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Robust Association Between Inflammatory Bowel Disease and Generalized Anxiety Disorder
Abstract
Although the link between inflammatory bowel diseases (IBD) and depression is well accepted, less is known about the relationship between IBD and anxiety disorders and factors associated with anxiety among those with IBD.
Data were derived from the nationally representative 2012 Canadian Community Health Survey-Mental Health. The survey response rate was 68.9%. Two sets of analyses were undertaken. First, a series of logistic regression analyses were used to estimate the odd ratios of generalized anxiety disorder among those with IBD compared with those without (n = 22,522). The fully adjusted model controlled for sociodemographics, depression, substance abuse/dependence, pain, and adverse childhood experiences. Second, among those with IBD (n = 269), significant correlates of generalized anxiety disorder were identified using logistic regression. The presence of generalized anxiety disorder was determined using the WHO-CIDI lifetime criteria, and IBD was assessed by a self-reported health professional diagnosis.
Individuals with IBD had over twice the odds of anxiety compared with those without IBD, even when controlling for a range of potential explanatory factors (odds ratio = 2.18; 95% confidence interval, 1.50-3.16). Controlling for chronic pain and childhood adversities attenuate the relationship the most. Among those with IBD, a history of childhood sexual abuse, female gender, and chronic pain are the strongest correlates of anxiety. Those with Crohn's and ulcerative colitis were equally vulnerable to generalized anxiety disorder.
Our findings show that IBD is robustly related to generalized anxiety disorder. Health care professionals should be aware of the increased prevalence of generalized anxiety disorder among their patients with IBD, particularly women, those in chronic pain, and those with a history of childhood sexual abuse.
... In the systematic review, 13 studies were analyzed to examine the association between anxiety and IBD, 6,23,26,[39][40][41]45,46,[48][49][50][51]58 as detailed in Table 3. These studies included a wide range of study designs, populations, and methods. ...
... These studies included a wide range of study designs, populations, and methods. Regarding the target diagnoses, some studies 26,58 focused only on generalized anxiety disorder, while others 6,23,39 took into account various ICD-10 diagnoses, including panic attack disorder, agoraphobia, generalized anxiety disorder, and dissociative disorders. Similarly, Irving employed non-phobia-related anxiety disorder diagnoses. ...
... While 2 studies highlighted a higher prevalence in UC patients, 26,45 most studies did not find a significant statistical difference between UC and CD. 39,40,46,58 Interestingly, 1 study reported a greater frequency of anxiety in CD patients. 41 Gender differences in the prevalence of anxiety have been observed in some studies, with women having a higher risk of anxiety. ...
Background
Psychiatric disorders in patients with inflammatory bowel disease (IBD) represent a significant but uncertain facet of the disease, with unsolved questions regarding their overall magnitude, their impact on intestinal disease, and the whole burden of psychiatric manifestations.
Aim
This systematic review summarizes the evidence on the prevalence and impact of psychiatric disorders, including depression, anxiety, bipolar disorder (BD), and schizophrenia, among patients with IBD.
Methods
A systematic search across PubMed/MEDLINE, Embase, and Scopus databases from January 2010 to January 2023 was performed to identify relevant studies. The focus was on studies exploring the prevalence of specific psychiatric disorders in IBD patients compared to the general population and that reported specific outcome measures. A subsequent meta-analysis (MA) assessed the strength of the association between IBD and these psychiatric disorders, with data reliability ensured through rigorous extraction and quality assessment.
Results
Out of 3,209 articles, 193 met the inclusion criteria and only 26 provided complete data for comprehensive analysis. These studies showed a significantly higher overall prevalence of psychiatric comorbidities in IBD patients compared to the general population. The MA showed a significant association between IBD and depression (pooled OR 1.42, 95% CI = 1.33-1.52, P < .0001) and anxiety (pooled OR 1.3, 95% CI = 1.22-1.44, P < .0001). The association between IBD and BD was significant (pooled OR 1.64, 95% CI = 1.20-2.24, P < .0001) but showed considerable heterogeneity (I2 = 94.01%). Only 3 studies examined the association between schizophrenia and IBD, providing widely heterogeneous results, with an inconclusive OR, estimated at 0.93 (95% CI = 0.62-1.39, P = .73).
Conclusions
This MA highlights the high prevalence of psychiatric disorders, particularly depression and anxiety, in IBD patients, which exceeds rates in the general population. BD in IBD is proving to be an important but under-researched area. The sparse and contradictory data on schizophrenia requires further investigation. These findings highlight the need for better understanding, early detection, and tailored mental health interventions in the management of IBD to significantly improve patients’ quality of life.
... Prior studies have shown relationships between physical and psychological stressors and both inflammation and IBD. For instance, IBD has been associated with an increased risk of depression and anxiety (35)(36)(37) and depression in turn has been associated with incident CD (38). Early childhood stress has also been associated with increased inflammation, impaired cellular immunity, and altered gut microbiota in adulthood (39,40). ...
... Childhood abuse has been found to increase the risk of incident lupus, an autoimmune disorder, in a cohort of women in the United States (14). More specific to this study, the relationship between child abuse and IBD has previously been studied in a Canadian cohort (36). The study found a greater than 2-fold increased risk of UC in participants with physical and sexual abuse and no increased risk of CD (44). ...
Introduction
A link between inflammatory bowel disease (IBD), stressful life events and psychological factors has previously been reported. Our objective was to examine the relationship between childhood emotional, physical, and sexual abuse and risk of IBD using a large cohort of female health professionals.
Methods
We included participants in the Nurses’ Health Study II who completed the Physical and Emotional Abuse Subscale of the Childhood Trauma Questionnaire and the Sexual Maltreatment Scale of the Parent-Child Conflict Tactics Scale in 2001. Diagnosis of IBD was determined by self-report and confirmed independently by two physicians through review of medical records. We used Cox proportional hazard modeling to estimate the risk of Crohn’s disease (CD) and ulcerative colitis (UC) while adjusting for covariates.
Results
Among 68,167 women followed from 1989 until 2017, there were 146 incident cases of CD and 215 incident cases of UC. Compared to women with no history of abuse, the adjusted hazard ratios of CD were 1.16 (95% CI 0.67 – 2.02) for mild, 1.58 (95% CI 0.92 – 2.69) for moderate, and 1.95 (95% CI 1.22 – 3.10) for severe abuse (P trend = 0.002). We did not observe an association between childhood abuse and risk of UC.
Conclusions
Women who reported early life severe abuse had an increased risk of CD. These data add to the growing body of evidence on the critical role of early life stressors in development of CD.
... Individuals experiencing symptoms are often diagnosed at vital junctions in their lives: teenagers grappling with identity development, young adults at college or university finding themselves, adults building their careers and starting families, and middle-aged adults working towards financial independence (Fuller-Thomson et al., 2015). While balancing IBD and life, those diagnosed with IBD are also frequently diagnosed with a comorbid mental health condition, such as anxiety, depression, and/ or PTSD (Fuller-Thomson et al., 2015;Fuller-Thomson & Sulman, 2006;Kurina et al., 2001;Taft et al., 2021). ...
... Individuals experiencing symptoms are often diagnosed at vital junctions in their lives: teenagers grappling with identity development, young adults at college or university finding themselves, adults building their careers and starting families, and middle-aged adults working towards financial independence (Fuller-Thomson et al., 2015). While balancing IBD and life, those diagnosed with IBD are also frequently diagnosed with a comorbid mental health condition, such as anxiety, depression, and/ or PTSD (Fuller-Thomson et al., 2015;Fuller-Thomson & Sulman, 2006;Kurina et al., 2001;Taft et al., 2021). The severe symptoms of IBD can thus cause individuals to abandon parts of their lives and life plans/trajectories that they once deemed essential to their identity due to their changing energy levels and unpredictable and uncertain health status (Devlin et al., 2014;Sammut et al., 2015). ...
Inflammatory bowel disease (IBD) is a chronic illness that affects 10 million individuals worldwide; however, Canada has the highest rates of IBD per capita in the world. Presently, 0.7% of Canadians are diagnosed with IBD, which is expected to rise to 1% by 2030. Disease onset is typically between the ages of 15-45 years old. This is a crucial period for identity development and growth; however, IBD symptoms often disrupt these processes and cause individuals to abandon or reconstruct parts of their identity. As a result, changes in individuals' life plans and health status may cause them to grieve their former pre-IBD identities. In this qualitative narrative study, we captured the lived experiences of IBD, with a focus on what individuals have lost, gained, or accomplished across various avenues (e.g. relationships, education, and future scripts). Thirteen participants constructed IBD narratives using a holistic-form narrative approach, a method that captures various plot formulations and discourses that emerge through storytelling. We found three main plotlines: The 'journey to acceptance' , which detailed a route to acceptance wherein individuals integrated IBD into their identity , 'the ambivalent story' , which exemplified individuals who were unsure of IBD and the resulting impacts of the diagnosis on their identity, and 'the grief story' , which outlined grief and loss surrounding one's pre-IBD self. These results illuminate the role of narrative in shaping meaning-making and identity processes over the life course. We urge future researchers to explore narrative inquiry as a route to further understand the integration of IBD into one's life story/identity.
... [3][4][5] The prevalence of mental health conditions such as depression and anxiety is reported to be higher in people with IBD compared with general populations. [6][7][8][9] However, for most studies of mental health and IBD, outcomes are based on self-reported measures, rather than formal diagnoses of mental health conditions. 8 Given the fact that IBD is a chronic, incurable condition often requiring prolonged treatment, it is important for all healthcare partners, ranging from clinicians to service commissioners, to have a good understanding of the total healthcare utilisation of people with IBD. ...
... The prevalence of depressive disorder observed in people with IBD in our study (17.5% for CD and 14.2% for UC) was consistent with previous population-based studies, including a US claims-based study of 330 000 people with IBD that reported depression in 16%, 7 and a systematic review which reported a pooled prevalence of depression disorders at 15.2% with higher rates observed in people with CD than UC. 8 Our higher rate of anxiety episodes observed in people with IBD versus controls is also consistent with previous reports. 6 In the aforementioned systematic review, the pooled prevalence of anxiety symptoms was 35.1%, and depression symptoms at 21.6%. 8 Our observed prevalence for active depressive episodes (3.5%) and anxiety episodes (5.7%) is much lower than these estimates. ...
Background
Inflammatory bowel disease (IBD) has a significant impact on quality of life for many people.
Objective
To assess the prevalence of common mental health conditions in IBD and the combined impact of IBD and mental health conditions on healthcare use and time off work.
Methods
A UK population-based primary care database (Royal College of General Practitioners Research and Surveillance Centre) was used to identify adults with IBD (n=19 011) (Crohn’s disease (CD) or ulcerative colitis (UC)), and matched controls (n=76 044). Prevalences of anxiety, depressive episodes and depressive disorder recorded in primary care were assessed between 2016 and 2018. Outcomes comprised of rates of primary care visits, emergency secondary care visits, certificates for time off work, antidepressant and anxiolytic prescriptions.
Findings
Mental health conditions were more common in people with CD than controls: anxiety episodes (3.5% vs 3.0%; p=0.02), depressive episodes (5.7% vs 4.1%; p<0.001) and depressive disorder (17.5% vs 12.9%; p<0.001), and people with UC versus controls: depressive episodes (4.4% vs 3.6%; p<0.001) and depressive disorder (14.2% vs 12.4%; p<0.001). Healthcare utilisation rates were higher in people with IBD than controls (primary care visits incidence rate ratio 1.47 (95% CI 1.43 to 1.51); emergency secondary care visits 1.87 (1.79 to 1.95); fitness for work certificates 1.53 (1.44 to 1.62); antidepressant use 1.22 (1.13 to 1.32); anxiolytic use 1.20 (1.01 to 1.41)). In people with IBD, mental health conditions were associated with additional increases in healthcare use and time off work.
Conclusion
Depression and anxiety are more common in people with IBD than matched controls. Healthcare utilisation and prescribing of psychotropic medications are also higher in people with IBD. Mental health conditions in people with IBD are associated with additional healthcare use and time off work.
Clinical implications
Evidence-based mental health support programmes, including psychological treatments, are needed for people with IBD.
... Early life events, such as a complicated birth and a lack of breastfeeding, as well as later childhood stressful events are considered to be potential risk factors for IBD [12]. Further, the effect of adverse childhood experiences, such as sexual abuse, physical abuse and witnessing domestic violence, in IBD were part of a study of Fuller-Thomson et al. [13]. ...
... A population-based study also concluded that IBD is strongly related to a generalised anxiety disorder, especially in women suffering from chronic pain and those with a history of childhood sexual abuse [13]. Differences in reporting stressors between men and women are present in our study as well. ...
Background: Stress has been suggested to play a potential role in inflammatory bowel disease (IBD) pathogenesis, but studies focussing on the occurrence of specific life stress events among IBD patients are scarce. Therefore, the aim of the present study was to explore the association between various life stress events and IBD. Methods: Patients with IBD (N = 98, mean age: 38.45, 54.1% men) were compared to a group of healthy controls (N = 405, mean age: 36.45, 58.0% men) originating from a health survey conducted on a representative population sample of Czech adults. The Life Stressor Checklist-Revised (LSC-R) was used to assess the stressors. Results: IBD patients had higher odds of reporting life stressors overall (p < 0.001), life stressors before the age of 16 (p < 0.004) and a higher score in traumatic stress (p < 0.005) and interpersonal violence (p < 0.001) when compared to the control group. Gender- and diagnosis-related differences are discussed. Conclusion: Reporting life stressors experienced during childhood or adulthood is strongly associated with IBD. This should be considered in illness management, especially in a severe course of IBD.
Keywords: inflammatory bowel disease; IBD; stressors; ulcerative colitis; Crohn’s disease
... Early life events, such as a complicated birth and a lack of breastfeeding, as well as later childhood stressful events are considered to be potential risk factors for IBD [12]. Further, the effect of adverse childhood experiences, such as sexual abuse, physical abuse and witnessing domestic violence, in IBD were part of a study of Fuller-Thomson et al. [13]. ...
... A population-based study also concluded that IBD is strongly related to a generalised anxiety disorder, especially in women suffering from chronic pain and those with a history of childhood sexual abuse [13]. Differences in reporting stressors between men and women are present in our study as well. ...
Psychological aspects of inflammatory bowel diseases (IBD) were given less attention in the social space of former Czechoslovak countries. The possibilities of psychological care for patients with IBD have to be re-evaluated due to the new worldwide trends in the management of IBD. In the complex management of IBD treatment arises a demand after psychologist as a helping member of the gastroenterological team in order to be available for patients, as well as to consult the cases with the specialists. In the following article we described psychological interventions (psychotherapeutic techniques), whose effectivity as a supplemental treatment in patients with IBD was examined. Recently, several studies on the effectivity of psychological interventions in patients with IBD have already been available. This trend is in accordance with a biopsychosocial model of patients‘ care. Promising results were observed in psychotherapeutic techniques which use the work with body feelings, relieving the tension and relaxation training. The presence of psychologist and psychological guidance in difficult periods during chronic diseases such as IBD appears to be helpful. Patients with a psychiatric comorbidity tend to have worse course of disease. It is important to identify the patients who are in need of psychological care, mostly the ones with trauma anamnesis. Overcoming traumatic experience may provide positive impact on the disease course.
... 5,6 Embarrassment and stigma of IBD symptoms, fear of negative long-term effects, and unpredictability of flares, have been shown to have negative psychological impacts, 7 including apprehension about loss of control and negative body image. IBD populations are twice as likely to experience generalised anxiety disorder 8 and report significantly higher levels of depression compared to non IBD populations. 9 Living with IBD also negatively impacts family life, with between one fifth and one third of IBD patients reviewed selecting voluntary childlessness due to concerns about pregnancy or how IBD would affect parenting ability. ...
... Periods of poor mental health, anxiety, reduced confidence, feeling a loss of control and reduced quality of life were described during periods of illness. 8,9,31,32 Some felt guilty when IBD disrupted day to day life. Even during remission, the fear of the unknown can increase levels of stress. ...
Objectives
To explore patients’ experiences of living with inflammatory bowel disease (IBD) with a focus on their information and support needs.
Methods
Qualitative interview study involving adults diagnosed with IBD recruited through social media. Interviews were audio recorded, transcribed and data were analysed thematically.
Results
Interviews with 15 patients (9 females, 6 males) highlighted how misdiagnosis or hesitation to diagnose had caused frustration and anxiety. Once diagnosed, only a few participants received detailed information about IBD from their doctor. Negative experiences shared on social media caused initial anxiety, as individuals assumed that they may have a similar experience, yet online communities enabled insights into the experiences of others, helping patients adjust to living with IBD. Participants described both positive and negative impacts of living with IBD, including improved confidence and periods of anxiety. Discussion: Our findings highlight the importance of clear information and support from health professionals, as well as the benefits of online communities for ongoing support. At the point of diagnosis, patients would benefit from information about what IBD is, as well as how it may impact day to day life from doctors so that social media is not the only source of initial information about IBD.
