Symptoms of anxiety and depression are independently associated with inflammatory bowel disease-related disability

Chan, Webber; Shim, Hang Hock; Lim, Miao Shan; Sawadjaan, Fatimin Leila Bahjin; Isaac, Sangeetha; Chuah, Sai Wei; Leong, Rupert W.; Kong, Chris San Choon

doi:10.1016/j.dld.2017.08.020

Cited by 42 publications

(39 citation statements)

References 32 publications

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“…These authors found that the disability measured by the IBD-DI had a significant positive correlation with the IBDQ (r = 0.84, P < 0.01). 20 Similarly, in two previous studies from Singapore 21 and Australia, 3 which applied the same instrument to a small group of patients with IBD, the IBD-DI score was significantly correlated with disease activity and the IBDQ score. In our investigation, we found that the degree of disability evaluated by IBD-DI was associated with disease activity.…”

Section: Discussionmentioning

confidence: 65%

“…In fact, the IBD‐DI includes not only questions about sleepness, energy, body image and pain, but offers the possibility of including information on environmental factors, such as access to and quality of the health‐care and social support system, and family interactions, such as the support of able caregivers, which reduce disability and benefit the lives of patients . To date, except for studies on IBD‐DI development and validation, there are limited data on its application and usefulness in clinical practice …”

Section: Introductionmentioning

confidence: 99%

“…5 To date, except for studies on IBD-DI development and validation, 3,15-18 there are limited data on its application and usefulness in clinical practice. [19][20][21][22] Thus, our purpose was to evaluate the association between disease chronicity and the state of disability, in a large population of patients with UC and to clarify how it was related to patients' characteristics, their clinical and biomarker data, surgery, ongoing therapies and quality of life.…”

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confidence: 99%

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Factors associated with disability in patients with ulcerative colitis: A cross‐sectional study

Marinelli

Zingone

Inferrera

et al. 2020

J of Digest Diseases

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Objectives Ulcerative colitis (UC) can give rise to several restrictions of patients' working and social activities. We aimed to determine the association between disease chronicity and the state of disability in a large population with UC. Methods We recruited consecutive patients with UC attending the inflammatory bowel disease (IBD) unit of the Azienda Ospedaliera of Padua between July and December 2017. We collected patients' characteristics and clinical information, and all participants completed the IBD questionnaire (IBDQ) for quality of life assessment and the IBD disability index (IBD‐DI) questionnaire. Using univariate logistic regression models we assessed whether the patients' characteristics and IBD‐related variables were associated with an IBD‐DI score ≤3.5. Statistically significant variables in the univariate analyses were then included in a multivariate regression model. Correlations between IBD‐DI and all the above mentioned characteristics were investigated using the Spearman's rank correlation coefficient. Results We included 201 patients. A positive correlation was observed between IBD‐DI and IBDQ (r = 0.82, P < 0.001). Multivariate regression modelling identified the following as independent factors related to disability: active disease (partial Mayo score ≥2) (odds ratio [OR] 6.54, 95% CI 3.21‐13.22), the presence of extraintestinal manifestations (EIM) (OR 2.48, 95%, CI 1.11‐5.54) and occasional alcohol consumption (OR 0.39, 95% CI 0.20‐0.76). Conclusions Impaired disability is mainly correlated with disease activity, the presence of EIM and no alcohol consumption. Moreover, there is a strong correlation with patients' quality of life. Therefore, in clinical practice, greater awareness of IBD‐related disability is needed to better manage patients' outcomes.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Factors associated with disability in patients with ulcerative colitis: A cross‐sectional study

Marinelli

Zingone

Inferrera

et al. 2020

J of Digest Diseases

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“…Notably, depressive symptoms occur in more than 20% of people with IBD, which is approximately two to four times more common than in the general population [7,8] as reduced quality of life, the co-morbidity of depressive symptoms and IBD is associated with poor biomedical outcomes, including increased risk of IBD relapse, hospitalization and surgery [9]. A psychological model would position depressive symptoms as a secondary reaction to the burden of IBD, including difficulties with coping, disability, pain, socially unacceptable symptoms and fear of complications [10][11][12]. In turn, the poor prognosis of depressive symptoms could occur through negative effects on selfcare and treatment adherence [13,14].…”

