Several analyses presented at AIBD 2024 reflect an association between mental disorders and inflammatory bowel disease (IBD).

In an analysis of Brazilian individuals, 194 IBD patients (63.4 percent women) were evaluated for depression, suicidal thoughts, and anxiety using the PHQ*-9 and GAD**-7. Of these, 93 had Crohn’s disease (CD) and 101 had ulcerative colitis (UC). Over three-quarters (77.9 percent) of participants reported a monthly income of up to three minimum wages. About 41 percent were in clinical remission. [AIBD 2024, abstract S18]

Thirty-two percent of participants had depression, 41.2 percent had anxiety, and 16 percent had suicidal thoughts. The prevalence was higher in CD vs UC patients, be it for depression (41.9 percent vs 26.7 percent; odds ratio [OR], 1.98; p=0.026), anxiety (48.4 percent vs 34.7 percent; OR, 1.77; p=0.052), or suicidal thoughts (22.6 percent vs 9.9 percent; OR, 2.65; p=0.016).

Patients with active disease were more likely to be depressed than those in remission (p=0.032). Depression was also more frequent in women (p=0.024) and among those with lower income (p=0.014) and lower haemoglobin (p=0.022).

Factors associated with the higher likelihood of experiencing anxiety were being female (p=0.001), older or younger (p=0.017), lower monthly income (p=0.045), previous surgery (p=0.033), and biologic users (p=0.011). For suicidal thoughts, factors were lower current age (p=0.018), lower income (p=0.016), and lower haemoglobin (p=0.013). According to the researchers, the odds of suicidal thoughts dropped by 33 percent for each 1-g/dL increase in current haemoglobin levels.

“Our Brazilian sample confirmed high rates of mental disorders and suicidal ideation in IBD patients. These findings reinforce the need for screening for mental disorders in the care of IBD patients,” said the researchers, underlining the need to focus on controlling IBD severity, especially in patients with depression who wish to achieve clinical remission.

Anxiety tied to flares, high disease severity

In another trial, 76 (11.8 percent) out of 643 IBD patients reported experiencing anxiety symptoms. These patients were more likely to experience comorbid depressive symptoms and have a high burden of disease severity than those without anxiety. They were also more likely to flare during follow-up (25 percent vs 13 percent). [AIBD 2024, abstract S30]

“These findings underscore the importance of routinely monitoring for anxiety symptoms in IBD patients,” said the researchers. “This has major implications for value-based care programmes with bidirectional risk models and the need for integrated care approaches that include mental health support to improve patient outcomes in IBD management.”

This study included IBD patients enrolled in a community-based technology-enabled care coordination platform providing value-based care for gastroenterology practices. They completed screening questionnaires for anxiety (GAD-2) and depression (PHQ-2) at enrolment and were evaluated for IBD severity and complications.

Sleep affected, too

A separate retrospective study demonstrated a significant association between poor sleep quality (PSQ) and anxiety and depression (p<0.0001 for both). [AIBD 2024, abstract S12]

Of the 143 participants (median age 48 years, 96 with CD), 42 had anxiety and 52 had depression (mostly mild). Eighteen patients had clinically active disease (HBI*** ≥5, SCCAI^# ≥3).

Eighty patients (n=54 [CD] and 26 [UC]) reported PSQ. Of the 35 patients with known sleep disorders (primarily obstructive sleep apnoea and insomnia), nearly three-quarters (74.3 percent) reported PSQ. “PSQ is especially common among patients with comorbid anxiety and depression regardless of clinical or biochemical disease activity,” said the researchers.

“This study confirms the high prevalence of mental health disturbances and PSQ among patients with IBD … We propose ongoing efforts to screen and treat patients with IBD for mental health disorders and sleep disorders,” they continued.

They added that future studies should examine how mental health treatment in the IBD space may enhance clinical disease activity and sleep quality.

*PHQ: Patient Health Questionnaire

**GAD: Generalized Anxiety Disorder

***HBI: Harvey-Bradshaw Index

^#SCCAI: Simplified Clinical Colitis Activity Index