Review article
Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review

https://doi.org/10.1016/j.jpsychores.2016.06.001Get rights and content

Highlights

  • We performed the largest comprehensive systematic review on the prevalence of anxiety and depression in IBD to date.

  • The prevalence of anxiety disorders in IBD is 21%; the prevalence of anxiety symptoms 35%.

  • The prevalence of depressive disorder in OBD is 15%; the prevalence of depressive symptoms is 22%.

  • IBD patients in active disease states have more depression and anxiety.

Abstract

Objective

An increasing number of studies have been conducted to look at anxiety and depression in IBD; however, there is no clear consensus on the prevalence of anxiety and depression in this population. The objective of this systematic review was to compile the existing data on the prevalence of all mood and anxiety disorders in Inflammatory Bowel Disease patients.

Methods

A series of comprehensive literature searches of Medline, Cochrane Library, PsycINFO, CINAHL, Embase, AMED, and ProQuest Dissertations were performed through March 2014. Inclusion criteria included peer-reviewed, published scientific articles that reported a measurement of mood or anxiety among IBD patients. Only studies with adults (≥ 18 years old) and with more than 10 patients were included. Methodological quality was assessed for all included studies.

Results

171 articles were identified with a total of 158,371 participants. Pooled prevalence estimate for anxiety disorders was 20.5% [4.9%, 36.5%] and 35.1% [30.5, 39.7%] for symptoms of anxiety. IBD patients in active disease had higher prevalence of anxiety of 75.6% [65.5%, 85.7%] compared to disease remission. Pooled prevalence of depression disorders was 15.2% [9.9%, 20.5%] and was 21.6% [18.7%, 24.3%] for symptoms of depression. The prevalence of depressive symptoms was higher in Crohn's disease (25.3% [20.7%, 30.0%]) compared to UC, and higher with active disease (40.7% [31.1%, 50.3%]) compared to IBD patients in remission.

Conclusion

Results from this systematic review indicate that patients with IBD have about a 20% prevalence rate of anxiety and a 15% prevalence rate of depression.

Introduction

Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition that results in damage to the mucosal surface of the gastrointestinal tract. Crohn's disease (CD) and ulcerative colitis (UC) are the two subset disorders of IBD. The incidence and prevalence of IBD is increasing worldwide. According to a systematic review by Molodecky et al., the prevalence of IBD is highest in Europe (UC: 505 per 100,000 persons, CD: 322 per 100,000) and North America (UC: 249 per 100,000, CD: 319 per 100,000) and that 75% of the CD studies and 60% of the UC studies showed an increasing incidence over time [1]. Burden of disease is high in IBD patients due to the chronic nature of the disease, symptoms of disease (fatigue, diarrhea, pain), higher mortality rates, and work disability [2], [3].

Despite some indications of increased depression and anxiety in IBD patients, most of these patients are not getting the mental health treatment they need [4], [5]. IBD patients with anxiety and depressive symptoms have a lower quality of life [4], [6] and the course of disease is worse in patients with depression [7]. Depressive disorders are a leading cause of global disease burden [8], [10]. Generalized anxiety disorder is considered to be equivalent to depression in disease burden and reduced psychosocial functioning [11]. Chronically ill patients who suffer from major depression often experience a higher degree of physical symptoms and a decreased ability for self-care [12]. In addition, these patients will have higher medical costs [12].

While many individual studies have looked at the prevalence of mood and anxiety disorders in Inflammatory Bowel Disease patients, no comprehensive systematic review has been conducted. One previous review only included a limited number of studies [13] and a second only analyzed studies with a control group [7], thus limiting the amount of data available for analysis. A systematic review on the psychosocial adjustment of youth with IBD found that youth with IBD had higher rates of depressive disorders than those with other chronic conditions [14]. However, they found that anxiety symptoms and anxiety disorders and symptoms of depression (not disorders) were no different in IBD youth than other youths. The goal of this systematic review was to synthesize all the data available regardless of study design to: 1) evaluate the prevalence of mood disorders and anxiety disorders or mood and anxiety symptoms in IBD patients, 2) evaluate whether disease type (UC, CD) impacts prevalence, 3) evaluate active disease versus disease in remission on prevalence of mood and anxiety disorders and symptoms, and 4) characterize the type of measurements used and mean values reported for each measure. Gaining a better understanding of the prevalence of anxiety and mood disorders in IBD patients can help guide clinicians, drive further research, and reduce the total burden of disease in these patients.

Section snippets

Methods

This systematic review was performed following the Meta-analysis of Observational Studies in Epidemiology guidelines for observational studies [15].

Results

A total of 2816 studies were identified in the search, 493 full papers were assessed for eligibility, and 171 articles were included in this review (Fig. 1). Of the 171 articles, 41 were supplemental abstracts and the remaining were published journal articles. The complete list of included studies and results are available in Supplemental Table 1. A total of 158,371 IBD patients were included in the analysis (with one study consisting of 100,687 of the participants). Excluding the one large

Discussion

This is the largest systematic review and meta-analysis that examines the prevalence of anxiety and depression in IBD patients. Both anxiety and depression are common in IBD and screening patients for these conditions can help improve quality of life and improve health outcomes [4], [6], [7]. Our analysis, based on 79 primary studies, estimates that about 15% of patients with IBD have depression and over 20% of patients have symptoms of depression, which is higher than expected in the general

Funding

This work was completed at the Helfgott Research Institute, National College of Natural Medicine without any external funding.

Acknowledgements

We would like to thank Heather James for her assistance in locating journal articles.

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    Institution work was performed at: Helfgott Research Institute, National College of Natural Medicine.

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