Section: Introductionmentioning

confidence: 99%

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Moulton

Pavlidis

Norton

et al. 2019

Clinical and Experimental Immunology

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Summary Depressive symptoms are reported by more than 20% of people with inflammatory bowel disease (IBD), while sleep difficulties and fatigue are even more common. Co‐morbid depressive symptoms predict a poor IBD course, including increased risk of relapse and surgery, which is inconsistently improved by psychological treatments. Rather than being distinct systems, there is compelling evidence for bidirectional communication between gut and brain, driven by neural, metabolic, endocrine and inflammatory mediators. An emerging concept is that depressive symptoms may be mechanistically linked to excess inflammation and dysregulation of the gut–brain axis. Given the close link between the intestinal microbiota and host immune responses, patients prone to shifts in their intestinal microbiome, including smokers, those with poor diet and early life stress, may be exposed to exaggerated immune responses. Excess inflammation is associated with brain changes (depressive symptoms, fatigue, sleep difficulties) and worsening gastrointestinal symptoms, which are exacerbated by psychological distress. Equally, treatments both for depressive symptoms and IBD provide opportunities to break this cycle by reducing the causes and effects of inflammation. As well as addressing potential risk factors such as smoking and diet, treatments to alter the microbiome may reduce depressive symptoms. Observational evidence suggests that anti‐inflammatory treatments for IBD may improve co‐morbid depressive symptoms correlating with reduction in inflammation. With a growing range of treatments targeting inflammation centrally, peripherally and in the gut, IBD provides a unique model to understand the interplay between brain and gut in the pathogenesis of depressive symptoms, both in IBD and in the whole population.

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“…Previous literature suggests that anxiety is present in up to 40% of adults with CD [9, 11-13] and that up to 10% suffer from depression [11, 13-15]. Active CD is associated with greater symptoms of anxiety and depression [13, 14, 16, 17], and the achievement of disease remission mostly results in a reduction in symptoms of anxiety and depression [10].…”

Section: Introductionmentioning

confidence: 99%

Newly Diagnosed Crohn’s Disease Treated with Standard Care or Enteral Nutrition: Psychological Outcomes over 6 Months

et al. 2019

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Background and Aim: Impaired health-related quality of life and higher rates of anxiety and depression are observed in patients with Crohn’s disease. This single center study aimed to describe and compare longitudinal psychological outcomes of newly diagnosed Crohn’s disease patients treated with standard care or enteral nutrition to induce remission. Methods:Two separate cohorts of patients were recruited from one center and treated with standard care (n = 22) or enteral nutrition (n = 18) to induce disease remission. Disease activity, quality of life, anxiety, and depression were assessed at diagnosis and month 6. Results:At baseline, quality of life (n = 40) was not correlated with disease activity; symptoms of anxiety and depression were present in 15 (38%) and 5 (13%) of the 40 patients, respectively. Significant improvements in quality of life (p <0.0001) and anxiety scores (p = 0.002) were observed after 2 weeks of exclusive enteral nutrition, and at month 6 significant improvements in all psychological outcomes were observed. At month 6, patients who received standard care had a significant improvement in quality of life (p = 0.004), but not in anxiety or depression scores, and there were no differences in psychological outcomes between the treatment groups. Overall, 34/40 (85%) patients were in clinical remission at month 6, and a clinically significant quality of life score was achieved by 31/40 (78%). Conclusions:Patient health-related quality of life and symptoms of anxiety and depression improved as disease activity improved, and 6 months after diagnosis psychological outcomes were similar in patients treated with standard care or enteral nutrition to initially induce remission.

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Symptoms of anxiety and depression are independently associated with inflammatory bowel disease-related disability

Cited by 42 publications

References 32 publications

Factors associated with disability in patients with ulcerative colitis: A cross‐sectional study

Factors associated with disability in patients with ulcerative colitis: A cross‐sectional study

Depressive symptoms in inflammatory bowel disease: an extraintestinal manifestation of inflammation?

Newly Diagnosed Crohn’s Disease Treated with Standard Care or Enteral Nutrition: Psychological Outcomes over 6 Months

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