The Relationship Between Symptoms of Depression and Anxiety and Disease Activity in IBD Over Time

Ruth Ann Marrie; Lesley A Graff; John D Fisk; Scott B Patten; Charles N Bernstein

doi:10.1093/ibd/izaa349

The Relationship Between Symptoms of Depression and Anxiety and Disease Activity in IBD Over Time

Inflamm Bowel Dis. 2021 Jul 27;27(8):1285-1293. doi: 10.1093/ibd/izaa349.

Authors

Ruth Ann Marrie^{1

2

3}, Lesley A Graff^{3

4}, John D Fisk⁵, Scott B Patten⁶, Charles N Bernstein^{1

3}

Affiliations

¹ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA.
² Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA.
³ University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, CANADA.
⁴ Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, CANADA.
⁵ Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, Nova Scotia, CANADA.
⁶ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA.

Abstract

Brackground: We aimed to examine associations between elevated symptoms of depression and anxiety and disease activity in inflammatory bowel disease (IBD). Previous findings have been inconsistent and have not accounted for variability in the courses of these conditions over time.

Methods: We followed 247 participants with IBD (153 Crohn's disease [CD], 94 ulcerative colitis [UC]) for 3 years. Annually, participants underwent an abdominal examination, reported therapies used for IBD, and completed the Hospital Anxiety and Depression Scale (HADS) questionnaire. We evaluated associations of elevated symptoms (scores ≥11) of anxiety (HADS-A) and depression (HADS-D) with the presence of active IBD as measured using the Powell Tuck Index for UC and the Harvey-Bradshaw Disease Activity Index for CD. We employed logistic regression with generalized estimating equations, simultaneously estimating between-person and within-person effects.

Results: Of 247 participants, 15 (6.1%) had elevated symptoms of depression (HADS-D ≥11) at enrollment, 41 (16.6%) had elevated symptoms of anxiety (HADS-A ≥11), and 101 (40.9%) had active IBD. On average, individuals with elevated symptoms of depression (odds ratio [OR], 6.27; 95% CI, 1.39-28.2) and anxiety (OR, 2.17; 95% CI, 1.01-4.66) had increased odds of active IBD. Within individuals, elevations in symptoms of depression over time were associated with increased odds of active IBD (OR, 2.70; 95% CI, 1.15-6.34), but elevated symptoms of anxiety were not. After adjustment for covariates (including disease activity), elevated symptoms of depression were also associated with increased odds of biologic therapy use (OR, 2.02; 95% CI, 1.02-4.00).

Conclusion: Symptoms of depression and anxiety are associated with disease activity in IBD over time. Reducing these symptoms should be incorporated into the management of IBD.

Keywords: IBD; anxiety; depression; mood disorders; self-reported outcomes; symptoms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety* / epidemiology
Chronic Disease
Colitis, Ulcerative* / epidemiology
Colitis, Ulcerative* / psychology
Crohn Disease* / epidemiology
Crohn Disease* / psychology
Depression* / epidemiology
Humans