... Various health determinants are also associated with lower or higher levels of anxiety disorders. Adults who are obese [19] or who have chronic conditions such as migraines [20], inflammatory bowel disease [21], or cancer [22,23] are more likely to have anxiety disorders compared to those without these conditions. Health behaviors, such as regular exercise, are associated with lower levels of anxiety [24][25][26]. ...
... Consistent with other studies, there was a higher likelihood of anxiety disorders in women [14], younger respondents [16], individuals with lower income [17], and who had never married [19]. The findings of higher odds of anxiety disorders among those with chronic health conditions and pain have been reported in earlier studies [21,23,24]. The higher odds of anxiety disorders may be attributed to the mental health consequences of experiencing physical health problems. ...
The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010–2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45–65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67–0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79–3.52), being a woman (aOR = 1.25, 95% CI: 1.07–1.46), single status (aOR = 1.27, 95% CI: 1.09–1.48), lower income (aORs = 1.28–2.68), multi-morbidities (aORs = 2.73–5.13), chronic pain (aOR = 1.31, 95% CI: 1.18–1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23–1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20–2.92), body fat ≥ 26% (aORs = 1.28–1.79), fruit and vegetable intake (< 3/day; aORs = 1.24–1.26), and pastry consumption (> 1/day; aOR = 1.55, 95% CI: 1.12–1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.
... require multiple interventions and continuous monitoring, which can force them to deviate from their routine life and lead to mental and social disorders in these patients [11], such that patients with IBD are twice as likely to experience generalized anxiety disorder [12]. ...
Background and Aims
Inflammatory bowel disease (IBD) is a chronic digestive disease that has a detrimental effect on the quality of life of IBD patients. This study aims to identify the informational needs and design the essential informational needs for a smartphone application for the self‐management of IBD.
Methods
This study was conducted in two stages and the informational needs of the patients were extracted in a questionnaire designed in three separate sections and given to 120 patients with UC and 60 patients with CD.
Results
After a literature review and analysis of patient responses, it was found that Knowledge of the disease, Medication, Educational information, Complications, Diet & Nutrition, and Lifestyle habits are among the most important domains of informational needs of inflammatory bowel disease patients.
Conclusion
Patients with IBD have many informational needs, and in this study, identifying these needs, can help improve the quality of life of these patients and be of interest to healthcare providers, designers, and developers of applications.
... In our study, hypertension, pain, depression, and cancer are considered the four most common chronic comorbidities among IBD patients. Multiple studies indicate a close correlation between IBD and an increased likelihood of mental health disorders such as anxiety and depression [22][23][24]. In our study, depression predominates among comorbidities in the first class of CD patients and the third class of UC patients. ...
Background
With existing researches identifying an increased rate of long-term conditions (LTCs) among Inflammatory Bowel Disease (IBD) patients, yet there is a lack of exploration into the patterns of comorbidity and prognostic rates for IBD patients with multiple morbidities.
Methods
The study included 8,305 participants who self-reported having IBD, comprising ulcerative colitis (UC) and Crohn’s disease (CD). Latent class analysis (LCA) was utilized to create optimal categories of LTC combinations for UC and CD patients with additional long-term conditions. Using Cox proportional hazards models, we compared the all-cause mortality rates over a 16-year follow-up among UC and CD patients within different LTC categories, both without LTCs and with the addition of one LTC, the probability of major adverse cardiovascular events (MACE), and the rates of IBD-related surgeries.
Results
A total of 5,617 participants reported having two or more LTCs, with the LCA method identifying three prevalence categories among CD patients, and four prevalence categories among UC patients. The highest mortality rate among CD patients was found in category 3: (HR 1.789, 95% CI (1.439–2.224)), and the highest rates of MACE were also in category 3: (HR 11.432, 95% CI (9.332–14.005)), with hypertension being the distinguishing characteristic of this category, and the highest rates of IBD-related surgeries being associated with pain in category 1: (HR 1.217, 95% CI (0.983–1.506)). Among UC patients, the highest mortality rate was in category 3: (HR 2.221, 95% CI (1.837–2.684)), with the highest MACE rates found in category 3: (HR 6.422, 95% CI (5.659–7.288)), and the highest rates of IBD-related surgeries being associated with pain, also in category 3: (HR 1.218, 95% CI (1.041–1.425)).
Conclusion
The rates of adverse health outcomes in IBD patients is closely associated with multimorbidity patterns, underscoring the need to fully consider multimorbidity patterns in the assessment, management, and treatment strategies for IBD.
... Individuals with IBD report higher levels Biomedicines 2024, 12, 214 9 of 11 of anxiety and depression compared to the general population [13,30,41,42] and patients with active IBD experience higher rates of anxiety and depression [41,43]. Females with IBD have higher rates of anxiety [13,44] compared to males with IBD. ...
Psychological stress exposure is well recognized to exacerbate inflammatory bowel disease (IBD) but the mechanisms involved remain poorly understood. In this study, chronic T cell-mediated colitis was induced by adoptively transferring CD4+CD45RBhigh splenic T cells from C57BL/6 WT donor mice into Rag1tm1Mom mice. Two weeks after T cell transfer, mice were exposed to a prolonged restraint stressor (RST) for 8 h per day for 6 consecutive days. The colitis phenotype was assessed via histopathology and semi-quantitative rt-PCR at humane endpoints or 10 weeks post-T-cell transfer. Mice that received the T cell transplant developed chronic colitis marked by increases in colonic histopathology and inflammatory cytokines. Colonic histopathology was greater in males than females regardless of RST exposure but RST exposure increased histopathology scores in females such that they reached scores observed in the males. This pattern was consistent with cytokine gene expression and protein levels in the colon (especially for IFN-γ, IL-17A, and TNF-α). Serum cytokine levels were not strongly affected by exposure to the stressor. Using a murine model of chronic T cell-mediated colitis, this study demonstrates that biological sex strongly influences colonic inflammation and exposure to chronic stress has a more pronounced effect in females than in males.
... The prevalence of depressive disorders in IBD patients varies from 21% to 25%, while anxiety disorders are present in 19.1% to 35% of these patients [11]. Compared with the general population, IBD patients are twice as likely to have an affective disorder [12]. A study by Panara et al. showed that depression is independently associated with the female gender, the active form of a disease, and a more aggressive disease course [13]. ...
Inflammatory bowel disease (IBD), a common term for Crohn’s disease and ulcerative colitis, is a chronic, relapse-remitting condition of the gastrointestinal tract that is increasing worldwide. Psychiatric comorbidities, including depression and anxiety, are more prevalent in IBD patients than in healthy individuals. Evidence suggests that varying levels of neuroinflammation might underlie these states in IBD patients. Within this context, microglia are the crucial non-neural cells in the brain responsible for innate immune responses following inflammatory insults. Alterations in microglia’s functions, such as secretory profile, phagocytic activity, and synaptic pruning, might play significant roles in mediating psychiatric manifestations of IBD. In this review, we discuss the role played by microglia in IBD-associated comorbidities.
... In our study, hypertension, pain, depression, and cancer are considered the four most common chronic comorbidities among IBD patients. Multiple studies indicate a close correlation between IBD and an increased likelihood of mental health disorders such as anxiety and depression [19][20][21]. In our study, depression predominates among comorbidities in the rst class of CD patients and IBD progressively evolves into systemic chronic in ammation, where aberrant activation of in ammatory cells and abnormal release of in ammatory mediators (tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)) lead to endothelial dysfunction, reduced vascular dilation capacity, and inadequate tissue perfusion. ...
Background
With existing researches identifying an increased risk of long-term conditions (LTCs) among Inflammatory Bowel Disease (IBD) patients, yet there is a lack of exploration into the patterns of comorbidity and prognostic risks for IBD patients with multiple morbidities.
Methods
We included 8,305 participants who self-reported having IBD (comprising UC and CD) and utilized latent class analysis (LCA) to create optimal categories of LTC combinations for UC and CD patients with additional LTCs. Using Cox proportional hazards models, we compared the all-cause mortality risk over a 16-year follow-up among UC and CD patients within different LTC categories, both without LTCs and with the addition of one LTC, risks of major adverse cardiovascular events (MACE), and the risk of IBD-related surgeries.
Results
A total of 5,617 participants reported having two or more LTCs, with the LCA method identifying three prevalence categories among CD patients, and four prevalence categories among UC patients. The highest mortality rate among CD patients was found in category 3: (HR 1.789, 95% CI (1.439–2.224)), and the highest risk of MACE was also in category 3: (HR 11.432, 95% CI (9.332–14.005)), with hypertension being the distinguishing characteristic of this category, and the highest rate of IBD-related surgeries being associated with pain in category 1: (HR 1.217, 95% CI (0.983–1.506)). Among UC patients, the highest mortality rate was in category 3: (HR 2.221, 95% CI (1.837–2.684)), with the highest MACE risk found in category 3: (HR 6.422, 95% CI (5.659–7.288)), and the highest rate of IBD-related surgeries being associated with pain, also in category 3: (HR 1.218, 95% CI (1.041–1.425)).
Conclusion
The risk of adverse health outcomes in IBD patients is closely associated with multimorbidity patterns, underscoring the need to fully consider multimorbidity patterns in the assessment, management, and treatment strategies for IBD.
... The prevalence of depressive disorders in IBD patients varies from 21% to 25%, while anxiety disorders are seen in 19.1% to 35% of patients with IBD [7]. Compared with the general population, IBD patients are twice as likely to have an affective disorder [8]. In addition, the link between IBD and mental disorders seems to be bidirectional: flares of gastrointestinal disease are associated with an increased risk of anxiety and depression, while conversely, patients with mood disorders seem to be at a higher risk of developing IBD [9][10][11][12]. ...
Gender differences were identified in the frequency and clinical presentations of inflammatory bowel disease (IBD) and depressive and anxiety disorders, which are more common in IBD patients than in the general population. The present manuscript provides a critical overview of gender differences in the frequency and clinical course of mood and anxiety disorders in IBD patients, with the aim of helping clinicians provide individualized management for patients. All of the included studies found that IBD patients reported a higher frequency of depressive and anxiety disorders than the general population. These findings should encourage healthcare providers to employ validated tools to monitor the mental health of their IBD patients, such as the Patient Health Questionnaire (PHQ-9). In addition, most studies confirm that women with IBD are more likely than men to develop affective disorders and show that up to 65% of women with IBD have depressive and anxiety disorders. Women with IBD require close mental health monitoring and ultimately a multidisciplinary approach involving mental health professionals. Drug treatment in women should be individualized and medications that may affect mental health (e.g., corticosteroids) should be thoroughly reconsidered. Further data are needed to ensure individualized treatment for IBD patients in a framework of precision medicine.
... W badaniach przeprowadzonych na populacji osób z chorobami zapalnymi jelit stwierdzono, że doświadczają oni wyższego poziomu objawów depresyjnych w porównaniu z ogólną populacją [39]. Inne prace wykazały, że występowanie objawów depresyjnych jest związane z większym nasileniem choroby i częstszymi nawrotami[40]. ...
Introduction: Inflammatory bowel disease (IBD) is a group of chronic digestive disorders that affects an increasing number of people. As the peak incidence of IBD occurs during the reproductive age and affects young people, it is worth examining the impact of IBD on the fertility of patients. In view of the growing problem of infertility in society and the probable relationship between decreased reproductive function and the occurrence of chronic diseases, it is reasonable to examine this phenomenon in detail. Objective: The aim of this study is to summarize the current knowledge on the association between IBD and infertility based on available literature. Materials and methods: A literature review was conducted using PubMed and Google Scholar databases with the following search terms: IBD, infertility, infertility diagnosis, the relationship between IBD and infertility, drugs and infertility, psychological aspects of infertility in IBD. State of knowledge: There are few meta-analyses on the association between IBD and infertility in the literature, and this is due to the small number of studies on this topic. Conclusions: Infertility is becoming an increasingly common problem in people with IBD. Stress and anxiety disorders can have a negative impact on the course of the disease, and thus limit reproductive opportunities. Taking medications to control the course of the disease is crucial for patients to remain in remission, however, patients should be informed about the impact of some medications on reproduction and adjust their conception plans according to their current therapy. Treatment of the underlying disease, reducing anxiety levels, regular physical activity, and a healthy and balanced diet are all components of appropriate management in people with IBD who are trying to conceive. Without these pillars, it is difficult to guarantee successful pregnancy outcomes.
... Besides depression symptomatology, we also observed that IBD patients with ELS were more anxious. This finding is in accordance with previous results showing that IBD is robustly related to anxiety, particularly in women with a history of childhood sexual abuse (Fuller-Thomson et al., 2015). ...
The aim of this study was to evaluate the prevalence of early life stress (ELS) in a population with inflammatory bowel diseases (IBD) and to estimate its burden on mental, physical, and digestive health. Ninety-three participants with IBD were asked to anonymously complete questionnaires (Childhood Trauma Questionnaire-Short Form, Early Life Event Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Ways of Coping Checklist, Gastro-Intestinal Quality of Life Index questionnaire, and ad hoc questions about symptoms). The prevalence of patients with IBD who were exposed to at least one childhood abuse was 53%. Mental health and quality of life were significantly poorer in patients with IBD who were exposed to early abuse than in those who were not. Patients exposed to ELS had also more digestive perturbations and fatigue. These results suggest that early abuse should be considered a component of IBD care.
... Thus, spinal afferents can also relay sensory information from the gut to the brain via the spinothalamic, spinoreticular and spinomesencephalic tracts. (56), not all studies found significant gender differences in comorbid anxiety prevalence in IBD patients (57)(58)(59). Nonetheless, a recent study has reported that both DSS-treated male and female mice showed increased anxiety-like behaviors as revealed using the OF and EPM tests (15). Intestinal permeability analysis. ...
Inflammatory bowel disease (IBD) is a relapsing-remitting disorder characterized by chronic inflammation of the gastrointestinal (GI) tract. Anxiety symptoms are commonly observed in IBD patients, but the mechanistic link between IBD and anxiety remains elusive. Here, we sought to characterize gut-to-brain signaling and brain circuitry responsible for the pathological expression of anxiety-like behaviors in male dextran sulfate sodium (DSS)-induced experimental colitis mice. We found that DSS-treated mice displayed increased anxiety-like behaviors, which were prevented by bilateral GI vagal afferent ablation. The locus coeruleus (LC) is a relay center connecting the nucleus tractus solitarius to the basolateral amygdala (BLA) in controlling anxiety-like behaviors. Chemogenetic silencing of noradrenergic LC projections to the BLA reduced anxiety-like behaviors in DSS-treated mice. This work expands our understanding of the neural mechanisms by which IBD leads to comorbid anxiety and emphasizes a critical role of gastric vagal afferent signaling in gut-to-brain regulation of emotional states.
... Patients with IBD could be more likely to receive a diagnosis of anxiety or depression, as they are more often seen by a doctor, potentially leading to detection bias. However, studies using survey-based design for symptoms of anxiety and depression also find an increased occurrence of anxiety and depression in patients with IBD [36][37][38], which speaks against such bias. The included studies differed somewhat with regards to exposure and outcome definitions. ...
Objective:
Inflammatory bowel disease (IBD) is associated with anxiety and depression, but the magnitude and directionality of risk remains uncertain. This study quantifies the risk of anxiety or depression following a diagnosis of IBD, and the risk of IBD in individuals with anxiety or depression, using population representative data.
Method:
We performed a systematic literature search using MEDLINE and Embase and included unselected cohort studies reporting risk of anxiety or depression in patients with IBD or risk of IBD in patients with anxiety or depression. We undertook Random Effect Model meta-analysis to calculate pooled Hazard Ratios (HR) for the risk of anxiety and depression in IBD and subgroup meta-analysis to calculate risk by IBD subtype and in pediatric-onset IBD.
Results:
Nine studies were included; seven of which examined incidence of anxiety or depression among a total of >150,000 IBD patients. Meta-analysis showed an increased risk of both anxiety (HR: 1.48, 95% CI: 1.29-1.70) and depression (HR: 1.55, 95% CI: 1.35-1.78) following IBD diagnosis. Two studies investigating >400,000 individuals with depression showed a 2-fold increased risk of IBD.
Conclusions:
The bidirectional association between IBD and anxiety and depression is clinically relevant and could indicate shared or mutually dependent disease mechanisms.
