Original article
Alimentary tract
Symptoms of Depression and Anxiety Are Independently Associated With Clinical Recurrence of Inflammatory Bowel Disease

https://doi.org/10.1016/j.cgh.2015.12.045Get rights and content

Background & Aims

We examined the relationship between symptoms of depression and anxiety and clinical recurrence of inflammatory bowel disease (IBD) in a large patient cohort. We considered the progression of depression and anxiety over time.

Methods

We collected clinical and treatment data on 2007 adult participants of the Swiss IBD study (56% with Crohn’s disease [CD], 48% male) performed in Switzerland from 2006 through 2015. Depression and anxiety symptoms were quantified by using the Hospital Anxiety and Depression Scale. The relationship between depression and anxiety scores and clinical recurrence was analyzed by using survival-time techniques.

Results

We found a significant association between symptoms of depression and clinical recurrence over time (for all patients with IBD, P = .000001; for subjects with CD, P = .0007; for subjects with ulcerative colitis, P = .005). There was also a significant relationship between symptoms of anxiety and clinical recurrence over time in all subjects with IBD (P = .0014) and in subjects with CD (P = .031) but not ulcerative colitis (P = .066).

Conclusions

In an analysis of a large cohort of subjects with IBD, we found a significant association between symptoms of depression or anxiety and clinical recurrence. Patients with IBD should therefore be screened for clinically relevant levels of depression and anxiety and referred to psychologists or psychiatrists for further evaluation and treatment.

Section snippets

Design and Setting

This is a prospective cohort study that used data from participants who had been included in the SIBDC between 2006 and 2015.2 Participants were included through their treating gastroenterologists, who were located in Swiss university hospitals, regional hospitals, and private practices. Clinical and treatment data were collected during the enrollment and yearly follow-up medical visits; in addition, participants were receiving self-administered questionnaires (at enrollment and on a yearly

Descriptive Statistics

Of the 2886 participants registered in the SIBDC, 879 did not meet the inclusion criteria for the present study and were excluded. In particular, after excluding pregnant patients, 2870 cases (99.4%) remained in the study. After excluding those who did not answer the questionnaire, 2321 cases (80.4%) remained in the study. After excluding patients for whom depression and anxiety levels were unknown, 2289 (79.3%) remained in the study, and finally, after excluding participants who were lost to

Discussion

This study is the largest to date prospective design on the relationship between depression and anxiety and clinical recurrence in IBD. Although previous prospective studies on the topic exist, because of small samples, short observation periods, and inconsistencies in measuring depression/anxiety and disease activity, the relationship between depression, anxiety, and disease activity in IBD has been controversial.

Examining the longitudinal data of more than 2000 Swiss IBD participants, we

Conclusion

Depression (and to some degree anxiety as well) is strongly associated with clinical recurrence over time. Thus it seems prudent to recommend that screening for common mental disorders and referring for psychological/psychiatric treatment should be included in standard IBD care. Whether this improves patient outcomes and is cost-effective remain to be established. Studies in other populations do not always support the value of routine screening particularly in primary care,40 although

Acknowledgments

The first author would like to acknowledge the Brocher Foundation for awarding her a monthly residency fellowship in Geneva to enable the work on this paper. The authors thank all the patients for their collaboration and are grateful to the SIBDCS Scientific Committee for granting approval for this study.

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by the Swiss National Science Foundation (SNSF), grant no. 33CS30-148422.

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