Incorporation of a Screening Program for Mental Health in Inflammatory Bowel Disease Identifies Many Patients With Undiagnosed or Ineffectively Treated Anxiety and Depression
AIBD 2023
Background:
Patients with inflammatory bowel disease (IBD) with comorbid anxiety or depression are more likely to be hospitalized or utilize emergency department services. Implementation of routine screening for generalized anxiety and depression in patients with IBD is recommended by the United States Preventive Services Task Force and included in clinical guidelines for IBD management by the ACG, but is not routinely performed due to a number of logistical and ethical challenges.
Methods:
We performed a retrospective cohort study of adult patients with a confirmed diagnosis of ulcerative colitis (UC) or Crohn’s disease (CD) being treated for IBD at our tertiary IBD center, and who were screened for depression and anxiety using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) from March to July 2023. Active disease was defined as Harvey-Bradshaw Index (HBI) >5 or Simple Clinical Colitis Activity Index (SCCAI) >2.5. Univariate analysis was conducted to demonstrate the correlation between anxiety or depression severity with sociodemographic and clinical variables using chi-square, Wilcoxon rank-sum, and Kruskal-Wallis tests. Logistic regression of significant variables was performed.
Results:
103 patients (55 female sex, 70 CD) were included. Anxiety was categorized according to standard GAD-7 scoring: minimal (64, 62.1%), mild (24, 23.3%), moderate (10, 9.7%), or severe (5, 4.9%). Depression was categorized according to standard PHQ-9 scoring: minimal (38, 36.9%), mild (26, 25.2%), moderate (10, 9.7%), moderately severe (3, 2.9%), or severe (2, 1.9%). 75 (15 mild, 6 moderate, 1 severe) patients who described no prior diagnosis of anxiety screened positive for anxiety. 77 (19 mild, 3 moderate, 1 moderately severe, 1 severe) patients with no prior diagnosis of depression screened positive for active depression. 23 patients reported ongoing medical treatment for anxiety or depression within 1 month of screening; of these, 15 (10 mild, 4 moderate, 1 severe) screened positive for active anxiety and 17 (10 mild, 6 moderate, 1 moderately severe) screened positive for active depression. Female sex (P=.021), prior diagnosis of anxiety (P=.002) or depression (P=.001) and active CD by HBI (P=.001) were significantly associated with screening positive for anxiety. Prior diagnosis of anxiety (P=.004) or depression (P=.0002), CD diagnosis (P=.024), active CD by HBI (P=.03), elevated C-reactive protein (P=.004), and lower hemoglobin level (P=.008) were significantly associated with screening positive for depression. Ordinal logistic regression demonstrated younger age (OR=0.9319, 95% CI 0.89-0.98) and previous IBD-related surgery (OR=0.0001, 95% CI 2.51E-8-0.417) were significantly associated with anxiety severity. Younger age (OR=0.9430, 95% CI 0.90-0.98) was significantly associated with depression severity.
Conclusions:
We demonstrate the importance of mental health screening among patients with IBD to identify previously undiagnosed patients with anxiety and depression. A significant number of patients receiving medical treatment for anxiety or depression screened positive for ongoing symptoms of these mental health conditions, suggesting ineffective treatment. Younger age and greater disease activity in CD is associated with increased likelihood of anxiety and depression. These findings should inform additional screening efforts and the need to identify additional resources for treatment and support.
