Abstract
Background
Psychiatric comorbidities are associated with inflammatory bowel disease (IBD). We conducted an observational study to evaluate the prevalence of depression and anxiety in patients with IBD.
Methods
Seventy consecutive consenting patients with IBD (62 ulcerative colitis [UC], 8 Crohn’s disease [CD]; 40 males, mean age [SD] 36.2 [11.3] years) and 100 healthy volunteers (44 males, age 31.22 [SD] [10.5] years) as controls were enrolled. All participants were directed to take self-assessment tests, Patient Health Questionnaire -9 (PHQ-9) and Symptom Checklist Anxiety Scale (SCL-A20). Participants having a score ≥ 10 on PHQ-9, or ≥ 29 on SCL-A20 were administered the Hamilton Depression Rating Scale (HAM-D) or Hamilton Anxiety (HAM-A) scales, respectively. The severity of depression and anxiety was graded with HAM-D and HAM-A scales, respectively. The protocol was approved by the Institutional Ethics Committee.
Results
The prevalence of depression (34.3% vs. 5%, p < 0.0001, OR 9.7) and anxiety (18.6% vs. 2%, p = 0.0002, OR 11.17) was higher in patients with IBD as compared to controls. The severity of depression was higher in patients compared to controls (mean rank 17 vs. 7, p = 0.04). The prevalence of depression was not different between UC and CD; all IBD patients with anxiety had UC. The mean duration of disease and history of corticosteroid treatment or surgery for IBD were not associated with the presence of depression or anxiety. Patients with severe CD (Crohn’s disease activity index, CDAI > 450) had more severe depression. The severity of UC did not correlate with severity of anxiety or depression in UC.
Conclusions
Anxiety and depression are more prevalent in IBD patients as compared to healthy individuals.
Similar content being viewed by others
References
Kurina LM, Goldacre MJ, Yeates D, Gill LE. Depression and anxiety in people with inflammatory bowel disease. J Epidemiol Community Health. 2001;55:716–20.
Filipovoc BR, Filipovoc BF. Psychiatric comorbidity in the treatment of patients with inflammatory bowel disease. World J Gastroenterol. 2014;20:3552–63.
Bonaz BL, Bernstein CN. Brain-gut interactions in inflammatory bowel disease. Gastroenterology. 2013;144:36–49.
Andrews H, Barczak P, Allan RN. Psychiatric illness in patients with inflammatory bowel disease. Gut. 1987;28:1600–4.
Bech, Per. Measuring states of anxiety with clinician-rated and patient-rated scales. InTech. Available via http://www.intechopen.com/books/different-views-of-anxiety-disorders/measuring-states-of-anxiety-with-clinician-rated-and-patient-rated-scales. Accessed 1 Feb 2018.
Mendeloff AI, Monk M, Siegel CI, Lilienfeld A. Illness experience an life stress in patients with irritable colon and ulcerative colitis. N Engl J Med. 1970;282:14–7.
Tarter RE, Switala J, Carra J, Edwards KL, Van Thiel DH. Inflammatory bowel disease: psychiatric status of patients before and after disease onset. Int J Psychiatry Med. 1987;17:173–81.
Hauser W, Janke KH, Klump B, Hinz A. Anxiety and depression in patients with inflammatory bowel disease: comparisons with chronic liver disease patients and the general population. Inflamm Bowel Dis. 2011;17:621–32.
Besharat S, Amiriani T, Roshandel G, Besharat M, Semnani S, Kamkar M. Depressive mood and disease activity in inflammatory bowel disease. Arab J Gastroenterol. 2012;13:136–8.
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–94.
Understand the Facts: Depression. Anxiety and Depression Association of America. Available via https://adaa.org/understanding-anxiety/depression. Accessed 1 Feb 2018.
Any Anxiety Disorder Among Adults. National Institute of Mental Health. Available via https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml. Accessed 1 Feb 2018.
Walker JR, Ediger JP, Graff LA, et al. The Manitoba IBD cohort study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders. Am J Gastroenterol. 2008;103:1989–97.
Thabet BJ, Charfi N, Mnif L, et al. Emotional disorders and inflammatory bowel disease. Tunis Med. 2012;90:557–63.