... Fuller-Thomson and Sulman [25] analyzed the link between IBD and clinical depression and found that approximately one in three patients diagnosed with IBD reported depression, and one in six patients had suicidal thoughts within a one-year study period. The findings from our data are also consistent with a national survey conducted in Canada which revealed that IBD patients had a two-fold increase in anxiety [26]. The American College of Gastroenterology (ACG) has now recommended psychiatric evaluation in the clinical guidelines for the management of Crohn's disease [27]. ...
Aim: Patients with inflammatory bowel disease (IBD) are more likely to develop anxiety or depression. The study aimed to describe the trends and disparities of suicidal ideation (SI) in hospitalized IBD patients.
Methods: A retrospective study was conducted using the National Inpatient Sample (NIS) database, to analyze SI among the IBD hospitalizations from 2009 to 2019. Bivariate analysis was conducted using a chi-square test for categorical variables and an independent t-test for continuous variables. For prevalence, the trend over time was evaluated using the score test.
Results: There were 1,724 IBD hospitalizations with SI for the study period. There was a male (53.8%) and white race (74.2%) predominance. The mean age was 41.47 ± 0.25 years. The hospital stay decreased for IBD hospitalizations with SI from 7.97 days in 2009 to 7.57 days in 2019 (P < 0.001). The mean hospital charge increased from 66,639 in 2019 (P < 0.001). The prevalence of SIs increased from 0.17% in 2009 to 0.29% in 2019 (P < 0.001). The mean age of these hospitalizations increased from 38 years in 2009 to 42.3 years in 2019 (P = 0.02). The prevalence of generalized anxiety disorder (GAD) increased from < 1% in 2009 to 12.19% in 2019 (P < 0.001). The prevalence of depression increased from 18.04% in 2009 to 51.21% in 2019 (P < 0.001). Inpatient mortality increased from 0% in 2009 to 2.43% in 2019 (P = 0.024). Among IBD hospitalizations, the male gender had a higher association with SIs than females (odds ratio 1.32 [95% confidence interval (CI) 1.06–1.66], P = 0.014).
Conclusions: There is a rise of SI among the IBD population. Specialized protocols should be in place in clinical settings and communities to identify and assess high-risk patients.
... These challenges are amplified in patients with inflammatory bowel disease (IBD), who are estimated to have a 2-to 6-fold increased odds for developing an anxiety disorder [5][6][7]. IBD and anxiety disorders have a bidirectional relationship, highlighting the importance of managing anxiety disorders in the treatment of IBD [6,8]. ...
Background:
Health anxiety has many damaging effects on patients with chronic illness. Physicians are often unable to alleviate concerns related to living with a disease that has an impact on daily life, and unregulated websites can overrepresent extreme anxiety-inducing outcomes. Educational clinician video interventions have shown some success as an acute anxiolytic in health settings. However, little research has evaluated if peer-based video interventions would be a feasible alternative or improvement.
Objective:
This pilot study assesses the efficacy of anxiety reduction for patients with Crohn disease (CD) and those with ulcerative colitis (UC) by showing patient testimonial videos during hospital visits. It investigates the degree to which patient testimonials can affect state anxiety, and whether patients are comfortable enough with the technology to share their stories.
Methods:
Patients with CD (n=51) and those with UC (n=49) were shown testimonial videos of patients with CD during their physician consultations at Kitasato University Kitasato Institute Hospital in Japan. The video testimonials were collected from Dipex Japan, the Japan branch of an international organization specializing in understanding patient experiences. Patients completed a Visual Analogue Scale for Anxiety before and after viewing the videos, a Hospital Anxiety and Depression Scale (HADS) survey before the videos, and satisfaction surveys. Patients receiving infusion therapy participated in the study while receiving treatment to minimize hospital workflow disruption.
Results:
Anxiety reduction, on the Visual Analog Scale for Anxiety, was significant in the entire cohort both when viewed as an ordinal variable (P=.003, t98=1086.5) and as a continuous variable (P=.01, t94=-2.54, 90% CI -3.47 to -0.72). Eighty percent (n=15) of patients with high HADS Anxiety (HADS-A) scores and 71% (n=24) of patients with high starting state anxiety experienced reduced anxiety after watching testimonials. Patients with high state anxiety but low HADS-A scores experienced anxiety reduction (69%, n=16). Forty-two percent (n=100) of patients responded that they would share their stories for future users. When patients with UC received testimonials from patients with CD, 71% (n=49) of patients reported that they were relevant despite differences in condition.
Conclusions:
Our pilot results suggest that patient testimonial videos can reduce illness-related state anxiety for patients with CD and those with UC, especially in those with higher baseline state anxiety. The success of this study in reducing anxiety and achieving patient involvement suggests that video interventions for reducing anxiety might be a low-cost intervention that could scale to any number of hospitals, suggesting that technology can help scale up efforts to record and share patient testimonials. Future work can establish whether patient testimonials can be helpful in other contexts, such as before major surgeries or when a family member receives a difficult diagnosis.
... Anxiety disorders have a high lifetime prevalence in the USA with about one-third of all adults being diagnosed with an anxiety disorder [7,8]. IBD patients are twice as likely to be diagnosed with a generalized anxiety disorder (GAD) as compared to the general population [9]. GAD is a prevalent type of anxiety; the lifetime prevalence of GAD is 6.2% for patients between the ages of 18 and 64 years old [8]. ...
Background
The development of inflammatory bowel disease (IBD), which encompasses ulcerative colitis and Crohn’s disease, is multifactorial. Stress from anxiety is a risk factor for IBD. Generalized anxiety disorder (GAD) is twice as likely in IBD patients. This study explores the outcomes of patients hospitalized for IBD with comorbid GAD.
Methods
A retrospective analysis utilizing the 2014 USA National Inpatient Sample database was performed to assess the outcomes of hospitalized IBD patients with and without GAD. The outcomes analyzed were sepsis, acute hepatic failure, hypotension/shock, acute respiratory failure, acute deep vein thrombosis, acute renal failure, intestinal obstruction, myocardial infarction, ileus, inpatient mortality, colectomy, intestinal abscess, intestinal perforation, and megacolon. A multivariate logistic regression analysis was employed to explore whether GAD is a risk factor for these outcomes.
Results
Among 28,173 IBD hospitalized patients in the study, GAD was a comorbid diagnosis in 3,400 of those patients. IBD patients with coexisting GAD were found to be at increased risk for acute hepatic failure (adjusted odds ratio (aOR) 1.80, p = 0.006), sepsis (aOR 1.33, p < 0.001), acute respiratory failure (aOR 1.24, p = 0.018), inpatient mortality (aOR 1.87, p < 0.001), intestinal abscess (aOR 2.35, p = 0.013), and intestinal perforation (aOR 1.44, p = 0.019). The aORs for the remaining outcomes were not statistically significant.
Conclusions
In hospitalized IBD patients, GAD is a risk factor for sepsis, acute hepatic failure, acute respiratory failure, intestinal abscess, intestinal perforation, and inpatient mortality. IBD and GAD are becoming increasingly common, which will likely lead to a larger number of complications among inpatients with these comorbidities.
... The impact of IBD is wide-ranging and symptoms include diarrhoea, rectal bleeding, unintended weight loss, and fatigue, while IBD also confers an increased risk of certain cancers [1,2]. Co-morbid psychological difficulties are also prevalent, including elevated stress, depression, anxiety, and body image impairment [3][4][5][6][7]. This further exacerbates the impact on the individual's quality of life, but also impacts disease management. ...
Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.
... IBD patients also worry about possible disease complications and other issues related to their illness [7]. Furthermore, IBD is known to cause mental conditions such as anxiety and depression [8][9][10]. ...
Objective:
Inflammatory bowel disease, consisting of Crohn's disease and ulcerative colitis, is known to negatively impact an individual's quality of life. Leisure-time activities are an important part of life by creating and strengthening social networks. The aim of this study was to thoroughly evaluate the perceived impact of inflammatory bowel disease on leisure-time activities by quantifying limitations in activities caused by the disease.
Methods:
A structured questionnaire, hospital records and national registers were combined to assess limitations caused by the disease in a patient's leisure-time activities. The final study sample was 561 patients.
Results:
More than half of the patients (52.8%) reported that IBD had caused limitations in their leisure-time activities. Women perceived that their limitations were greater when compared to the reports by men. One-third of the patients (33.3%) reported reducing and 17.6% abandoning at least one leisure-time activity due to their disease. Most often mentioned activities that were reduced and abandoned were physical activities. The IBDQ32 score had a significant correlation with all of the studied outcomes. Laboratory tests results and the patient's age or the level of income did not correlate with limitations in leisure-time activities.
Conclusions:
In conclusion, this study showed that patients with inflammatory bowel disease perceived a marked limitation in their leisure-time activities due to their disease.
... A study published in 2015 have reported that diabetes is associated with higher chances of developing GAD, this could be to the overwhelming of the new diagnosis of diabetes which may cause excessive worrying to the patient [28]. Another example is inflammatory bowel disease (IBD) in which there is a higher rate of GAD development [29]. Lastly, pain syndromes and chronic unexplained pain have a strong association with GAD [26,30]. ...
Generalized anxiety disorder (GAD) is a mental disorder defined as excessive worrying over little things. It is a one of the most common types of anxiety disorders. A study stated that 1-5% of the general population suffers from GAD. The condition affects the quality of life of a patient negatively and activities in their everyday life. In this review article, we highlighted several studies that compared combined therapy of psychotherapy and pharmacotherapy to either therapy alone, results were conflicting and differ from one study to another. Provide a thorough and comprehensive review of the different approaches of GAD management, several database websites were searched for articles discussing the pharmacological management of general anxiety disorder. Clinical trials, clinical guidelines, systematic reviews, meta-analyses and review articles were all reviewed and considered for inclusion. The review emphasizes the importance of taking the decision of therapy after counseling the patient, taking into account, the cost effectiveness of the treatment, patient’s symptomatology, comorbidity, medical conditions, concomitant using medications, previous trials and preference. Accordingly, thorough assessment should be done before moving to management plan, and a trial of other group or other therapies should be taken if there is no response seen. However, generalized anxiety disorder is one of the most common types of anxiety disorders. It has a lifetime prevalence around 5%, it can include intolerable cognitive, emotional and physical symptoms. Thus, GAD can adversely affect the patient’s life aspects, including personal, functional, social or educational. There are options to be taken among psychotherapy, pharmacotherapy or combined therapy.
... It is possible that fears of body change and attractiveness is much more relevant in women compared to young females, while possible explanations of the reduced QoL in younger girls include a different perception of illness compared to boys, a greater concern on having symptoms or relapse or on taking long term medications. Furthermore, in comparison to men, women with IBD are more exposed to the risk of psychological disturbances (particularly anxiety) [24][25][26] and social difficulties (e.g. in work productivity) 27,28 and this can at least partially explain their reduced QoL as adults. ...
Improving the quality of life (QoL) is crucial in the management of pediatric inflammatory bowel disease (IBD). We aimed to (1) Validate the IMPACT-III questionnaire in Italian IBD children; (2) explore factors associated to QoL in pediatric IBD. Internal consistency, concurrent validity, discriminant validity and reproducibility of the Italian version of the IMPACT-III questionnaire was measured in IBD children/adolescents in 8 centers. Associations between patient and disease characteristics and the IMPACT-III domains were analyzed through quantile regression analysis. The IMPACT-III questionnaire, collected in 282 children with IBD (median age: 14.8 years; IQR 12.4–16.4) showed a median total score of 76 (IQR 67–83). Female gender, active disease and age were negatively associated with the total IMPACT-III score. Specifically, female gender was negatively associated with the Bowel/Systemic Symptoms, Emotional and Treatment domain scores, while disease activity was significantly associated with Bowel Symptoms and Treatment/Interventions reported QoL. The IMPACT- III showed good internal consistency (Cronbach’s alpha coefficient = 0.87, 95% CI 0.85–0.89) and reproducibility (Concordance Correlation Coefficient = 0.66, 95% CI 0.57–0.74). In Italian children with IBD active disease, female gender and adolescence are associated to a worse QoL, indicating the need of more attention in this subgroup of young patients. IMPACT-III questionnaire is a reliable instrument to measure QoL in Italian children.
... However, our study found that age < 50 years is associated with SD in IBD patients. On the one hand, IBD is mainly prevalent in adolescents or early adult patients, and patients have been commonly reported complaints of elevated anxiety, lack of attractiveness, and feeling alone [44,45]. These factors can cause SD even at a young age [46]. ...
Purpose
Sexual dysfunction (SD) is increasingly identified in patients with inflammatory bowel disease (IBD), but there are few systematic reviews and meta-analyses of the studies of SD in IBD patients. The purpose of the study is to further quantify the association between IBD and SD.
Methods
MEDLINE (OVID), EMBASE (OVID), and the Cochrane Library (OVID) were searched (until August 2020) to identify observational studies that reported the prevalence and risk factors of SD in IBD patients. Pooled prevalence, odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated.
Results
Of the 945 citations evaluated, 18 studies (including 36,676 subjects) reporting the prevalence of SD in the IBD population were included for analysis. The overall pooled prevalence was 39% (95% CI 37–40%, P < 0.001). The prevalence of SD in women was 53% (95% CI 50–55%, P < 0.001), and it was 27% (95% CI 25–29%, P < 0.001) in men. The prevalence was higher in conjunction with operation (OR, 1.33, 95% CI 1.22–1.45, P < 0.001), depression (OR 6.14, 95% CI 3.51–10.76, P < 0.001), disease activity (OR 2.73, 95% CI 1.32–5.64, P = 0.007), comorbidities (OR 3.21, 95% CI 2.06–5.00, P < 0.001), age < 50 years (OR 3.85, 95% CI 2.41–6.14, P < 0.001), and the need for corticosteroids (OR 2.62, 95% CI 1.48–4.66, P = 0.001).
Conclusion
SD occurred frequently in the IBD population. Operation, depression, disease activity, comorbidities, age < 50 years, and the need for corticosteroids were risk factors for SD in IBD patients. SD screening might be recommended in IBD patients with the aforementioned factors.
... Patients with IBD are commonly diagnosed between the ages of 15 and 30 years, encompassing adolescence and early adulthood (1). This represents a dynamic period of time, where individuals typically focus on building relationships, establishing careers and striving toward personal and financial independence (14). Any disease that affects the mental state of individuals may also subsequently interfere with careers and relationships at a critical period in life which could have long-lasting consequences (15). ...
Background: The aim of this study was to examine the associations among depression, anxiety and health-related quality of life and predictors of improvement of quality of life in patients with inflammatory bowel disease.
Methods: This was a prospective cohort study conducted in the gastroenterology clinic at McMaster University Medical Center in Hamilton, Ontario, Canada from May 2014 to March 2015. We included 60 adult patients above the age of 18 years old with a diagnosis of inflammatory bowel disease. We assessed anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and Health Related Quality of Life (HRQoL) using the Short Inflammatory Bowel Disease questionnaire (SIBDQ) at baseline and after 6 months. Linear regression was performed to estimate the associations among depression, anxiety and predictors of improvement in health-related quality of life.
Results: The anxiety scores decreased over the span of 6 months (median HADS-A baseline 9.00 [interquartile range {IQR} 6 to 12], and median HADS-A 6 months 7.00 [IQR 3.75 to 7.00]). There was a moderate negative correlation between anxiety (baseline r = −0.510, and 6-month r = −0.620; P < 0.001), depression (baseline r = −0.630, and 6-month r = −0.670; P < 0.001) and HRQoL scores. Using a multivariate linear regression model, elevated HADS score were associated with lower SIBDQ scores at baseline (Beta coefficient −0.696 [95% confidence interval {CI} −1.51 to −0.842]; P < 0.001). Lower SIBDQ score at baseline predicted decreased SIBDQ at 6 months (Beta coefficient 0.712 [95% CI 0.486 to 1.02]; P < 0.001).
Conclusion: Anxiety and depression are frequently seen in inflammatory bowel disease patients and lead to poor HRQoL. Psychological comorbidities may contribute to maladaptive behaviours and difficult disease management.
... Such relationships between psychopathology and chronic pain are not limited to depression. In a study of adults with IBD, pain presents as one of the strongest correlates of anxiety, wherein those with chronic pain were 2.43 times more likely to experience anxiety than those without pain [14]. Moreover, other lines of inquiry have noted that in adults with chronic pain, as anxiety symptoms increase, the likelihood of experiencing disabling pain similarly increases [15]. ...
... In contrast, a population-based study from Canada associated female sex, a history of sexual abuse, and the presence of moderate or severe pain with GAD. 18 Even when the mechanisms of association between GAD and IBD are not clear, one of the explanations of this relationship involves a micronutrient deficiency and alterations in gut microbiota. 19 On the other hand, MDD was the most prevalent (27.9%) mood disorder in our study with higher rates than those reported by Neuendorf and colleagues in their systematic review 9 (15%), and the Manitoba Cohort Study 4 (9.1%). ...
