IBD: comorbid anxiety, not depression, tied to worse outcomes

  • Narula N & al.
  • Inflamm Bowel Dis
  • 7 Jan 2019

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Comorbid anxiety at baseline is associated with triple the risk for a poor IBD-related outcome in patients with inflammatory bowel disease (IBD), but there is no increased risk with comorbid depression.

Why this matters

  • Evaluation and treatment of anxiety at the beginning of care may improve IBD-related outcomes.

Study design

  • Prospective cohort of 414 patients with IBD aged ≥16 years at 2 sites in Ontario, Canada (2008-2016).
  • Patients were evaluated at baseline for IBD by Rome III questionnaire, and for anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). 
  • Poor IBD-related outcomes included IBD-related hospitalization, emergency department visit, and recurrent course of corticosteroids during follow-up.
  • Funding: None disclosed.

Key results

  • Mean duration of follow-up was 3.8-4.1 years.
  • Comorbid anxiety at baseline (HADS subscore >11), but not depression, was associated with increased risk for poor outcomes (aOR, 3.36; P=.003) vs no elevated anxiety (HADS subscore ≤11), after adjustment for covariates.
  • Other factors increased risk for poor outcomes:
    • severity of disease at baseline (aOR, 1.46; P=.04),
    • prior IBD-related surgery (aOR, 5.25; P<.001>
    • elevated C-related peptide (≥5 mg/L) at baseline (aOR, 3.23; P=.002), and
    • longer duration of follow-up (aOR, 1.50; P<.001>

Limitations

  • Endoscopy not uniformly used for disease severity.