Prevalence of Anxiety and Depression in Patients with Inflammatory Bowel Disease: Association with Disease Activity and its Impact on Quality of Life
DOI:
https://doi.org/10.52787/agl.v55i4.557Keywords:
Inflammatory bowel disease, ulcerative colitis, Crohn's disease, anxiety, depression, quality of life, inflammatory activity, gut-brain axisAbstract
Introduction. Inflammatory bowel diseases are chronic conditions whose digestive and extradigestive symptoms affect patients' quality of life. Multiple observational studies have also reported a significantly higher prevalence of psychiatric disorders, particularly anxiety and depression, in inflammatory bowel disease patients compared to the general population.
Objectives. To evaluate the prevalence of symptoms suggestive of anxiety and/or depression in inflammatory bowel disease patients, as well as their association with disease activity and quality of life.
Materials and methods. Patients over 18 years of age who attended the inflammatory bowel disease clinics of the Gastroenterology and Hepatology Service of the Güemes Hospital and the Centro Integral de Gastroenterología, in the Autonomous City of Buenos Aires, Argentina, from May 2023 to April 2025 were evaluated. The HADS (Hospital Anxiety and Depression Scale) and CCVEII-9 (Shortened quality of life questionnaire in inflammatory bowel disease) questionnaires were administered, alongside the collection of clinical data and fecal calprotectin as a marker of inflammatory activity.
Results. Ninety-nine patients with inflammatory bowel disease aged 18 years or older were included. Symptoms suggestive of anxiety were observed in 62.6% and depression in 19% of patients. No significant associations were found between psychiatric symptoms and calprotectin levels. However, the presence of anxiety or depression was associated with lower quality of life. Moderate negative correlations were observed for anxiety and strong negative correlations for depression between the scores of the two questionnaires.
Conclusion. More than half of inflammatory bowel disease patients present symptoms of anxiety and depression, significantly affecting their quality of life, although no relationship with inflammatory activity was observed. These findings emphasize the importance of screening and specifically treating psychiatric disorders in this population to improve overall well-being.
References
-1. Ludvigsson JF, Olén O, Larsson H, Halfvarson J, Almqvist C, Lichtenstein P, Butwicka A. Association between inflammatory bowel disease and psychiatric morbidity and suicide: a Swedish nationwide population-based cohort study with sibling comparisons. J Crohns Colitis. 2021;15(11):1824-1836.
-2. Bernstein CN, Hitchon CA, Walld R, Bolton JM, Sareen J, Walker JR, Graff LA, et al. Increased burden of psychiatric disorders in inflammatory disease. Inflamm Bowel Dis. 2019;25(2):360-368.
-3. Keefer L, Kane SV. Considering the bidirectional pathways between depression and IBD: recommendations for comprehensive IBD care. Gastroenterol Hepatol (N Y). 2017;13(3):164-169.
-4. Marín-Jiménez I, Gobbo Montoya M, Panadero A, Cañas M, Modino Y, Romero de Santos C, Guardiola J, Carmona L, Barreiro de Acosta M. Management of the psychological impact of inflammatory bowel disease: perspective of doctors and patients-the ENMENTE project. Inflamm Bowel Dis. 2017;23(9):1492-1498.
-5. Bennebroek Evertsz F, Thijssens NAM, Stokkers PCF, Grootenhuis MA, Bockting CLH, Nieuwkerk PT, Sprangers MAG. Do inflammatory bowel disease patients with anxiety and depressive symptoms receive the care they need? J Crohns Colitis. 2012;6(1):68-76.
-6. Byrne G, Rosenfeld G, Bressler B. Prevalence of anxiety and depression in patients with inflammatory bowel disease. Can J Gastroenterol Hepatol. 2017;2017:6496727.
-7. Walker JR, Ediger JP, Graff LA, Greenfeld JM, Clara I, Lix L, Rawsthorne P, Miller N, Rogala L, McPhail CM, Bernstein CN. 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(8):1989-1997.
-8. Allegretti JR, Borges L, Lucci M, Chang M, Cao B, Collins E, Vogel B, Arthur E, Emmons D, Korzenik JR. Risk factors for rehospitalization within 90 days in patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2016;22(3):752-762.
-9. Ananthakrishnan AN, Gainer VS, Perez RG, Cai T, Cheng SC, Savova G, et al. Psychiatric co-morbidity is associated with increased risk of surgery in Crohn's disease. Aliment Pharmacol Ther. 2013;37(4):445-454.
-10. Zhang C, Li Z, Li X, Li Y, Zhang X. The influence of depression on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(8):1732-1739.
