Influencing factors of anxiety and depression in mixed-age patients with inflammatory bowel disease: a systematic review and meta-analysis

Recently, the incidence of anxiety and depression in inflammatory bowel disease (IBD) patients has gradually increased. Critically, psychological comorbidities not only compromise quality of life but independently predict adverse IBD outcomes including heightened relapse risk and treatment non-adherence. Therefore, the aim is to conduct a systematic review and meta-analysis on the influencing factors of anxiety and depression in IBD patients and to provide a scientific basis for the effective prevention. We searched PubMed, Embase, PsycINFO, Web of Science and Cochrane Library until 30 January 2024. Included studies were cross-sectional or cohort designs. Quality was assessed using Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality. Data analysis used Stata 16.0 with fixed/random-effects models. Publication bias was assessed via Begg test and funnel plots. Twenty factors (e.g. age, marriage, education) were extracted. From 11, 755 citations, 28 studies (58,064 patients) met criteria. Overall, factors influencing anxiety in IBD patients include gender (OR = 1.85, 95% CI: 1.68-2.04), disease activity (OR = 1.56, 95% CI: 1.16-2.09), IBD-related surgery (OR = 0.64, 95% CI: 0.37-0.79) and non-white ethnicity (OR = 0.74, 95% CI: 0.62-0.88). Factors associated with depression in patients include gender (OR = 1.74, 95% CI: 1.62-1.86), disease activity (OR = 1.89, 95% CI: 1.50-2.39), IBD-related surgery (OR = 1.52, 95% CI: 1.20-1.92), male gender (OR = 1.59, 95% CI: 1.33-1.90), perianal disease (OR = 1.85, 95% CI: 1.35-2.55), higher education (OR = 1.56, 95% CI: 1.22-1.98), steroid use (OR = 2.05, 95% CI: 1.22-3.45), non-white ethnicity (OR = 0.72, 95% CI: 0.62-0.84) and family history (OR = 1.62, 95% CI: 1.33-1.97). Disease activity has a relatively high impact on the emotion of patients with inflammatory bowel disease, and gender differences and side effects of therapeutic drugs also play an auxiliary role. Therefore, early intervention should be carried out for the existence of modifiable risk factors of anxiety and depression in IBD patients.