Introduction
Different studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL.
Patients and methods
Subjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test.
Results
In all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p = 0.005), mood disorder (p = 0.004), anxiety disorder (p = 0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p = 0.01). Major depressive disorder (p = 0.004), social phobia (p = 0.03), PTSD (p = 0.02), and Generalized Anxiety Disorder (p < 0.001), were found to be significantly associated with lower QoL.
Conclusions
IBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.
... Risk factors independently associated with the increased incidence of depressive symptoms were IBD and a higher number of comorbidities [106]. Generalized anxiety disorder was twice as prevalent in IBD individuals than in healthy controls after adjustment for confounding factors such as sociodemographics, ACEs, depression, substance abuse and pain [107]. Anxiety and depression in patients with IBD, especially during the active phase of the disease, warrants a systematic assessment and management of mental health problems [16,17]. ...
The brain-gut axis represents a complex bi-directional system comprising multiple interconnections between the neuroendocrine pathways, the autonomous nervous system and the gastrointestinal tract. Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a chronic, relapsing-remitting inflammatory disorder of the gastrointestinal tract with a multifactorial etiology. Depression and anxiety are prevalent among patients with chronic disorders characterized by a strong immune component, such as diabetes mellitus, cancer, multiple sclerosis, rheumatoid arthritis and IBD. Although psychological problems are an important aspect of morbidity and of impaired quality of life in patients with IBD, depression and anxiety continue to be under-diagnosed. There is lack of evidence regarding the exact mechanisms by which depression, anxiety and cognitive dysfunction may occur in these patients, and whether psychological disorders are the result of disease activity or determinants of the IBD occurrence. In this comprehensive review, we summarize the role of the brain-gut axis in the psychological functioning of patients with IBD, and discuss current preclinical and clinical data on the topic and therapeutic strategies potentially useful for the clinical management of these patients. Personalized pathways of psychological supports are needed to improve the quality of life in patients with IBD.
... An association between high levels of neurosis, impulsivity and alexithymia and a reduction in mental and physical health in patients with IBD has also been found (Fuller- Thomson et al. 2015). The prevalence of alexithymia in these patients is around 35% (Hopkins & Moulton 2016;Viganò et al. 2018). ...
Act Nerv Super Rediviva 2020; 62(3-4): 95-105 ANSR62320A02 Abstract OBJECTIVES: Assessing the effect of antidepressant therapy (AD) on the abdominal symp-tomatology in Inflammatory Bowel Disease (IBD) patients with mood or anxiety disorders. METHODS: 58 IBD patients in clinical remission and without known psychiatric disorder but with positive scores in the Hospital Anxiety Depression Scale (HADS) were evaluated for the presence of anxiety and mood disorders (DSM-5 criteria) and administered the Self-report Symptoms Inventory, Revised (SCL-90-R), the Brief Coping Orientation to Problems Experienced (Brief-COPE), the Short Form-36 Health Survey (SF-36), the Hamilton Rating Scale for Anxiety (HAM-A) and Depression (HAM-D). Rectal bleeding and abdominal pain severity and evacuation frequency were evaluated. Patients with affec-tive disorders underwent AD therapy. We analyzed and compared clinical and psycho-metric findings at baseline, before therapy, and at 3-6-9-12 months follow-up. RESULTS: Of 58 patients enrolled 56,9% were diagnosed with anxiety or mood disorders. Compared to patients without psychiatric comorbidity, IBD-affective patients presented higher HAM-D and HAM-A scores, lower scores in "vitality" (SF-36), and "general anxiety" (SCL-90r) domains, poorer "positive restructuring" and "use of instrumental support" coping strategies, and increased evacuations. In the treated sample, AD therapy significantly reduced anxiety and depressive domains (HAM-A, HAM-D scores) and the data suggest a reduction of evacuation frequency. CONCLUSION: Comorbid IBD-affective patients show decreased levels of self-perceived health and of several coping mechanisms; Although they are in clinical remission most of them present increased number of bowel movements at the baseline, which decreased during AD therapy.
... This background might have influenced the results of our study. A study in 2015 showed that adverse childhood experiences, especially history of childhood sexual abuse in women, was associated with anxiety disorder and chronic abdominal pain in IBD patients [21], and having a positive outlook on interpersonal relationships will be even more difficult among patients with such adverse childhood experiences. ...
Background:
We previously treated patients with inflammatory bowel disease (IBD) using color therapy as part of projective psychotherapy and found differences in preferred colors selected in an imagined stressful situation between patients with ulcerative colitis (UC) and those with Crohn's disease (CD). In this study, we investigated differences in color selection among UC patients, CD patients, and healthy volunteers (HVs). More precisely, formal analysis using a projective technique was performed to evaluate their emotional characteristics when coping with stress, and egogram analysis was performed to investigate their collective psychological characteristics and behavioral characteristics as social selves.
Methods:
Eighty-three HVs, 70 UC patients, and 71 CD patients were shown a sheet displaying images of bottles each containing 2 horizontally separated compartments filled in the same color or different colors. The preferred colors selected under imagined psychological stress (loneliness) were analyzed using a projection approach to investigate the emotional characteristics of the inner self. The Tokyo University Egogram New Version II (TEG®II) was then used to analyze collective psychological characteristics and behavioral characteristics as social selves in the HV, UC, and CD groups.
Results:
Comparison of all 3 groups with the χ2 test showed that more participants chose calm colors in the CD group than in the HV and UC groups, while more participants chose stimulating colors in the UC group than in the CD group (p < 0.01). Analysis of TEG®II results with one-way analysis of variance and then with the Tukey-Kramer multiple comparison test revealed differences in collective psychological characteristics and behavioral characteristics in all 3 groups. Comparing scores for 5 types of ego states (Critical Parent, Nurturing Parent, Adult, Free Child, and Adapted Child) revealed that more participants in the CD group had a low Critical Parent score than in the HV group (p < 0.05). More participants in the IBD group had a low Nurturing Parent score than in the HV group (CD vs. HV, p < 0.01; UC vs. HV, p < 0.05). Significantly more participants in the UC group had a higher Adult score than in the HV or CD group (each p < 0.01).
Conclusions:
The psychological characteristics of patients with IBD differ depending on the type of disease (i.e., CD vs. UC). Management based on such differences should be provided for patients with each disease type.
... In addition, anxiety and negative body image perceptions including a relative feeling of lack of attractiveness and feeling alone are commonly seen in patients with IBD. 2,3 Despite this well-described association, a validated, unifying, easy-to-use tool in the office setting that addresses sexual health, disease activity, and severity in patients with IBD is lacking. Separate validated tools including the International Index of Erectile Function have been used in previous SD studies in male patients with IBD. 4 The National Institutes of Health Patient-Reported Outcomes Measurement Information System has a sexual function and satisfaction measures profile, which has also been used more recently in a study of sexual satisfaction in male patients with IBD. 5 In this issue of Crohn's & Colitis 360, Gaidos et al. report the findings of a prospective, multicenter Veteran's affairs study highlighting the high prevalence of SD in male Veterans with IBD: "High Prevalence of Male Sexual Dysfunction in a Prospective Multicenter VA Inflammatory Bowel Disease Population." ...
... 173,174 One possible explanation for this phenomenon is the concept of urbanisation, which is accompanied by significant changes in the gut microbiota 175 and associated with an increased incidence in IBD 175,176 as well as anxiety and depression disorders. [177][178][179] The link between childhood trauma and IBD 65,180 could also be mediated by the gut microbiota, since childhood is a critical phase for the development of several neuro-and immunobiological systems relevant for IBD, that is, the mucosal immune system, the intestinal microbiota, and immune tolerance in the gut. 181 Childhood trauma may contribute to dysfunctions in the interplay between these factors which may increase the risk for IBD and impact on mental health. ...
Background
Psychiatric co‐morbidities including depression and anxiety are common in inflammatory bowel diseases (IBD). Emerging evidence suggests that interactions between the gut microbiota and brain may play a role in the pathogenesis of psychiatric symptoms in IBD.
Aim
To review the literature on microbiota‐brain‐gut interactions in gut inflammation, psychosocial stress and mental disorders and to discuss the putative mediating role of gut microbiota in the development of psychiatric symptoms or co‐morbidities in IBD.
Methods
A literature search was conducted on Ovid and Pubmed to select relevant animal and human studies reporting an association between IBD, mental disorders and gut microbiota.
Results
Gut microbial alterations are frequently reported in subjects with IBD and with mental disorders. Both have been associated with reduced faecal bacterial diversity, decreased taxa within the phylum Firmicutes and increased Gammaproteobacteria. In animal studies, microbial perturbations induce behavioural changes and modulate inflammation in mice. Anxiety‐ and depression‐like behaviours in animals can be transferred via faecal microbiota. In humans, modulation of the gut microbiota with probiotics is associated with behavioural and mood changes. Recent data show correlations in changes of faecal and mucosal microbiota and psychological distress in patients with IBD independent of disease activity.
Conclusion
Both IBD and mental disorders are associated with gut microbial alterations. Preclinical and preliminary human studies have shown a mediating role of the gut microbiota in intestinal inflammation and anxiety, depression and stress. Targeting the gut microbiota may represent a useful therapeutic approach for the treatment of psychiatric co‐morbidities in IBD.
... [26][27][28] Also, psychotherapy by a counselor specially trained in the management of IBD improves the course of IBD in individuals with psychosocial stress, [29] indicating that managing psychologic stress may be a therapeutic target for IBD. Previous reports also show that female sex is associated with anxiety in IBD patients [30] as well as in the general population, [31] which is consistent with our present data that more female patients reported that psychologic stress induced disease exacerbation. Increased psychologic stress in the PSTE group may augment the fear for exacerbation and thereby affect these mechanisms, whereas other factor(s) may affect disease activity in the non-PSTE group. ...
Background and aims
Psychologic stress can affect the pathogenesis of inflammatory bowel disease (IBD), but the precise contribution of psychologic stress to IBD remains unclear. We investigated the association of psychologic stress with disease activity in patients with IBD, especially in terms of mental state and sleep condition.
Methods
This was a multi-center observational study comprising 20 institutions. Data were collected using survey forms for doctors and questionnaires for patients, and the association of psychologic stress with clinical parameters was investigated. Mental state was evaluated using the Center for Epidemiologic Studies Depression (CES-D) scale, and sleep condition was evaluated by querying patients about the severity of insomnia symptoms.
Results
A total of 1078 IBD patients were enrolled, including 303 patients with Crohn’s disease and 775 patients with ulcerative colitis. Seventy-five percent of IBD patients believed that psychologic stress triggered an exacerbation of their disease (PSTE group) and 25% did not (non-PSTE group). The CES-D scores were significantly higher for patients with clinically active disease than for those in remission in the PSTE group (median (interquartile range) = 7 (4–9.5) vs. 5 (3–7), p < .0001), but not in the non-PSTE group (5 (2–8) vs. 4 (3–7), p = 0.78). Female sex and disease exacerbation by factors other than psychologic stress were independent factors of psychologic stress-triggered disease exacerbation. Also, patients with insomnia had higher disease activity than those without insomnia, especially in the PSTE group.
Conclusions
A worsened mental state correlates with disease activity in IBD patients, especially those who believe that their disease is exacerbated by psychologic stress.
... Psychiatric comorbidity among individuals with an IMID condition has emerged as a topic of increasing interest, with recent studies demonstrating an increased prevalence of mental health disorders in individuals with IMID compared to the general population [3,4]. For example, a Canadian study found that individuals with IBD had twice the odds of generalized anxiety disorder compared to individuals without IBD after adjusting for potential contributing predictors [5]. However, studies have found that mental health disorders such as major depressive disorder (MDD) and anxiety disorder remain underdiagnosed in individuals with IMID [6][7][8]. ...
Objective
Individuals with immune-mediated inflammatory disease (IMID) have a higher prevalence of psychiatric disorders than the general population. We utilized machine-learning to identify patient-reported outcome measures (PROMs) that accurately predict major depressive disorder (MDD) and anxiety disorder in an IMID population.
Methods
Participants with IMID were enrolled in a cohort study and completed a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), and multiple PROMs. PROM items were ranked separately for MDD and anxiety disorder by the standardized mean difference between individuals with and without psychiatric disorders. Items were added sequentially to logistic regression (LR), neural network (NN), and random forest (RF) models. Discriminative performance was assessed with area under the receiver operator curve (AUC) and calibration was assessed with Brier scores. Ten-fold cross-validation was used.
Results
Of 637 participants, 75% were female and average age was 51 years. AUC and Brier scores respectively ranged from 0.87–0.91 and 0.07 (i.e., no variation) for MDD models, and from 0.79–0.83 and 0.09–0.11 for anxiety disorder models. In LR and NN, few PROM items were required to obtain optimal discriminatory performance. RF did not perform as well as LR and NN when few PROM items were included.
Conclusions
Predictive model performance was respectable and revealed insight into PROM items that are predictive of MDD and anxiety disorder. Models that included only the items ‘I felt depressed’ and ‘I felt like I needed help for my anxiety’ performed similarly to models that included all items from multiple PROMs.
... Persons with IBD have over twice the odds of generalized anxiety disorder (AD) and major depressive disorder (MDD) compared with the general population. [1][2][3] However, there has been minimal investigation of substance use disorder (SUD) in those with IBD. Existing research regarding SUD in those with IBD has been limited to either specific subpopulations with IBD, including pregnant and postpartum women, 4 or has investigated self-reported substance use but not specialist-or interviewer-diagnosed SUD. ...
Background
Substance use disorders (SUDs) impose a substantial individual and societal burden; however, the prevalence and associated factors in persons with inflammatory bowel disease (IBD) are largely unknown. We evaluated the prevalence and risk factors of SUD in an IBD cohort.
Methods
Inflammatory bowel disease participants (n = 247) were recruited via hospital- and community-based gastroenterology clinics, a population-based IBD research registry, and primary care providers as part of a larger cohort study of psychiatric comorbidity in immune-mediated inflammatory diseases. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV was administered to participants to identify lifetime SUD, anxiety disorder, and major depressive disorder. Additional questionnaires regarding participants’ sociodemographic and clinical characteristics were also completed. We examined demographic and clinical factors associated with lifetime SUD using unadjusted and adjusted logistic regression modeling.
Results
Forty-one (16.6%) IBD participants met the criteria for a lifetime diagnosis of an SUD. Factors associated with elevated odds of SUD were ever smoking (adjusted odds ratio [aOR], 2.96; 95% confidence interval [CI], 1.17–7.50), male sex (aOR, 2.44; 95% CI, 1.11–5.36), lifetime anxiety disorder (aOR, 2.41; 95% CI, 1.08–5.37), and higher pain impact (aOR, 1.08; 95% CI, 1.01–1.16).
Conclusions
One in six persons with IBD experienced an SUD, suggesting that clinicians should maintain high index of suspicion regarding possible SUD, and inquiries about substance use should be a part of care for IBD patients, particularly for men, smokers, and patients with anxiety disorders and pain.
... The absence of a significant relationship between anxiety and pain is unusual given reported relationships between these two variables in other chronic pain populations, eg, back and neck pain, 78 chronic pelvic pain, 79 and pediatric chronic pain. [80][81][82] Potential explanations for the lack of relationship in IBD might be limitations in pain measurements methods, 83 such as using a single item from a disease activity index 61 or a dichotomous present/absent pain rating. 62 Further investigations of pain and anxiety in IBD using robust pain measures are therefore warranted. ...
Background
Pain is commonly experienced in both active and dormant inflammatory bowel disease (IBD). Psychological and social factors, which can be key to pain experience, have been relatively neglected; the only prior comprehensive review focused solely on studies of adults. The present review, therefore, sought to systematically examine relationships between pediatric and adult experience of pain and psychosocial variables.
Method
Systematic searches of 5 databases were conducted to identify studies including measures of pain and psychosocial variables, in pediatric or adult IBD populations. Quality appraisal of studies was undertaken using a qualified assessment tool.
Results
Twenty-three articles met the inclusion criteria. Ten examined relationships between pain and psychosocial variables in adults, and 13 examined in pediatric populations. Inverse relationships were identified between pain and quality of life (QOL) in both populations, with potential differences in pain localization between the two populations. Psychological distress, notably depression, was also important in both populations, with inconsistent evidence for a role for anxiety in pediatric samples. Specific coping styles, and familial responses to communications, also appeared relevant, but with weaker evidence. There was substantial heterogeneity in measures, statistical analyses and sample characteristics, and quality appraisal revealed methodological weaknesses.
