Characteristics and Impact of Anxiety and Depression Trajectories in Inflammatory Bowel Disease

Introduction:

Symptoms of common mental disorders, like anxiety or depression, are associated with adverse clinical outcomes in inflammatory bowel disease (IBD). We report trajectories of these symptoms in IBD, patient characteristics associated with different trajectories, and effects on healthcare utilization and prognosis.

Methods:

We collected demographic, symptom, psychological, and quality of life data, with questionnaires at 3-month intervals, over 12 months of follow-up. We collected healthcare utilization and IBD outcomes via notes review. We compared characteristics of those with persistently normal or improving anxiety or depression scores with those with persistently abnormal or worsening scores, as well as the number of flares, glucocorticosteroid prescriptions, escalations of therapy, hospitalizations, or intestinal resections due to IBD activity.

Results:

Among 771 and 777 patients, respectively, worsening or persistently abnormal anxiety or depression scores were associated with increased antidepressant (28.6% vs. 12.3% anxiety, 35.8% vs. 10.1% depression, p <0.001) and opiate use (19.0% vs. 7.8% anxiety, p = 0.001 and 34.0% vs. 7.4% depression, p <0.001), compared with those with persistently normal or improving scores. These individuals were also more likely to have been diagnosed with IBD in the last 12 months (16.3% vs. 5.0% anxiety, p = 0.001 and 15.1% vs. 5.5% depression, p = 0.006), to have clinically active disease at baseline (57.1% vs. 26.6% anxiety and 71.7% vs. 29.1% depression, p <0.001) and lower quality of life scores (p <0.001). Individuals with worsening or persistently abnormal trajectories of anxiety or depression required significantly more outpatient appointments, radiological investigations, and endoscopic procedures for IBD-related symptoms.

Discussion:

In this 12-month follow-up study, patients with IBD with worsening or persistently high anxiety or depression scores were higher utilizers of healthcare but were not at increased risk of future adverse disease outcomes.