Kim MC, Jung YS, Song YS, et al. Factors associated with anxiety and depression in Korean patients with inactive inflammatory bowel disease. Gut and Liver. 2016;10:399–405.
Mikocka-Walus AA, Turnbull DA, Molding NT, Wilson IG, Andrews JM, Holtmann GJ. Controversies surrounding the comorbidity of depression and anxiety in inflammatory bowel disease patients: a literature review. Inflamm Bowel Dis. 2007; 13:225–34.
Murthy RS. National mental health survey of India 2015–2016. Indian J Psychiatry. 2017;59:21–6.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Marc LG, Henderson WR, Desrosiers A, Testa MA, Jean SE, Akom EE. Reliability and validity of the Haitian Creole PHQ-9. J Gen Intern Med. 2014;29:1679–86.
Manea L, Gilbody S, McMillan D. Optimal cut-off off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012;184:E191-6.
Sahoo S, Khess CR. Prevalence of depression, anxiety, and stress among young male adults in India: a dimensional and categorical diagnoses-based study. J Nerv Ment Dis. 2010;198:901–4.
Mikocka-Walus A, Knowles SR, Keefer L, Graff L. Controversies revisited: a systematic review of the comorbidity of depression and anxiety with inflammatory bowel diseases. Inflamm Bowel Dis. 2016;22:752–62.
WHO. Composite International Diagnostic Interview CIDI: Auto 2.1 Administrator’s guide and reference. Geneva, Switzerland: World Health Organization. 1997.
Khosla SN, Girdhar NK, Lal S, Mishra DS. Epidemiology of ulcerative colitis in hospital and select general population of northern India. J Assoc Physicians India. 1986;34:405–7.
Sood A, Midha V, Sood N, Bhatia AS, Avasthi G: Incidence and prevalence of ulcerative colitis in Punjab, North India. Gut. 2003; 52:1587–90.
Screener Overview. Pfizer Inc. Available via https://www.phqscreeners.com/select-screener/36. Accessed 1 Feb 2018.
Zimmerman M, Martinez JH, Young O, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord. 2013;150:384–8.
Gaines LS, Slaughter JC, Horst SN, et al. Association between affective-cognitive symptoms of depression and exacerbation of Crohn’s disease. Am J Gastroenterol. 2016;111:864–70.
Alexakis C, Kumar S, Saxena S, Pollok R. Systematic review and meta-analysis: the impact of a depressive state on disease course in adult inflammatory bowel disease. Aliment Pharmacol Ther. 2017;46:225–35.
Brown ES, Chandler PA. Mood and cognitive changes during systemic corticosteroid therapy. Prim Care Companion J Clin Psychiatry. 2001;3:17–21.
Goodhand JR, Wahed M, Mawdsley JE, Farmer AD, Aziz Q, Rampton DS. Mood disorders in inflammatory bowel disease: relation to diagnosis, disease activity, perceived stress, and other factors. Inflamm Bowel Dis. 2012;18:2301–9.
Evertsz FB, Bockting CL, Stokkers PC, Hinnen C, Sanderman R, Sprangers MA. The effectiveness of cognitive behavioral therapy on the quality of life of patients with inflammatory bowel disease: multi-center design and study protocol (KLC- study). BMC Psychiatry. 2012;12:227.
RCP. National Audit Report of Inflammatory Bowel Disease Service Provision: Adult National Report. London, United Kingdom: Royal College of Physicians. 2014.
Keefer L. Editorial: depression in the setting of inflammatory bowel disease means we have failed to provide early, effective, psychosocial care. Aliment Pharmacol Ther. 2017;46:553–4.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
RB, SS, SA, RS, and SJB declare that they have no conflict of interest.
Informed consent
Written informed consent was taken from all the subjects.
Ethics statement
The authors declare that the study was performed in a manner to conform to the Helsinki Declaration of 1975 as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.
Disclaimer
The authors are solely responsible for the findings and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board members, or the printer/publishers are responsible for the results/findings and content of this article.
Rights and permissions
About this article
Cite this article
Bhamre, R., Sawrav, S., Adarkar, S. et al. Psychiatric comorbidities in patients with inflammatory bowel disease. Indian J Gastroenterol 37, 307–312 (2018). https://doi.org/10.1007/s12664-018-0870-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-018-0870-9