Conclusions
Significant relationships were found between pain and various psychological indices, notably QOL and depression. However, most studies were underpowered, did not sufficiently control for key confounds, and almost exclusively reported on Western participants. Adequately powered, statistically sound studies encompassing diverse populations are required to further clarify relationships between pain and psychosocial variables in IBD.
Introduction
Accumulating research suggests both eating disorders (EDs) and internalizing disorders (e.g., anxiety, depression) are associated with gastrointestinal disease (e.g., irritable bowel syndrome, inflammatory bowel disease). However, the mechanisms underlying comorbidity with gastrointestinal disease—and whether they may differ for eating and internalizing disorders—remain poorly understood. Addressing these gaps is a critical first step to refining etiologic models of comorbidity and identifying potential targets for intervention.
Method
Participants included female and male twins ages 18–65 from the population‐based MSU Twin Registry ( N = 5883). Lifetime history of EDs, internalizing disorders, and gastrointestinal disease was assessed via questionnaire. We first examined whether EDs and internalizing disorders were independently associated with gastrointestinal disease phenotypically. We then used trivariate Cholesky decomposition twin models to investigate whether EDs and internalizing disorders were related to gastrointestinal disease through overlapping or distinct genetic/environmental pathways.
Results
Eating (OR = 2.54, p = 0.009) and internalizing (OR = 2.14, p < 0.001) disorders were independently associated with gastrointestinal disease. Conclusions were unchanged after adjusting for important covariates (e.g., body mass index, age) and did not significantly differ across sex. Twin models suggested genetic influences shared by all three conditions explained their co‐occurrence, with 31% of the variance in EDs and 12% of the variance in gastrointestinal disease attributable to genetic influences shared with internalizing disorders.
Conclusion
Shared genetic mechanisms may contribute to comorbidity between EDs, internalizing disorders, and gastrointestinal disease. Identifying overlapping molecular pathways could potentially lead to novel interventions that simultaneously address all three conditions.
Background: Inflammatory bowel diseases (IBDs) have seen an exponential increase in incidence, particularly among pediatric patients. Psychological stress is a significant risk factor influencing the disease course. This review assesses the interaction between stress and disease progression, focusing on articles that quantified inflammatory markers in IBD patients exposed to varying degrees of psychological stress. Methods: A systematic narrative literature review was conducted, focusing on the interaction between IBD and stress among adult and pediatric patients, as well as animal subjects. The research involved searching PubMed, Scopus, Medline, and Cochrane Library databases from 2000 to December 2023. Results: The interplay between the intestinal immunity response, the nervous system, and psychological disorders, known as the gut–brain axis, plays a major role in IBD pathophysiology. Various types of stressors alter gut mucosal integrity through different pathways, increasing gut mucosa permeability and promoting bacterial translocation. A denser microbial load in the gut wall emphasizes cytokine production, worsening the disease course. The risk of developing depression and anxiety is higher in IBD patients compared with the general population, and stress is a significant trigger for inducing acute flares of the disease. Conclusions: Further large studies should be conducted to assess the relationship between stressors, psychological disorders, and their impact on the course of IBD. Clinicians involved in the medical care of IBD patients should aim to implement stress reduction practices in addition to pharmacological therapies.
Idiopathic gastrointestinal diseases include Crohn's disease (CD), ulcerative colitis (UC), and inflammatory bowel disease (IBD) (IBD). These cause severe morbidity and lower quality of life for patients and increase society's costs in both direct and indirect ways. The likelihood of getting IBD and the severity of the illness may be affected by dietary choices, as suggested by epidemiological studies. Symptoms include stomach discomfort, bloody diarrhea, and weight loss. These symptoms can lead to intestinal perforation, strictures, fistulising illness, and cancer. Inflammatory bowel disease has a complicated etiology, but current revelations in our comprehension of the pathophysiology of IBD have led to significant improvements in both diagnosis and treatment. This comprehensive study includes symptoms, diagnosis, clinical pathogenesis, genetic involvement, and mediators responsible for inflammatory bowel disease and related complications. Various animal models are also discussed in detail, along with their specific features. The role that certain nutrients in the diet have in the onset and treatment of inflammatory bowel disease is also highlighted.
In einer Perspektive der psychischen und somatischen Komorbidität werden folgende gastrointestinale Krankheiten betrachtet: gastroduodenale Ulkuskrankheit, gastroösophageale Refluxkrankheit, entzündliche und maligne Erkrankungen des Gastrointestinaltrakts. Erhöhte Prävalenzraten einer affektiven und Stress-bezogenen Komorbidität sind mit je negativen Auswirkungen auf das dynamische Krankheitsgeschehen im Verlauf assoziiert. Potentielle Einflüsse vorbestehender depressiver, ängstlicher oder posttraumatischer Störungen auf erhöhte Inzidenzrisiken einzelner gastrointestinaler Krankheiten sind differentiell zu betrachten. Sie sind selbst beim Ulkus pepticum mit seinem identifizierten Hauptkausalfaktor einer Helicobacter pylori-Infektion konstruktiv zu diskutieren, bei den Malignomen des Gastrointestinaltrakts aber empirisch weiter offenzuhalten. Ätiopathogenetisch sind komplexe Interaktionen zwischen zentralen und peripheren Prozessen innerhalb einer „brain-gastrointestinal tract-brain“ Achse zu diskutieren. Empirische Studien zur Psychotherapie und Pharmakotherapie koexistenter affektiver und Stress-bezogener Symptome werden referiert.
IBD, a chronic inflammatory disease, has been manifested as a growing health problem. No Crohn’s and Colitis councils have officially ratified anti-depressants as a routine regimen for IBD patients. However, some physicians empirically prescribe them to rectify functional bowel consequences such as pain and alleviate psychiatric comorbidities. On the other side, SSRIs’ prescription is accompanied by adverse effects such as sleep disturbances. Prolonged intermittent hypoxia throughout sleep disturbance such as sleep apnea provokes periodic reductions in the partial oxygen pressure gradient in the gut lumen. It promotes gut microbiota to dysbiosis, which induces intestinal inflammation. This phenomenon and evidence representing the higher amount of serotonin associated with Crohn’s disease challenged our previous knowledge. Can SSRIs worsen the IBD course? Evidence answered the question with the claim on anti-inflammatory properties (central and peripheral) of SSRIs and illuminated the other substantial elements (compared to serotonin elevation) responsible for IBD pathogenesis. However, later clinical evidence was not all in favor of the benefits of SSRIs. Hence, in this review, the molecular mechanisms and clinical evidence are scrutinized and integrated to clarify the interfering molecular mechanism justifying both supporting and disproving clinical evidence. Biphasic dose-dependent serotonin behavior accompanying SSRI shifting function when used up for the long-term can be assumed as the parameters leading to IBD patients’ adverse outcomes. Despite more research being needed to elucidate the effect of SSRI consumption in IBD patients, periodic prescriptions of SSRIs at monthly intervals can be recommended.
Background
During the COVID-19 pandemic in Italy, decisions were taken adopting restrictive legislative measures, such as the first half of 2020 lockdown. In those months, patients with inflammatory bowel disease have experienced social isolation and reduced access to health care.
Objective
Our aim was to evaluate, in this condition, the presence of remission subgroups that were most impacted by the lockdown.
Methods
In the midst of the first Italian lockdown, we recruited patients with remission inflammatory bowel disease administering an online questionnaire including patient demographics, the Beck Anxiety questionnaire Inventory, the Beck Depression Inventory questionnaire and the Pittsburg Sleep Quality Index, all validated standardized questionnaires for anxiety symptom levels, depression and sleep quality.
Results
Our results showed how female patients (p<0.0001) with Crohn’s disease (p<0.001) experienced worse levels of anxiety symptoms. Female patients (p<0.0001), between 50 and 60 years of age (p=0.013) and with Crohn’s disease (p=0.047) experienced worse levels of depressive symptoms. Females experienced significantly worse sleep levels (p<0.001). We found a correlation between the number of sleeping hours (p<0.001) and the time taken to fall asleep (p<0.001) and the Beck Anxiety questionnaire Inventory with a linear worsening of the number of minutes taken to sleep as well as with the Beck Depression Inventory questionnaire.
Conclusion
Among patients with inflammatory bowel disease in remission, female patients, patients with Crohn’s disease, and aged between 50 and 70 years should be considered for screening for anxiety and depression disorders and for an assessment of sleep quality.
Background
Research has identified a link between Attention-Deficit Hyperactivity Disorder (ADHD) and Generalized Anxiety Disorder (GAD). The aims of this study were to investigate the relationship between ADHD and GAD, and to identify significant correlates of GAD among those with ADHD.
Methods
Data were derived from the nationally representative 2012 Canadian Community Health Survey—Mental Health. The sample included 6,989 respondents aged 20–39, of whom 682 had GAD. Bivariate and logistic regression analyses were conducted to determine the degree to which the association between ADHD and GAD was attenuated by demographics, socioeconomic status, social support, spirituality, childhood adversities, depression, and substance abuse/dependence. Additional analyses were conducted using the subsample of those diagnosed with ADHD (n = 272) to determine factors associated with GAD.
Results
1 in 9 respondents with GAD had ADHD, in comparison to 1 in 33 of those without GAD. The age-sex-race adjusted odds of GAD were four-fold for those with ADHD in comparison to those without ADHD. After adjusting for all covariates, the odds of GAD were still more than double for those with ADHD. Factors associated with GAD among those with ADHD include being female, having an income <$40,000, having fewer close relationships, and having a lifetime history of depression.
Limitations
Cross-sectional design prohibits causal inferences.
Conclusion
The high co-morbidity between ADHD and GAD emphasizes the need for targeted intervention to support these often overlapping disorders.
Objective 1) To examine the relationship between migraine status and complete mental health (CMH) among a nationally representative sample of Canadians; 2) To identify significant correlates of CMH among those with migraine. Methods Secondary analysis of the nationally representative Canadian Community Health Survey – Mental Health (CCHS-MH) (N=21,108). Bivariate analyses and a series of logistic regression models were performed to identify the association between migraine status and CMH. Significant correlates of CMH were identified in the sample of those with migraine (N=2,186). Results Individuals without a history of migraine had 72% higher odds of being in CMH (OR=1.72; 95% CI=1.57, 1.89) when compared with those with a history of migraine. After accounting for physical health and mental health problems, the relationship between migraine status and CMH was reduced to non-significance, with both groups having an approximately equal likelihood of achieving CMH (OR=1.03; 05% CI=(0.92, 1.15). Among those with migraine, factors that were strongly associated with CMH were a lack of a history of depression, having a confidant, and having an income of $80,000 or more. Conclusion Clinicians and health care providers should also address co-occurring physical and mental health issues to support the overall well-being of migraineurs.
Peripheral inflammatory conditions, including those localized to the gastrointestinal tract, are highly comorbid with psychiatric disorders such as anxiety and depression. These behavioral symptoms are poorly managed by conventional treatments for inflammatory diseases and contribute to quality of life impairments. Peripheral inflammation is associated with sustained elevations in circulating glucocorticoid hormones, which can modulate central processes, including those involved in the regulation of emotional behavior. The endocannabinoid (eCB) system is exquisitely sensitive to these hormonal changes and is a significant regulator of emotional behavior. The impact of peripheral inflammation on central eCB function, and whether this is related to the development of these behavioral comorbidities remains to be determined. To examine this, we employed the trinitrobenzene sulfonic acid-induced model of colonic inflammation (colitis) in adult, male, Sprague Dawley rats to produce sustained peripheral inflammation. Colitis produced increases in behavioral measures of anxiety and elevations in circulating corticosterone. These alterations were accompanied by elevated hydrolytic activity of the enzyme fatty acid amide hydrolase (FAAH), which hydrolyzes the eCB anandamide (AEA), throughout multiple corticolimbic brain regions. This elevation of FAAH activity was associated with broad reductions in the content of AEA, whose decline was driven by central corticotropin releasing factor type 1 receptor signaling. Colitis-induced anxiety was reversed following acute central inhibition of FAAH, suggesting that the reductions in AEA produced by colitis contributed to the generation of anxiety. These data provide a novel perspective for the pharmacological management of psychiatric comorbidities of chronic inflammatory conditions through modulation of eCB signaling.
Introduction: Different studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL.
Patients and methods: Subjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test.
Results: In all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p=0.005), mood disorder (p=0.004), anxiety disorder (p=0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p=0.01). Major depressive disorder (p=0.004), social phobia (p=0.03), PTSD (p=0.02), and Generalized Anxiety Disorder (p<0.001), were found to be significantly associated with lower QoL.
Conclusions: IBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.
This collection of reports presents recent advances in our understanding of P-IBD and opportunities for improving care through further research and innovation
JUSTIFICATIVA E OBJETIVOS: As citocinas são substâncias necessárias para a resposta inflamatória, favorecendo a cicatrização apropriada da ferida. No entanto, a produção exagerada de citocinas pró-inflamatórias a partir da lesão pode manifestar-se sistemicamente com instabilidade hemodinâmica ou distúrbios metabólicos. O objetivo desta revisão foi descrever os efeitos das citocinas na dor. CONTEÚDO: Este artigo faz uma revisão dos efeitos das citocinas na dor. Em doenças que cursam com processo inflamatório agudo ou crônico, as citocinas podem ser reconhecidas por neurônios e utilizadas para desencadear diversas reações celulares que influenciam na atividade, proliferação e sobrevida da célula imunológica, bem como na produção e atividade de outras citocinas. As citocinas podem ser pró-inflamatórias e anti-inflamatórias. As pró-inflamatórias estão relacionadas com a fisiopatologia das síndromes dolorosas. Foram descritas as células que secretam as citocinas, as citocinas pró-inflamatórias (IL-1, IL-2, IL-6, IL-7 e FNT) e anti-inflamatórias (IL-4, IL-10, IL-13 e FTCβ), as funções de cada citocina e como ocorre a ação dessas substâncias no processamento da dor. CONCLUSÕES: As citocinas desempenham importante papel na dor, agindo através de diferentes mecanismos em vários locais das vias de transmissão da dor.
Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (OR = 6.67; P<.001), anxiety (OR = 4.84; P<.001), or co-morbid depressive and anxiety disorder (OR = 30.26; P<.001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (OR = 3.53; P<.001) as compared to controls. A current anxiety disorder (OR = 2.96; p<.001) and a co-morbid depressive and anxiety disorder (OR = 5.15; P<.001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research.
As traditional methods have become increasingly difficult, the Internet offers a mechanism for conducting survey research quickly and efficiently. However, the validity of this research depends on the ability of respondents to accurately report health status. We used a large Internet-based inflammatory bowel disease (IBD) cohort to validate self-reported IBD against physician reports.
Between June 22, 2012, and April 01, 2013, all participants of CCFA Partners (n = 6681) were invited to participate, and 450 were selected by random stratified sampling. We sent physicians a survey to confirm IBD diagnosis and characteristics. We used descriptive statistics to compare data.
A total of 4423 participants (66%) indicated interest. Of 450 selected, 261 (58%) consented, and physician reports were obtained for 184 (71%). Physicians confirmed IBD status in 178 (97%) and type in 171 (97% of confirmed). The matching between patient and physician reports for Crohn's disease (CD) was 82% for disease location, 89% for the presence of perianal disease, and 46% for disease behavior. For ulcerative colitis (UC), disease location matched 54% of the time. Physician reports confirmed the status of ever having bowel surgery for 97% of CD and 94% for UC and confirmed current pouch or ostomy in 84% of CD and 81% of UC.
Self-reported IBD in CCFA Partners is highly accurate, and participants are willing to release medical records for research. Self-reported phenotypic characteristics were less valid. The validity of IBD diagnoses among the participants of CCFA Partners supports the use of this cohort for patient-centered outcome research.
Knowledge of factors impacting adolescents' ability to adhere to their inflammatory bowel disease (IBD) regimen is limited. The current study examines the collective impact of barriers to adherence and anxiety/depressive symptoms on adolescent adherence to the IBD regimen.
Adolescents (n = 79) completed measures of barriers to adherence, adherence, and anxiety/depressive symptoms at one of two specialty pediatric IBD clinics.
Most adolescents reported barriers to adherence and 1 in 8 reported borderline or clinically elevated levels of anxiety/depressive symptoms. Anxiety/depressive symptoms moderated the relationship between barriers to adherence and adherence. Post hoc probing revealed a significant, additive effect of higher anxiety/depressive symptoms in the barriers-adherence relationship, with adherence significantly lower among adolescents with higher barriers and higher anxiety/depressive symptoms.
In order to optimize adherence in adolescents, interventions should target not only barriers to adherence but also any anxiety/depressive symptoms that may negatively impact efforts to adhere to recommended treatment.
