quality of life.

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