-11. Jayasooriya N, Blackwell J, POP-IBD Study Group. Antidepressant medication use in inflammatory bowel disease: a nationally representative population-based study. Aliment Pharmacol Ther. 2022;55(12):1330-1341.
-12. Blackwell J, Alexakis C, Saxena S, Creese H, Bottle A, Petersen I, et al. Association between antidepressant medication use and steroid dependency in patients with ulcerative colitis: a population-based study. BMJ Open Gastroenterol. 2021;8:e000588.
-13. Yamamoto-Furusho J, Bozada Gutiérrez K, Kayta, Sarmiento Aguilar A, Fresán Orellana A, Arguelles Castro P, García Alanis M. Depression and anxiety disorders impact in the quality of life of patients with inflammatory bowel disease. Psychiatry J. 2021;2021:6496727.
-14. Calixto RP, Flores C, Francesconi CF. Inflammatory bowel disease: impact on scores of quality of life, depression and anxiety in patients attending a tertiary care center in Brazil. Arq Gastroenterol. 2018;55(3):249-257.
-15. Camacho-Martel L. Apoyo y tratamiento psicológico en la enfermedad inflamatoria intestinal: relación médico-paciente. Gastroenterol Hepatol. 2009;32(Suppl 2):13-18.
-16. Suarez-Almazor ME. Patient-physician communication. Curr Opin Rheumatol. 2004;16(1):91-95.
-17. Barreiro de Acosta M, Marín Jiménez I, Panadero A, Guardiola J, Cañas M, Gobbo Montoya M, et al. Recomendaciones del GETECCU y ACCU para el manejo de los aspectos psicológicos de la enfermedad inflamatoria intestinal. Gastroenterol Hepatol. 2018;41(2):118-127.
-18. Iglesias M, González-Castillo S, Pérez-Cuadrado A, et al. Impacto psicológico de la enfermedad de Crohn en pacientes en remisión: riesgo de ansiedad y depresión. Rev Esp Enferm Dig. 2009;101(4):249-257.
-19. Avinit A, Dar S, Taler M, Haj O, Gothelf D, Kopylov U, et al. Keeping it simple: mental health assessment in the Gastroenterology Department – using the Hospital Anxiety and Depression Scale (HADS) for IBD patients in Israel. Therap Adv Gastroenterol. 2022; Mar 15:17562848211066439.
-20. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.
-21. Alcalá Escriche MJ. Elaboración y validación de un cuestionario reducido de la versión española del cuestionario de calidad de vida específico para la enfermedad inflamatoria intestinal. Bellaterra: Universitat Autònoma de Barcelona, 2003.
-22. Alcalá MJ, Cassellas F, Fontanet G, Prieto L, Malagelada JR. Shortened questionnaire on quality of life for inflammatory bowel disease. Inflamm Bowel Dis. 2004;10:383-391.
-23. Siddharth Singh S, Ananthakrishnan AN, Nguyen NH, Cohen BL, Velayos FS, Weiss JM, et al. AGA Clinical Practice Guideline on the Role of Biomarkers for the Management of Ulcerative Colitis. Gastroenterology. 2023;164:344-372.
-24. Guardiola J, Lobatón T, Cerrillo E, Ferreiro-Iglesias R, Gisbert JP, Domenech E, et al. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre la utilidad de la determinación de calprotectina fecal en la enfermedad inflamatoria intestinal. Gastroenterología y Hepatología. 2018;41(8):514-529.
-25. Bisgaard TH, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol. 2022;19(11):686-700.
-26. Stroie T, Preda C, Istratescu D, Ciora C, Croitoru A, Diculescu M. Anxiety and depression in patients with inactive inflammatory bowel disease: the role of fatigue and health-related quality of life. Medicine (Baltimore). 2023;102(30):e33713.
-27. Mikocka-Walus A, Pittet V, Rossel JB, Von Kanel R, Swiss IBD Cohort Study Group. Symptoms of depression and anxiety are independently associated with clinical recurrence of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2016;14(6):829-835.
-28. Alexakis C, Humar A, Saxena S, Pollok R. Systematic Review and Meta-analysis: The impact of a depressive state on disease course in adult inflammatory bowel disease. Inflamm Bowel Dis. 2021;27(11):1719-1729.
-29. López Blanco J, Moreno Jiménez B, Devesa Múgica JM, Rodriguez Muñoz A. Relación entre variables sociodemográficas y clínicas y calidad de vida relacionada con la salud en pacientes con enfermedad inflamatoria intestinal. Rev Esp Enferm Dig. 2005;97(11):757-764.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Camila María Briz, Federico Ignacio Cassella, Pablo Martín Perez, Santiago Marzullo, Luis Viola

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.