Cytokines are necessary for the inflammatory response, favoring proper wound healing. However, exaggerated proinflammatory cytokine production can manifest systemically as hemodynamic instability or metabolic derangements. The objective of this review was to describe the effects of cytokines in pain.
This article reviews the effects of cytokines in pain. In diseases with acute or chronic inflammation, cytokines can be recognized by neurons and used to trigger several cell reactions that influence the activity, proliferation, and survival of immune cells, as well as the production and activity of other cytokines. Cytokines can be proinflammatory and anti-inflammatory. Proinflammatory cytokines are related with the pathophysiology of pain syndromes. Cells that secrete proinflammatory (IL-1, IL-2, IL-6, IL-7, and TNF) and anti-inflammatory (IL-4, IL-10, IL-13, and TGFβ) cytokines, the functions of each cytokine, and the action of those compounds on pain processing, have been described.
Cytokines have an important role in pain through different mechanisms in several sites of pain transmission pathways.
It has long been appreciated that the experience of pain is highly variable between individuals. Pain results from activation of sensory receptors specialized to detect actual or impending tissue damage (i.e., nociceptors). However, a direct correlation between activation of nociceptors and the sensory experience of pain is not always apparent. Even in cases in which the severity of injury appears similar, individual pain experiences may vary dramatically. Emotional state, degree of anxiety, attention and distraction, past experiences, memories, and many other factors can either enhance or diminish the pain experience. Here, we review evidence for "top-down" modulatory circuits that profoundly change the sensory experience of pain.
Clinicians are becoming aware of the increased attention paid to the occurrence of sexual and physical abuse in our society and its consequences. However, only recently has attention been paid to their association with medical and particularly gastrointestinal illnesses.
Recently, we investigated the frequency of sexual or physical abuse among female patients in our gastroenterology clinic, and their association with health status. Of 206 women, 89 (44%) reported some type of sexual or physical abuse in their lifetime. We also found that patients diagnosed with functional GI disorders when compared with those with organic diagnoses reported a significantly greater frequency of sexual (53% versus 37%) and physical abuse (13% versus 2%). Of these, 59% had never discussed the abuse experience outside their families, a third had never told anyone, and only 17% of their GI physicians were aware of this history. We also found that abuse history led to a poorer health outcome: more severe GI pain and a higher frequency of pelvic pain (16% versus 6%), more non-GI symptoms (7.1 versus 5.8), more physician visits in the previous six months (4.2 versus 3.3) and more lifetime operations (2.8 versus 2.0).
In a GI referral practice, abuse history is a hidden factor that is associated with poorer adjustment to illness, greater symptom severity and higher health care use rates. Since the publication of these data, several groups have supported our findings and obtained additional new data on associating factors and possible mechanisms of symptom generation. This paper will: (i) review this epidemiologic data, (ii) propose hypotheses about their association, (iii) offer suggestions to identify this information in a sensitive and supportive manner, and (iv) discuss how to initiate referral for ancillary psychosocial care.
The World Health Organization collaborative study on "Psychological Problems in General Health Care" investigated the form, frequency, course and outcome of common psychological problems in primary care settings at 15 international sites. The research employed a two-stage case-finding procedure. GHQ-12 was administered to 25916 adults who consulted health-care services. The second-stage assessment (n = 5438) consisted of the Composite international Diagnostic Interview (CIDI), the Social Disability Schedule, and questionnaires. Possible cases or borderline cases of mental disorder, and a sample of known cases, were followed up at three months and one year. Using standard diagnostic algorithms (ICD-10), prevalence rates were calculated for current disorder (one-month) and lifetime experience disorder. Well-defined psychological problems are frequent in all the general health-care settings examined (median 24.0%). Among the most common were depression anxiety, alcohol misuse, somatoform disorders, and neurasthenia. Nine per cent of patients suffered from a "subthreshold condition" that did not meet diagnostic criteria but had clinically significant symptoms and functional impairment. The most common co-occurrence was depression and anxiety. Comorbidity increases the likelihood of recognition of mental disorders in general health care, and the likelihood of receiving treatment.
Identifying the normal concerns of people with ulcerative colitis and Crohn's disease (CD) facilitates a comprehensive approach to their medical care. Clinically, it can be easily appreciated that the concerns of men and women with inflammatory bowel disease (IBD) may differ and that this may have a substantial impact on both coping and treatment decisions. However, sex differences have received little empirical study.
Significant differences between the sexes on the 25 items of the Rating Form of IBD Patient Concerns (RFIPC) were determined in 343 subjects by univariate ANOVA with disease type and sex as factors, correcting for multiple comparisons and covarying for IBD symptom severity.
Compared with men, women reported higher levels of IBD symptom severity and higher overall RFIPC scores. Women were more concerned than men about feelings related to their bodies, attractiveness, feeling alone and having children. There was an interaction between disease and sex regarding concern about sexual performance and intimacy. In both cases, men with CD reported less concern than each other comparison group. The illness concerns that differ between sexes are not the most intense concerns in either sex.
These results confirm that sex has a significant influence on a number of illness concerns, particularly concerns related to self-image and relationships. The interaction of disease type and sex with respect to concern over sexual performance and intimacy is open to several potential explanations and requires further research. Sex differences should be considered in the treatment of IBD. Specific inquiry into sex-specific concerns may be useful for the clinician. Further research is required to replicate these retrospective findings.
To determine whether depression or anxiety co-occurs with ulcerative colitis (UC) or Crohn's disease (CD) more often than expected by chance, and, if so, whether the mental disorders generally precede or follow the inflammatory bowel diseases (IBD).
Nested case-control studies using a database of linked hospital record abstracts.
Southern England.
Both depression and anxiety preceded UC significantly more often than would be predicted from the control population's experience. The associations were strongest when the mental conditions were diagnosed shortly before UC, although the association between depression and UC was also significant when depression preceded UC by five or more years. Neither depression nor anxiety occurred before CD more often than expected by chance. However, depression and anxiety were significantly more common after CD; the associations were strongest in the year after the initial record of CD. UC was followed by anxiety, but not by depression, more often than expected by chance and, again, the association was strongest within one year of diagnosis with UC.
The concentration of risk of depression or anxiety one year or less before diagnosis with UC suggests that the two psychiatric disorders might be a consequence of early symptoms of the as yet undiagnosed gastrointestinal condition. The data are also, however, compatible with the hypothesis that the psychiatric disorders could be aetiological factors in some patients with UC. Most of the excess anxiety or depression diagnosed subsequent to diagnosis of IBD occurs during the year after IBD is diagnosed and the probable explanation is that the mental disorders are sequelae of IBD.
A role for the intestinal microbial community (microbiota) in the onset and chronicity of Crohn's disease (CD) is strongly suspected. However, investigation of such a complex ecosystem is difficult, even with culture independent molecular approaches.
We used, for the first time, a comprehensive metagenomic approach to investigate the full range of intestinal microbial diversity. We used a fosmid vector to construct two libraries of genomic DNA isolated directly from faecal samples of six healthy donors and six patients with CD. Bacterial diversity was analysed by screening the two DNA libraries, each composed of 25,000 clones, for the 16S rRNA gene by DNA hybridisation.
Among 1190 selected clones, we identified 125 non-redundant ribotypes mainly represented by the phyla Bacteroidetes and Firmicutes. Among the Firmicutes, 43 distinct ribotypes were identified in the healthy microbiota, compared with only 13 in CD (p<0.025). Fluorescent in situ hybridisation directly targeting 16S rRNA in faecal samples analysed individually (n=12) confirmed the significant reduction in the proportion of bacteria belonging to this phylum in CD patients (p<0.02).
The metagenomic approach allowed us to detect a reduced complexity of the bacterial phylum Firmicutes as a signature of the faecal microbiota in patients with CD. It also indicated the presence of new bacterial species.
Stress is often perceived by patients with inflammatory bowel disease (IBD) as the leading cause of their disease. The aim of this study was to assess whether stress, evaluated through life event (LE) occurrence, is associated with IBD onset.
Incident cases of IBD, including 167 patients with Crohn's disease (CD) and 74 with ulcerative colitis (UC), were compared with two control groups, one of 69 patients with acute self-limited colitis (ASLC) and another of 255 blood donors (BDs). Stress was assessed using Paykel's self-questionnaire of LEs. Only LEs occurring within 6 months before the onset of symptoms in IBD cases and ASLC controls and before blood donation in BD controls were registered. Anxiety and depression were assessed using Bate's and Beck's questionnaires, respectively.
In univariate analysis, occurrence of LEs was more frequent in the 6-month period prior to diagnosis in CD cases than in UC cases or either control group. After adjustment for depression and anxiety scores as well as other characteristics such as smoking status and sociodemographic features, this association appeared no longer significant. No associations were noted between occurrence of LEs and onset of UC relative to controls.
Despite its separate association with CD, LE occurrence does not appear to be an independent risk factor for IBD onset.
Current and comprehensive information on the epidemiology of DSM-IV 12-month and lifetime drug use disorders in the United States has not been available.
To present detailed information on drug abuse and dependence prevalence, correlates, and comorbidity with other Axis I and II disorders. Design, Setting, and
Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule of the National Institute on Alcohol Abuse and Alcoholism in a large representative sample of US adults (N=43093).
Twelve-month and lifetime prevalence of drug abuse and dependence and the associated correlates, treatment rates, disability, and comorbidity with other Axis I and II disorders.
Prevalences of 12-month and lifetime drug abuse (1.4% and 7.7%, respectively) exceeded rates of drug dependence (0.6% and 2.6%, respectively). Rates of abuse and dependence were generally greater among men, Native Americans, respondents aged 18 to 44 years, those of lower socioeconomic status, those residing in the West, and those who were never married or widowed, separated, or divorced (all P<.05). Associations of drug use disorders with other substance use disorders and antisocial personality disorder were diminished but remained strong when we controlled for psychiatric disorders. Dependence associations with most mood disorders and generalized anxiety disorder also remained significant. Lifetime treatment- or help-seeking behavior was uncommon (8.1%, abuse; 37.9%, dependence) and was not associated with sociodemographic characteristics but was associated with psychiatric comorbidity.
Most individuals with drug use disorders have never been treated, and treatment disparities exist among those at high risk, despite substantial disability and comorbidity. Comorbidity of drug use disorders with other substance use disorders and antisocial personality disorder, as well as dependence with mood disorders and generalized anxiety disorder, appears to be due in part to unique factors underlying each pair of these disorders studied. The persistence of low treatment rates despite the availability of effective treatments indicates the need for vigorous educational efforts for the public and professionals.
The present study was designed to determine the reported prevalence of childhood sexual abuse in sample populations of females with depressive and anxiety disorders. Reported prevalence of childhood sexual abuse was studied in 119 women diagnosed with a depressive disorder and 66 women diagnosed with an anxiety disorder. Results showed that 43.7% of the depressive-disordered and 48.5% of the anxiety-disordered women reported a history of childhood sexual abuse. Unexpectedly high rates of reported sexual abuse were found among women specifically diagnosed with panic disorder, obsessive compulsive disorder, major depression, and depressive disorder NOS. A discussion of the findings is included. © 1993 American Association of Sex Educators, Counselors and Therapists.
Iron is required for appropriate behavioral organization. Iron deficiency results in poor brain myelination and impaired monoamine metabolism. Glutamate and GABA homeostasis is modified by changes in brain iron status. Such changes not only produce deficits in memory/learning capacity and motor skills, but also emotional and psychological problems. An accumulating body of evidence indicates that both energy metabolism and neurotransmitter homeostasis influence emotional behavior, and both functions are influenced by brain iron status. Like other neurobehavioral aspects, the influence of iron metabolism on mechanisms of emotional behavior are multifactorial: brain region-specific control of behavior, regulation of neurotransmitters and associated proteins, temporal and regional differences in iron requirements, oxidative stress responses to excess iron, sex differences in metabolism, and interactions between iron and other metals. To better understand the role that brain iron plays in emotional behavior and mental health, this review discusses the pathologies associated with anxiety and other emotional disorders with respect to body iron status.
Cannabinoids are used by patients with inflammatory bowel disease (IBD) to alleviate their symptoms. Little is known on patient motivation, benefit, or risks of this practice. Our aim was to assess the extent and motives for Cannabis use in patients with IBD and the beneficial and adverse effects associated with self-administration of Cannabis.
Consecutive patients with IBD (n = 313) seen in the University of Calgary from July 2008 to March 2009 completed a structured anonymous questionnaire covering motives, pattern of use, and subjective beneficial and adverse effects associated with self-administration of Cannabis. Subjects who had used Cannabis specifically for the treatment of IBD or its symptoms were compared with those who had not. Logistic regression analysis was used to identify variables predictive of poor IBD outcomes, specifically surgery or hospitalization for IBD.
Cannabis had been used by 17.6% of respondents specifically to relieve symptoms associated with their IBD, the majority by inhalational route (96.4%). Patients with IBD reported that Cannabis improved abdominal pain (83.9%), abdominal cramping (76.8%), joint pain (48.2%), and diarrhea (28.6%), although side effects were frequent. The use of Cannabis for more than 6 months at any time for IBD symptoms was a strong predictor of requiring surgery in patients with Crohn's disease (odds ratio = 5.03, 95% confidence interval = 1.45-17.46) after correcting for demographic factors, tobacco smoking status, time since IBD diagnosis, and biological use. Cannabis was not a predictor for hospitalization for IBD in the previous year.
Cannabis use is common in patients with IBD and subjectively improved pain and diarrheal symptoms. However, Cannabis use was associated with higher risk of surgery in patients with Crohn's disease. Patients using Cannabis should be cautioned about potential harm, until clinical trials evaluate efficacy and safety.
Internet-based surveys provide a potentially important tool for Inflammatory Bowel Disease (IBD) research. The advantages include low cost, large numbers of participants, rapid study completion and less extensive infrastructure than traditional methods. The aim was to determine the accuracy of patient self-reporting in internet-based IBD research and identify predictors of greater reliability.
197 patients from a tertiary care center answered an online survey concerning personal medical history and an evaluation of disease specific knowledge. Self-reported medical details were compared with data abstracted from medical records. Agreement was assessed by kappa (κ) statistics.
Participants responded correctly with excellent agreement (κ=0.96-0.97) on subtype of IBD and history of surgery. The agreement was also excellent for colectomy (κ=0.88) and small bowel resection (κ=0.91), moderate for abscesses and fistulas (κ=0.60 and 0.63), but poor regarding partial colectomy (κ=0.39). Time since last colonoscopy was self-reported with better agreement (κ=0.84) than disease activity. For disease location/extent, moderate agreements at κ=69% and 64% were observed for patients with Crohn's disease and ulcerative colitis, respectively. Subjects who scored higher than the average in the IBD knowledge assessment were significantly more accurate about disease location than their complementary group (74% vs. 59%, p=0.02).
This study demonstrates that IBD patients accurately report their medical history regarding type of disease and surgical procedures. More detailed medical information is less reliably reported. Disease knowledge assessment may help in identifying the most accurate individuals and could therefore serve as validity criteria. Internet-based surveys are feasible with high reliability about basic disease features only. However, the participants in this study were engaged at a tertiary center, which potentially leads to a bias and compromises generalization to an unfiltered patient group.
Background:
Chronic pain (CP) is a common symptom in patients with inflammatory bowel disease. This study aimed to examine its prevalence, severity, clinical associations, and impact on psychological well-being and to identify patient factors that independently predict the presence of severe/disabling pain.
Methods:
One hundred and twenty consecutive patients with inflammatory bowel disease attending a hospital-based clinic provided information through questionnaires on quality of life, mood disturbance, and functional gut symptoms. Those who had CP (pain occurring every day for 3 months within the past 6 months) provided additional information on the pain's intensity and associated disability and management and coping strategies.
Results:
Forty-six patients (38%) had CP, most commonly in the abdomen (91%), and they had higher disease activity, reduced quality of life, and more depression and anxiety and took more paracetamol and opiates than those without. These indices were worse in the subgroup of 23 with moderate-severe pain/disability. Criteria for irritable bowel syndrome were met in 70% of those with pain irrespective of its severity. Multivariate analysis identified 4 independent associations with moderate-severe pain/disability: active disease (odds ratio, 49 [95% confidence intervals, 1.6-1455]), catastrophizing tendency (35 [3-228]), medication belief score (0.05 [0.005-0.55], and depression score (1.80 [1.02-3.17]).
Conclusions:
CP has major effects on quality of life and functional and social outcomes. Active disease and maladaptive coping strategies and negative attitudes and beliefs toward symptoms are independently associated with more severe pain. Management strategies should move the focus away from analgesic dependence toward psychosocial intervention and nonpharmacologic therapy.
