Mental Health—An invisible driver of IBD cost of care

Living with a chronic illness, like Crohn’s disease or ulcerative colitis, can affect not only your physical health but also your mental health and emotional well-being. In fact, the rate of anxiety and depression among IBD patients is two to three times higher than that of the general population.

Last year, the results from the Foundation’s Cost of IBD Care study found that the annual costs incurred by IBD patients is over three-times higher than non-IBD patients. And one of the biggest drivers of these high costs is psychiatric illness, like anxiety and depression, among other comorbidities (one or more chronic illnesses). 

We wanted to get a better understanding of why mental illnesses drive up patient costs. To do that, we analyzed the data gathered from our cost of care study and recently published the findings in Inflammatory Bowel Diseases. 
Of the 52,782 IBD patients included in our cost of care study, 42.6% had at least one mental health diagnosis, with the most common ones being depressive disorders, anxiety disorders, adjustment disorders, substance use disorders, and bipolar and related disorders. Patients with mental health diagnoses had:

• More emergency department visits and inpatient stays
• Higher emergency department and inpatient costs
• Significantly higher total annual IBD-related surgical and non-surgical costs

Additionally, IBD patients with mental health diagnoses paid a larger portion of the total out-of-pocket costs for IBD services. 

So, what does this all mean?

Simply put, having IBD and a mental illness significantly increases your out-of-pocket costs. This can be due to a variety of reasons – and more research needs to be done to fully identify those reasons. But we speculate that the increased costs may be due to lack of screening and intervention for mental illness.

There are resources available to help you manage the financial burden of IBD. Whether you’re the caregiver of a kid with IBD, a young adult leaving your parent’s insurance for the first time, or an older adult transitioning to Medicare, you can find information about patient financial assistance programs, appeal letters, and other financial management resources on our website. 

Given the prevalence of mental health diagnoses among IBD patients, it’s important that you recognize the signs and symptoms and proactively discuss any concerns about your emotional health with your provider. Signs of anxiety and depression include:

DEPRESSION

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or negativity
• Feelings of guilt, worthlessness, and/or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy and/or fatigue
• Difficulty concentrating, remembering, and/or making decisions
• Changes in sleep patterns (insomnia, waking up early, or oversleeping)
• Appetite changes and/or weight gain/loss
• Restlessness and irritability

ANXIETY

• Feeling nervous, anxious, or on edge
• Not being able to stop or control worrying
• Worrying too much about different things
• Trouble relaxing
• Restlessness
• Becoming easily annoyed or irritable
• Feeling afraid as if something awful might happen

The good news is that there’s a lot of help available out there to manage a mental health diagnosis. Once you start the conversation, ask your doctor if you might benefit from seeing a mental health professional. Seeking treatment may include medication to help stabilize your mood and/or therapy. The Rome Foundation’s Psychogastroenterology Directory includes a list of mental health professionals with experience treating individuals with chronic digestive diseases, like Crohn’s and colitis. 

You can also seek out support from family, friends, or other IBD patients. Support groups (in-person and online) are great ways to connect with others who understand what you’re going through. And if you have questions and aren’t sure where to go, you can always reach out to our IBD Help Center at [email protected] or 888MYGUTPAIN. Remember – you are not alone!

Rebecca Kaplan is the Public Affairs and Social Media Manager for the Crohn's & Colitis Foundation and the caregiver of a Crohn's disease patient.