Prevalence and Predictors of Symptoms of Anxiety or Depression at Diagnosis in Patients With Inflammatory Bowel Disease: An Inception Cohort

BACKGROUND: The prevalence of symptoms of a common mental disorder, including anxiety or depression, is high among patients with established inflammatory bowel disease (IBD). This may represent a therapeutic target for affected patients. However, whether these symptoms arise from genuine gut-brain effects, or are merely a consequence of a preceding adverse disease course is unclear. AIMS: To assess prevalence and predictors of anxiety and depression in an inception cohort of patients with IBD. METHODS: We collected demographic data, disease-related information, diagnosis of a pre-existing common mental disorder, symptoms of a common mental disorder, using the hospital anxiety and depression score, and gastrointestinal symptom-specific anxiety, using the Visceral Sensitivity Index (VSI), from individuals newly diagnosed with IBD during their index outpatient appointment or inpatient admission. The prevalence of symptoms of a common mental disorder at diagnosis, and predictors of the presence of these symptoms, were examined. RESULTS: Of 300 participants, 117 (39.0%) reported symptoms of a common mental disorder (107 (35.7%) anxiety, 47 (15.7%) depression). Younger age, female sex, tobacco use, a longer duration of symptoms prior to diagnosis, higher gastrointestinal symptom-specific anxiety, and stressful life events in the preceding 12 months were associated with a significantly increased likelihood of reporting these symptoms. Higher gastrointestinal symptom-specific anxiety remained significant following logistic regression (OR 2.19; 95% CI 1.00-4.79 for VSI moderate and OR 13.5; 95% CI 5.86-31.2 for VSI high, p < 0.001 for trend). CONCLUSION: Poor psychological health is highly prevalent at the time of an IBD diagnosis, suggesting genuine gut-brain effects.