There is considerable controversy about the role of child sexual abuse in the etiology of anxiety disorders. Although a growing number of research studies have been published, these have produced inconsistent results and conclusions regarding the nature of the associations between child sexual abuse and the various forms of anxiety problems as well as the potential effects of third variables, such as moderators, mediators, or confounders. This article provides a systematic review of the several reviews that have investigated the literature on the role of child sexual abuse in the etiology of anxiety disorders. Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. Four meta-analyses, including 3,214,482 subjects from 171 studies, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for anxiety disorders, especially posttraumatic stress disorder, regardless of gender of the victim and severity of abuse. Additional biological or psychosocial risk factors (such as alterations in brain structure or function, information processing biases, parental anxiety disorders, family dysfunction, and other forms of child abuse) may interact with child sexual abuse or act independently to cause anxiety disorders in victims in abuse survivors. However, child sexual abuse may sometimes confer additional risk of developing anxiety disorders either as a distal and indirect cause or as a proximal and direct cause. Child sexual abuse should be considered one of the several risk factors for anxiety disorders and included in multifactorial etiological models for anxiety disorders.
Most studies of depression and inflammatory bowel disease (IBD) have been drawn from clinical populations or from samples selected from the membership of Crohn's and ulcerative colitis community organizations. This study determined the prevalence and correlates of depression in people with IBD or a similar bowel disorder from 2 nationally representative Canadian surveys. In the Canadian Community Health Survey, conducted in 2000 through 2001, there were 3076 respondents who reported that they had “a bowel disorder such as Crohn's disease or colitis” that had lasted ≥6 months and had been diagnosed by a health professional. The National Population Health Survey, conducted from 1996 through 1997, had 1438 respondents who reported that they had such a condition. Within each subsample, bivariate analyses were conducted to compare the depressed and nondepressed individuals. Logistic regression analyses also were conducted using the Canadian Community Health Survey 1.1 data set. The 12-month period prevalence of depression among individuals with IBD and similar bowel disorders was comparable in the 2 data sets (16.3% and 14.7%). Depression rates were higher among female respondents, those without partners, younger respondents, those who reported greater pain, and those who had functional limitations. Seventeen percent of depressed respondents had considered suicide in the past 12 months; an additional 30% had considered suicide at an earlier time. Only 40% of depressed individuals were using antidepressants. Individuals with IBD and similar bowel disorders experience rates of depression that are triple those of the general population. It is important for clinicians to assess depression and suicidal ideation among their patients with active IBD symptoms, particularly among those reporting moderate to severe pain.
Psychological disorders are highly prevalent in patients with inflammatory bowel disease (IBD). Anxiety and depression are known to independently affect quality of life and may additionally impair quality of life in IBD over and above the IBD itself. Some researchers have further proposed that anxiety and depression may influence the clinical course of IBD. However, despite the potential for anxiety and depression to play an important role in the clinical picture of IBD, there is little prospective well-controlled research in this area. Probably because of this lack of clear data, researchers dispute the actual role of these psychological disorders in IBD, with a number of conflicting opinions expressed. This article reports on a review of the literature in this field. Herein we discuss the five main areas of controversy regarding IBD and the specific psychological comorbidities of depression and anxiety: 1) the relative rate of cooccurrence of these psychological disorders with IBD; 2) the cooccurrence of these psychological disorders with particular phase of IBD; 3) the cooccurrence of these psychological disorders with the specific type of IBD; 4) the rate of these psychological comorbidities compared both to healthy subjects and to other disease states; and 5) the timing of onset of psychological comorbidity with respect to onset of IBD. Methodological weaknesses of the reviewed studies make it impossible to resolve these controversies. However, the results clearly show that anxiety/depression and IBD frequently interact. Given the long-term illness burden patients with IBD face, further prospective, appropriately controlled studies are needed to adequately answer the question of the precise interplay between anxiety/depression and IBD.(Inflamm Bowel Dis 2007)
Inflammatory bowel disease (IBD) has classically been associated with malnutrition and weight loss, although this has become less common with advances in treatment and greater proportions of patients attaining clinical remission. However, micronutrient deficiencies are still relatively common, particularly in CD patients with active small bowel disease and/or multiple resections. This is an updated literature review of the prevalence of major micronutrient deficiencies in IBD patients, focusing on those associated with important extraintestinal complications, including anemia (iron, folate, vitamin B12) bone disease (calcium, vitamin D, and possibly vitamin K), hypercoagulability (folate, vitamins B6, and B12), wound healing (zinc, vitamins A and C), and colorectal cancer risk (folate and possibly vitamin D and calcium). (Inflamm Bowel Dis 2012).
We conducted a systematic review to determine changes in the worldwide incidence and prevalence of ulcerative colitis (UC) and Crohn's disease (CD) in different regions and with time.
We performed a systematic literature search of MEDLINE (1950-2010; 8103 citations) and EMBASE (1980-2010; 4975 citations) to identify studies that were population based, included data that could be used to calculate incidence and prevalence, and reported separate data on UC and/or CD in full manuscripts (n = 260). We evaluated data from 167 studies from Europe (1930-2008), 52 studies from Asia and the Middle East (1950-2008), and 27 studies from North America (1920-2004). Maps were used to present worldwide differences in the incidence and prevalence of inflammatory bowel diseases (IBDs); time trends were determined using joinpoint regression.
The highest annual incidence of UC was 24.3 per 100,000 person-years in Europe, 6.3 per 100,000 person-years in Asia and the Middle East, and 19.2 per 100,000 person-years in North America. The highest annual incidence of CD was 12.7 per 100,000 person-years in Europe, 5.0 person-years in Asia and the Middle East, and 20.2 per 100,000 person-years in North America. The highest reported prevalence values for IBD were in Europe (UC, 505 per 100,000 persons; CD, 322 per 100,000 persons) and North America (UC, 249 per 100,000 persons; CD, 319 per 100,000 persons). In time-trend analyses, 75% of CD studies and 60% of UC studies had an increasing incidence of statistical significance (P < .05).
Although there are few epidemiologic data from developing countries, the incidence and prevalence of IBD are increasing with time and in different regions around the world, indicating its emergence as a global disease.
Experimental evidence suggests the endogenous cannabinoid system may protect against colonic inflammation, leading to the possibility that activation of this system may have a therapeutic role in inflammatory bowel disease (IBD). Medicinal use of cannabis for chronic pain and other symptoms has been reported in a number of medical conditions. We aimed to evaluate cannabis use in patients with IBD.
One hundred patients with ulcerative colitis (UC) and 191 patients with Crohn's disease (CD) attending a tertiary-care outpatient clinic completed a questionnaire regarding current and previous cannabis use, socioeconomic factors, disease history and medication use, including complimentary alternative medicines. Quality of life was assessed using the short-inflammatory bowel disease questionnaire.
A comparable proportion of UC and CD patients reported lifetime [48/95 (51%) UC vs. 91/189 (48%) CD] or current [11/95 (12%) UC vs. 30/189 (16%) CD] cannabis use. Of lifetime users, 14/43 (33%) UC and 40/80 (50%) CD patients have used it to relieve IBD-related symptoms, including abdominal pain, diarrhoea and reduced appetite. Patients were more likely to use cannabis for symptom relief if they had a history of abdominal surgery [29/48 (60%) vs. 24/74 (32%); P=0.002], chronic analgesic use [29/41 (71%) vs. 25/81 (31%); P<0.001], complimentary alternative medicine use [36/66 (55%) vs. 18/56 (32%); P=0.01] and a lower short inflammatory bowel disease questionnaire score (45.1±2.1 vs. 50.3±1.5; P=0.03). Patients who had used cannabis [60/139 (43%)] were more likely than nonusers [13/133 (10%); P<0.001 vs. users] to express an interest in participating in a hypothetical therapeutic trial of cannabis for IBD.
Cannabis use is common amongst patients with IBD for symptom relief, particularly amongst those with a history of abdominal surgery, chronic abdominal pain and/or a low quality of life index. The therapeutic benefits of cannabinoid derivatives in IBD may warrant further exploration.
Generalized anxiety disorder (GAD) is a prevalent psychiatric disorder with chronic symptoms and is commonly comorbid with depression.
To identify correlates of GAD among adults and to describe treatment patterns and functional limitations among individuals with this disorder.
Data for 2,082 subjects aged >or=21 years from the first Israeli national health interview survey (INHIS-1) (2003-2004) were analyzed. Information on GAD was collected using the short form of the Composite International Diagnostic Interview. Data were also obtained on socio-demographic, physical health characteristics, history of life threatening events, treatment seeking behaviors, use of medication and functional impairment.
The prevalence of GAD was highest among people aged 40-59 years, in those with asthma, hypertension and in those with osteoporosis. Regular exercise was associated with reduced prevalence for GAD (adjusted OR 0.46, 95% CI 0.22-0.95). The exclusion of individuals with major depression from analysis strengthened the association with age (adjusted OR 5.7, 95% CI 1.7, 19.7), weakened the association between GAD and osteoporosis (adjusted OR 3.4, 95% CI 1.2, 9.8), asthma (adjusted OR 3.4, 95% CI 1.2, 9.5) and regular exercise (adjusted OR 0.47 95% CI 0.2, 1.14). In this sub-sample, hypertension was no longer associated with GAD, and a significant association was found between GAD and past experience of life threatening events (adjusted OR 2.3, 95% CI 1.1-4.9). Psychiatric and psychological consultations were low among people with GAD (11.5% and 26.4% for those without and with comorbid depression, respectively), concurrent with a high degree of functional limitation.
Middle age, history of traumatic life events, and certain chronic medical diseases (e.g., asthma and osteoporosis) are important risk factors for GAD. They could be used to help identify and treat people with GAD.
In inflammatory bowel disease (IBD), ongoing gastrointestinal (GI) symptoms consistent with coexistent functional GI disorders (FGID) might occur. It is uncertain what effect these symptoms have on health-related quality of life (HRQoL) and psychological comorbidity. The aim of the present study was to identify interrelationships among IBD, symptoms consistent with FGID, HRQoL, and psychological comorbidity.
A total of 256 consecutive IBD patients had diagnoses and disease activity verified at case-note review. Patients completed a contemporaneous survey assessing HRQoL, anxiety/depression, and GI symptoms (classified by Rome III criteria).
Of 162 respondents (response rate: 63%), 95 (58.6%) had Crohn's disease and 63 (38.8%) had ulcerative colitis. By Rome III criteria, 66% met criteria for at least one FGID. Those with significant (Hospital Anxiety and Depression Scale ≥ 8) anxiety and/or depression were more likely to meet criteria for coexistent FGID (78% vs 22% and 89% vs 11%, respectively; each P < 0.001). A "load effect" was noted, such that the number of symptoms consistent with FGID in each patient correlated positively with anxiety and depression and negatively with HRQoL. Symptoms of any coexistent FGID were highly prevalent, even in those with currently-inactive IBD (57%). Conclusions: Symptoms consistent with FGID are highly prevalent in IBD and correlate with greater psychological comorbidity and poorer HRQoL in a "load-dependent" fashion. Therapy directed either at symptom load or psychological comorbidity might independently improve HRQoL in IBD.
Studies on anxiety and depression in inflammatory bowel disease (IBD) yielded inconsistent results. We compared anxiety and depression of patients with Crohn's disease (CD) and ulcerative colitis (UC) controlled for sociodemographic and medical variables with age- and sex-matched controls.
In all, 422 IBD patients (50% females, 314 CD, 108 UC) of different settings were compared with 140 age- and sex-matched patients with chronic liver diseases (CLD) of a tertiary care center and with 422 age- and sex-matched persons of a representative sample of the general German population (GP). Anxiety and depression and probable mental disorder were assessed by the German version of the Hospital Anxiety and Depression Scale. Comparisons between CD and UC were adjusted for medical (disease activity, number of IBD-associated diseases) and sociodemographic factors (age, gender, marital status).
CD and UC patients did not differ in the levels of anxiety and depression or in the frequency of a probable mental disorder. The levels of anxiety and depression of IBD patients with active disease were higher than that of the GP, but not of the IBD patients in remission. The depression score of the CLD sample was higher than that of the IBD sample (P<0.001), but not the anxiety score. Mental disorders were more frequent in IBD patients with slight (27.7%) and moderate/severe disease activity (49.3%) compared to GP (10.4%) (P<0.001), but not in IBD patients in remission (11.3%).
Patients with active IBD should be screened for anxiety and depression.
To examine race-ethnic differences in the lifetime prevalence rates of common anxiety disorders, we examined data from the Collaborative Psychiatric Epidemiology Studies. The samples included 6870 White Americans, 4598 African Americans, 3615 Hispanic Americans, and 1628 Asian Americans. White Americans were more likely to be diagnosed with social anxiety disorder, generalized anxiety disorder, and panic disorder than African Americans, Hispanic Americans, and Asian Americans. African Americans more frequently met criteria for post-traumatic stress disorder (PTSD) than White Americans, Hispanic Americans, and Asian Americans. Asian Americans were also less likely to meet the diagnoses for generalized anxiety disorder and PTSD than Hispanic Americans, and were less likely to receive social anxiety disorder, generalized anxiety disorder, panic disorder, and PTSD diagnoses than White Americans. The results suggest that race and ethnicity need to be considered when assigning an anxiety disorder diagnosis. Possible reasons for the observed differences in prevalence rates between racial groups are discussed.
Research has accumulated over the past several years demonstrating a relationship between childhood abuse and anxiety disorders. Extant studies have generally suffered from a number of methodological limitations, including low sample sizes and without controlling for psychiatric comorbidity and parental anxiety. In addition, research has neglected to examine whether the relationships between anxiety disorders and childhood abuse are unique to physical abuse as opposed to sexual abuse and vice versa. The current study sought to examine the unique relationships between anxiety disorders and childhood physical and sexual abuse using data from the National Comorbidity Survey-Replication. Participants (n=4141) completed structured interviews from which data on childhood abuse history, lifetime psychiatric history, parental anxiety, and demographics were obtained. After controlling for depression, other anxiety disorders, and demographic variables, unique relationships were found between childhood sexual abuse and social anxiety disorder (SAD), panic disorder (PD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD); in contrast, physical abuse was only associated with PTSD and specific phobia (SP). Further, among women, analyses revealed that physical abuse was uniquely associated with PTSD and SP, while sexual abuse was associated with SAD, PD, and PTSD. Among men, both sexual and physical abuse were uniquely associated with SAD and PTSD. Findings provide further evidence of the severe consequences of childhood abuse and help inform etiological accounts of anxiety disorders.
Although significant associations of childhood adversities (CAs) with adult mental disorders have been documented consistently in epidemiological surveys, these studies generally have examined only 1 CA per study. Because CAs are highly clustered, this approach results in overestimating the importance of individual CAs. Multivariate CA studies have been based on insufficiently complex models.
To examine the joint associations of 12 retrospectively reported CAs with the first onset of DSM-IV disorders in the National Comorbidity Survey Replication using substantively complex multivariate models.
Cross-sectional community survey with retrospective reports of CAs and lifetime DSM-IV disorders.
Household population in the United States.
Nationally representative sample of 9282 adults.
Lifetime prevalences of 20 DSM-IV anxiety, mood, disruptive behavior, and substance use disorders assessed using the Composite International Diagnostic Interview.
The CAs studied were highly prevalent and intercorrelated. The CAs in a maladaptive family functioning (MFF) cluster (parental mental illness, substance abuse disorder, and criminality; family violence; physical abuse; sexual abuse; and neglect) were the strongest correlates of disorder onset. The best-fitting model included terms for each type of CA, number of MFF CAs, and number of other CAs. Multiple MFF CAs had significant subadditive associations with disorder onset. Little specificity was found for particular CAs with particular disorders. Associations declined in magnitude with life course stage and number of previous lifetime disorders but increased with length of recall. Simulations suggest that CAs are associated with 44.6% of all childhood-onset disorders and with 25.9% to 32.0% of later-onset disorders.
The fact that associations increased with length of recall raises the possibility of recall bias inflating estimates. Even considering this, the results suggest that CAs have powerful and often subadditive associations with the onset of many types of largely primary mental disorders throughout the life course.
This study compares a community inflammatory bowel disease (IBD) sample of individuals with a matched non-IBD community sample of individuals on psychological functioning and health perceptions.
Participants in the population-based Manitoba IBD Cohort Study (n=388) were directly compared with sex-, age-, and region-matched controls from a national random-sample health survey on the aspects of psychological health, coping, and perceived general health.
