Young people with inflammatory bowel disease (IBD) — especially women and those with active disease — are at greater risk of developing anxiety and depression, a Dutch study shows.
These results support the need for regular psychological screening in these vulnerable patients to treat these conditions early.
The study, “Clinical disease activity is associated with anxiety and depressive symptoms in adolescents and young adults with inflammatory bowel disease,” was published in the journal Alimentary Pharmacology & Therapeutics.
Patients with IBD, consisting mainly of those with Crohn’s disease and ulcerative colitis, have been found to have higher rates of depression and anxiety, compared to the general population.
These emotional states greatly affect a person’s quality of life, and are often associated with poor treatment compliance in IBD patients.
This is even more pronounced in young patients, who are at a phase of significant psychological, cognitive, and physical challenges. Young people with IBD were found to be particularly at risk for these psychological problems, with a reported frequency rate of 20‐50% for anxiety and and 25-40% for depression.
IBD patients may enter a vicious cycle, where anxiety and/or depression can lead to intestinal inflammation and disease relapse, which in turn feeds those emotional problems.
Therefore, it is important to identify IBD patients at greater risk of anxiety and depression so that appropriate treatment and support can be provided, which is expected to improve patients’ quality of life and decrease IBD-related mortality.
Researchers evaluated the frequency of, and risk factors for, anxiety and depressive symptoms in 374 IBD patients, including adolescents (ages 10-17), and young adults (ages 18-25).
The presence of anxiety or depression, as well as patients’ health-related quality of life, were assessed through appropriate questionaires and scales within those age ranges.
In patients with elevated scores of anxiety or depressive symptoms, severity of symptoms was assessed through a psychiatric diagnostic interview over the telephone by a trained psychologist.
The team of researchers recruited 374 patients (209 women and 165 men) from six hospitals in the Netherlands, from October 2014 to September 2016. Their mean age was 18.92 years, 60.4% of participants had Crohn’s disease, and most patients (75.4%) were in a state of disease remission.
Among the 371 individuals who completed the anxiety and depression questionnaires, 176 (47.4%) had elevated symptoms of anxiety and/or depression.
Anxiety symptoms were more common (28.3%) than depression (2.9%), and 15.8% of patients had both. No difference in these frequencies were found between adolescent and young adults.
Only 134 patients with elevated anxiety/depressive symptoms agreed to do the interview. Clinical, severe symptoms were found in 46 patients (34.3%; 12.2% of the total sample), who were referred for psychological consultation and treatment.
Patients with severe symptoms were mostly women, had higher disease activity, more relapses in the preceding year, used steroids more frequently, and had a lower quality of life.
A shorter disease duration was also significantly associated with mild and severe anxiety and/or depressive symptoms, “which may indicate that patients with a longer disease duration have more time to adapt and build adaptive coping strategies,” the researchers wrote.
To the researchers’ surprise, differences in socio-economic status were not associated with the presence of those symptoms, unlike what had been found in other studies.
Additional analysis showed that active disease and female gender were the most significant predictors of anxiety and depressive symptoms.
The researchers recommended that psychological screening in adolescent and young adult IBD patients should be performed so that early diagnosis and early treatment can improve the psychological well‐being and the course of the disease.
Also, “screening physicians should be aware that female patients and patients with active disease are the most vulnerable,” they wrote.
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