The prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) is increasing in U.S. veterans with inflammatory bowel disease (IBD), according to a retrospective study.
Meanwhile, the risk for IBD patients to develop these mental health conditions, particularly depression, appears to be decreasing.
The study, titled “The Incidence and Prevalence of Anxiety, Depression, and Posttraumatic Stress Disorder in a National Cohort of US Veterans With Inflammatory Bowel Disease” was published in the journal Inflammatory Bowel Diseases.
People with IBD are more likely to have mental health problems, especially anxiety and depression, compared to the general population. Previous research suggests that those mental issues actually may arise before patients develop symptoms of IBD and are associated with disease recurrence.
However, evidence of trends in the incidence (the rate of new or newly diagnosed cases of the disease) and prevalence — the actual number of cases alive, with the disease either during a period of time (period prevalence), or at a particular date in time (point prevalence — of these health issues over time in patients living in the U.S. is limited.
In this study, researchers at the Baylor College of Medicine in Houston, Texas, and colleagues determined the temporal trends in the incidence and prevalence of anxiety, depression, and PTSD in veterans with IBD.
Veterans are especially more likely to have PTSD, which also has been shown to be associated with chronic health problems.
They collected data from 60,086 IBD patients (93.9% male) from 2000 to 2015 registered at the Veterans Health Administration, the largest integrated healthcare system in the U.S. The data was used to calculate the annual prevalence and incidence of anxiety, depression, and PTSD.
In total, 19,595 patients were diagnosed with anxiety, depression, and/or PTSD during the study period. The prevalence of the mental health conditions increased approximately 3.5-fold in male veterans with IBD — from 10.8 per 100 patients in 2001 to 38 per 100 patients in 2015.
This increase was slightly lower in female veterans with IBD, with the prevalence increasing from 19.8 per 100 in 2001 to 55 per 100 in 2015. This increase is consistent with previous evidence showing that IBD patients have accompanying mental health problems and it might be explained by “the chronic and relapsing/remitting nature of IBD,” the researchers wrote.
The incidence (new diagnoses) rates of the overall mental health conditions were higher in female patients compared to male patients. The annual incidence rates of overall mental health conditions decreased for both male and female patients from 6.1 per 100 in 2001 to 3.6 per 100 in 2015 for male patients, and 9.9 per 100 in 2001 to 6.1 per 100 in 2015 in female patients.
The decrease in annual incidence rates was predominantly due to a decrease in the incidence of depression. For male patients, the incidence of depression decreased from 4.8 per 100 in 2001 to 2.7 per 100 in 2014, followed by a slight increase to 2.8 per 100 in 2015. For female patients, the incidence of depression initially increased from 8.5 per 100 in 2001 to 9.7 per 100 in 2002, before decreasing to 5.4 per 100 in 2015.
“One possible reason for this observation is that improvements in IBD treatments helped individuals better manage their GI symptoms and have an improved functional status and quality of life, which consequently had a protective effect against the development of depressive symptoms,” the authors wrote.
Overall, “we observed that the prevalence of mental health problems increased among veterans with IBD, whereas the incident rates decreased. It is clear that mental health problems, such as anxiety, depression, and PTSD remain a burden among veterans with IBD; however, the impact and clinical implications of these disorders require further investigation,” researchers wrote.
“Improving our understanding of these factors would then facilitate the development of more targeted pharmacological and behavioral treatments that could effectively address comorbid mental health difficulties among patients with IBD,” the study concluded.