Overall, the IBD sample had lower psychological well-being and mastery, as well as higher distress than did the non-IBD controls (P<or=0.02). Those with IBD used avoidant coping significantly more often, and active coping modestly more often than did the non-IBD sample; both had similar levels of "self-soothing" behaviors. Patients with Crohn's disease and ulcerative colitis had similarly poor levels of functioning along these dimensions compared with the non-IBD sample, as did those with active disease (P<0.01). However, those with inactive disease were similar to the non-IBD sample, and had modestly higher mastery levels. Whereas nearly half of the non-IBD group reported chronic health conditions, those with IBD were threefold more likely to report poorer health (odds ratio 3.07, 95% confidence interval: 2.10-4.47). Psychological factors explained a greater amount of variance in perceived health for the IBD than for the non-IBD sample.
Those with IBD have significantly poorer psychological health than do those without IBD and view their general health status more negatively, although adaptive stress-coping strategies were similar. However, when disease is quiescent there is little detriment to functioning. Active disease should be a flag to consider psychological needs in the care of an IBD patient.
Abdominal pain is a common symptom of inflammatory bowel disease (IBD: Crohn's disease, ulcerative colitis). Pain may arise from different mechanisms, which can include partial blockage and gut distention as well as severe intestinal inflammation. A majority of patients suffering from acute flares of IBD will experience pain, which will typically improve as disease activity decreases. However, a significant percentage of IBD patients continue experiencing symptoms of pain despite resolving inflammation and achieving what appears to be clinical remission. Current evidence suggests that sensory pathways sensitize during inflammation, leading to persistent changes in afferent neurons and central nervous system pain processing. Such persistent pain is not only a simple result of sensory input. Pain processing and even the activation of sensory pathways is modulated by arousal, emotion, and cognitive factors. Considering the high prevalence of iatrogenic as well as essential neuropsychiatric comorbidities including anxiety and depression in IBD patients, these central modulating factors may significantly contribute to the clinical manifestation of chronic pain. The improved understanding of peripheral and central pain mechanisms is leading to new treatment strategies that view pain as a biopsychosocial problem. Thus, improving the underlying inflammation, decreasing the excitability of sensitized afferent pathways, and altering emotional and/or cognitive functions may be required to more effectively address the difficult and disabling disease manifestations.
Given the impact of anxiety and mood disorders on health, it is important to consider these disorders in persons with inflammatory bowel disease (IBD). We assessed the prevalence of anxiety and mood disorders in a population-based IBD cohort.
A structured diagnostic interview was administered to participants in the cohort (N = 351), and rates were compared to age-, gender-, and region-matched controls drawn from a national survey (N = 779).
A comparison of lifetime prevalence suggests higher rates of panic, generalized anxiety, and obsessive-compulsive disorders and major depression and lower rates of social anxiety and bipolar disorders in the IBD sample than in national samples in the United States and New Zealand. Direct comparisons with matched controls (with data available for three anxiety disorders) found lifetime prevalence (IBD vs controls) as follows: social anxiety disorder lower in IBD (6%vs 11%, OR 0.52, 95% CI 0.32-0.85), panic disorder not significantly different (8.0%vs 4.7%, OR 1.59, 95% CI 0.96-2.63), agoraphobia without panic not significantly different (1.1%vs 0.6%, OR 1.44, 95% CI 0.37-5.55), and major depression higher (27.2%vs 12.3%, OR 2.20, 95% CI 1.64-2.95). Comparing IBD respondents with and without lifetime anxiety or mood disorder, those with a disorder reported lower quality of life and earlier onset of IBD symptoms and there was a trend toward earlier IBD diagnosis.
Clinicians should be aware of the increased prevalence of depression and possibly other anxiety disorders in persons with IBD as these disorders may influence response to treatment and quality of life.
In a follow-up study of incarcerated Connecticut youth, 69 subjects were interviewed during young adulthood. On follow-up, 26 gave histories of abuse discrepant with histories obtained from records and interviews conducted in adolescence. Eleven subjects agreed to an additional clarification interview, at which time they were apprised of the discrepancies. Of these, eight had adolescent records indicating that abuse had occurred but denied abuse during the adult follow-up interview. The remaining three had adolescent records indicating no abuse had ever occurred, but, on follow-up, reported having been abused. The additional clarification interviews revealed that all 11 subjects with discrepant histories had, in fact, been abused. Reasons for these discrepant data and strategies to enhance the investigator's ability to obtain accurate data regarding abuse are discussed.
One hundred and sixty two consecutive patients attending a clinic for inflammatory bowel disease (91 Crohn's, 71 ulcerative colitis) were assessed for the presence of anxiety and depression using a simple self-rating questionnaire (HAD scale) and a detailed evaluation (DSM-III). The overall prevalence of psychiatric illness (DSM-III) in ulcerative colitis and Crohn's disease was 34% and 33% respectively. There was no statistically significant association in ulcerative colitis patients between the presence of psychiatric illness and the present physical illness. Psychiatric illness was more common in the physically ill patients with Crohn's disease, compared with those who were well: 50% v 8% (p less than 0.01), using (HAD) criteria 66% v 37% (p less than 0.001). The presence of patients between the presence of psychiatric illness and the presence of physical illness. Psychiatric who were well: 50% v 8% (p less than 0.01) by DSM-III criteria, using (HAD) criteria 66% v 37% (p less than 0.001). The presence of psychiatric illness adversely affected physical recovery. Seventeen percent recovered when psychiatrically ill v 53% when psychiatrically well (p less than 0.025). The HAD scale was assessed as a screening method for psychiatric illness in this medical setting and had a sensitivity of 76% and a specificity of 79%.
The authors investigated whether histories of childhood physical or sexual abuse were reported more frequently in a clinical sample of patients with anxiety disorders than in a matched community comparison sample.
A standardized interview with an extensive series of trauma probes was administered to 125 patients with DSM-IV anxiety disorders (panic disorder, social phobia, or obsessive-compulsive disorder) and to 125 age- and gender-matched subjects drawn from a random community sample.
Childhood physical abuse was higher among both men (15.5%) and women (33.3%) with anxiety disorders than among comparison subjects (8.1%). Childhood sexual abuse was higher among women with anxiety disorders (45.1%) than among comparison women (15.4%) and was higher among women with panic disorder (60.0%) than among women with other anxiety disorders (30.8%).
These findings confirm the association between anxiety disorders and reported childhood physical and sexual abuse and extend earlier findings by pointing to a particular association between sexual abuse and panic disorder in women.
The features of adolescents who had taken an overdose were assessed to determine the focus for a treatment trial.
Overdose cases were compared with psychiatric and community controls who had not taken an overdose in respect of mental disorders and family background.
Overdose cases had high rates of major depression, but most of them recovered from depression within six weeks of the overdose. There was a specific association between taking an overdose and family dysfunction.
Family dysfunction could be a useful focus in a clinical trial of the aftercare of adolescents who have taken an overdose.
The evaluation of psychologic states is very useful in the management of inflammatory bowel disease (IBD) patients, particularly when related to disease activity (DA). Our aim was to prospectively evaluate the relationship between psychologic distress and DA.
DA and psychologic distress were evaluated in 104 IBD outpatients by means of clinical criteria and the Hospital Anxiety and Depression Scale (HADS) at base line and after 6 months. Patients were grouped in unchanged, improved, and worsened DA from base line to follow-up.
Repeated-measures ANOVA showed a significant group-by-time interaction for HADS anxiety (F = 89.6, P = 0.0001) and depression (F = 3.67, P = 0.03) subscales. Conclusions: Over time changes in DA significantly affect psychologic distress and are closely related to corresponding increases and decreases in anxiety and depression in IBD patients. Our findings therefore suggest that the assessment of psychologic distress, particularly anxiety, should be included in the clinical management of IBD patients.
The etiology of inflammatory bowel disease is unclear, and the role played by anxiety and depression is highly controversial. Anxiety and depression in patients with inflammatory bowel disease could be secondary to disabling symptoms, but the interaction between physical morbidity and psychologic illness in these subjects has not been sufficiently investigated. Patients with inflammatory bowel disease are nevertheless frequently undernourished, but there are no studies on the association between anxiety and depression and malnutrition. This study was designed to characterize anxiety and depression in subjects affected by inflammatory bowel disease and to establish the influence of physical morbidity and/or nutritional status on psychologic disorders.
Seventy-nine consecutive patients, 43 with Crohn's disease (CD) and 36 with ulcerative colitis (UC), were enrolled in the study. An index of the disease activity and physical morbidity was obtained by the simplified Crohn's Disease Activity Index and Truelove-Witts criteria and using the Clinical Rating Scale. Thirty-six healthy volunteers were studied as controls. All the subjects were given the State and Trait Anxiety Inventory (STAI) test and the Zung self-rating Depression Scale.
The percentage of subjects with state anxiety was significantly higher in the CD (P < 0.001) and UC (P < 0.001) groups than in control subjects. There was no significant difference in trait anxiety among groups. The percentage of subjects with depression was significantly higher in the CD (P < 0.05) and UC (P < 0.05) groups than in control subjects. State anxiety and depression were significantly associated with physical morbidity and correlated with malnutrition in CD and UC patients.
Anxiety and depression in patients with inflammatory bowel disease could be reactive to the disabling symptoms and to malnutrition. As measured with the STAI, personality trait of anxiety does not seem to play an important role in inflammatory bowel disease.
Cytokines play a central role in the modulation of the intestinal immune system. They are produced by lymphocytes (especially T cells of the Th1 and Th2 phenotypes), monocytes, intestinal macrophages, granulocytes, epithelial cells, endothelial cells, and fibroblasts. They have proinflammatory functions [interleukin-1 (IL-1), tumor necrosis factor (TNF), IL-6, IL-8, IL-12] or antiinflammatory functions [interleukin-1 receptor antagonist (IL-1ra), IL-4, IL-10, IL-11, transforming growth factor beta (TGF beta)]. Mucosal and systemic concentrations of many pro- and antiinflammatory cytokines are elevated in inflammatory bowel disease (IBD). An imbalance between proinflammatory and antiinflammatory cytokines was found for the IL-1/IL-1ra ratio in the inflamed mucosa of patients with Crohn's disease, ulcerative colitis, diverticulitis, and infectious colitis. Furthermore, the inhibition of proinflammatory cytokines and the supplementations with antiinflammatory cytokines reduced inflammation in animal models, such as the dextran sulfate colitis (DSS) model, the trinitrobenzene sulfonic acid (TNBS) model, or the genetically engineered model of IL-10 knockout mice. Based on these findings a rationale for cytokine treatment was defined. The first clinical trials using neutralizing monoclonal antibodies against TNF alpha (cA2) or the antiinflammatory cytokine IL-10 have shown promising results. However, many questions must be answered before cytokines can be considered standard therapy for IBD.
There is some evidence that, in humans and experimental animals, psychological stress may suppress or enhance immune functions, depending on the nature of the stressor and the immune variables under consideration. The possibility that psychological stress may affect the production of pro-inflammatory and immunoregulatory cytokines was investigated in 38 medical students, who had blood samplings a few weeks before and after as well as one day before an academic examination. Psychological stress significantly increased the stimulated production of tumour necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), IL-1 receptor antagonist (IL-1Ra), interferon gamma (IFN-gamma) and IL-10. Students with high stress perception during the stressful condition had a significantly higher production of TNF-alpha, IL-6, IL-1Ra and IFN-gamma than students with a low-stress perception. Students with a high anxiety response had a significantly higher production of IFN-gamma and a lower production of the negative immunoregulatory cytokines, IL-10 and IL-4, than students without anxiety. These findings suggest that, in humans, changes in the production of the pro-inflammatory cytokines, TNF-alpha, IL-6 and IFN-gamma, and negative immunoregulatory cytokines, IL-10 and IL-4, take part in the homeostatic responses to psychological stress and that stress-induced anxiety is related to a T-helper-1-like response.
Objectives:
Inflammatory bowel diseases (IBD) are chronic diseases associated with considerable morbidity. This morbidity may have an impact on the ability of patients to remain employed, on their marital status, and on their ability to complete a course of higher education. It has long been held that IBD patients are of a higher socioeconomic status and more educated than the general population. Our aim was to determine the relationship between IBD and employment, income, disability, education, and marital status in two population-based data sets based in the province of Manitoba, Canada.
Methods:
Two studies are reported here. In study A, we surveyed persons with IBD, using the population-based University of Manitoba IBD Database, created in 1995-1996. We compared these IBD patients to the general population with respect to employment, education, and marital status using data from the 1996 National Population Health Survey. IBD patients were queried as to their socioeconomic status as of the time of diagnosis and also at the time of the survey (1995-1996). In study B, we used a database that linked health care and census variables to determine differences in employment, income, occupation, and marital status among individuals who met the administrative definition of IBD (created in forming the University of Manitoba IBD Database, based on ICD-9-CM codes 555 for Crohn's disease and 556 for ulcerative colitis) compared with the rest of working-age population.
Results:
In study A we found that, compared with the general population, patients with IBD were more likely to be unemployed. Crohn's disease appeared to affect employment more than ulcerative colitis. IBD patients, however, had a low rate of reporting themselves as disabled (1.3%). Among those married when diagnosed with IBD, approximately 10% of men and up to 20% of women were no longer married 5 yr later. More patients with IBD were married in 1995 compared with the general population; however, more were also divorced. Fewer patients with IBD achieved postsecondary education. In study B, we found that individuals with IBD were twice as likely to be out of the labor force as were controls. Sedentary occupations were twice as likely to be associated with IBD. The income, education level, and marital status of IBD patients were not significantly different from those of controls.
Conclusions:
Individuals with IBD at some time in the course of their illness are more likely not to be working than are those in the general population. Based on employment status and job classification, as well as income and education, IBD patients are not of a higher socioeconomic status as previously reported. IBD patients are at least as likely as the general population to be married.
The chronicity of inflammatory bowel disease (IBD) and effects of medical and surgical treatments probably affect the daily lives of patients and may thus impair their health-related quality of life and psychological well-being.
Health-related quality of life and psychological distress were investigated in a population-based Swedish sample of patients with IBD. A total of 492 patients, 331 with ulcerative colitis (UC) and 161 with Crohn disease (CD), filled out the Short Form-36 (SF-36), the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Hospital Anxiety and Depression (HAD) scale.
Patients with UC reported higher (superior) levels in all dimensions of health-related and disease-specific quality of life than did patients with CD.
Having an ileostomy does not seem to affect patients' quality of life, while having ileoanal anastomosis appears to reduce patients' quality of life in several of the dimensions assessed. CD patients reported more anxiety and depression than did patients with UC. The higher psychological distress in the CD group could be explained by more severe symptoms of the disease. Having ileoanal anastomosis may lead to more anxiety and depression, while having an ileostomy does not.
This review highlights recent research findings on the relationship between persistent pain and depression and discusses the implications of these findings for future research in persons who suffer from both pain and depression. First, we briefly discuss advances in theories of pain that underscore the important role that depression can play in the chronic pain experience. Second, we discuss depression in persons suffering from chronic pain from a biopsychosocial perspective that takes into account both biological and psychosocial mechanisms linking pain and depression. Third, we address biomedical, psychosocial, and combined medical-psychosocial approaches to treatment in persons with persistent pain and depression. We conclude by highlighting future directions for research related to screening and diagnosis of depression in persons having persistent pain, treatment of comorbid pain and depression, and individual and subgroup differences in the experience of persistent pain and depression.
Patients with Crohn's disease (CD) are at risk of developing nutritional deficiencies, especially because of restrictive diets. The aim of our study was to assess food intake and the status for vitamins and trace elements in nonselected CD patients in clinical remission.
A total of 54 consecutive CD patients (28 females, 26 males, 39 +/- 2 years of age [mean +/- SD]) in clinical remission for >3 months underwent body composition, resting energy expenditure, nutrient intake, and plasma concentration assessment, and were compared with 25 healthy controls (16 females, 9 males, 38 +/- 3 years old).
According to the nutritional risk index, 37 patients (70%) were not malnourished, 12 were at moderate risk, and 4 were at severe risk for malnutrition. Fat mass was lower in patients in remission compared with controls (P = 0.04). The mean daily energy intake was comparable between patients (2218 +/- 92 kcal/day) and controls (2066 +/- 101 kcal/day), covering their needs. No significant difference was observed for macronutrient intake in comparison with controls; compared to controls, female CD patients had lower intakes of beta-carotene (P < 0.005), vitamins B1 (P < 0.05), B6 (P < 0.01), and C (P < 0.005), and magnesium (P < 0.01). They had significantly higher intakes of zinc (P < 0.01). Male CD patients had lower intakes of beta-carotene and vitamin C (P < 0.05). More than 50% of patients had low plasma concentrations of vitamin C (84%), copper (84%), niacin (77%), and zinc (65%).
In CD patients in remission, macronutrient needs are usually covered by food intake. However, micronutrient deficiencies are frequent and call for specific screening and treatment.