We would like to extend our gratitude to the authors for their comprehensive appraisal of our article, and for drawing attention to the priorities for future research in the field 1, 2. Poor psychological health, including anxiety and depression, affects a significant proportion of patients with IBD, with the reported prevalence of these symptoms exceeding double that of the general population 3. Reporting of symptoms of both anxiety and depression is highest during periods of disease activity 4, 5, suggesting a potential inflammatory mediated aeitology 5. However, the notion that these symptoms are merely a consequence of inflammatory burden is oversimplistic and fails to explain why almost one quarter of patients with objectively confirmed disease quiescence continue to report symptoms of anxiety or depression 4. Gastrointestinal symptom persistence is also an issue for patients with quiescent IBD, with up to one third reporting symptoms compatible with irritable bowel syndrome 6. It may be, therefore, that disordered gut-brain interactions are the primary driver of poor psychological health in IBD 5. Regardless of the origins of poor psychological health in IBD, symptoms of anxiety and depression are linked to a reduced quality of life, social isolation, loss of income and increased healthcare utilisation, including an observed twofold increase in the annual IBD-related healthcare costs, irrespective of disease phenotype or severity 3, 7, 8. Abnormal or worsening mood trajectories have been demonstrated previously, in our cohort, to negatively impact healthcare utilisation 9. This would be a minor issue if poor psychological health was reversible with treatment of inflammatory activity; however, our study draws attention to the persistence of symptoms of anxiety in up to three quarters of patients, and depression in up to two thirds over a prolonged period of longitudinal follow-up, underscoring that these symptoms cannot merely be a consequence of disease activity alone and highlighting the need for a fully integrated biopsychosocial model of care in IBD to address the unmet needs of a significant proportion of our patients 1. Though, in contrast to similar large-scale studies 10, we have not demonstrated a relationship between poor psychological health and adverse disease outcomes in this cohort of patients, the period of longitudinal follow-up of 24 months is a relatively short to examine disease complications such as hospitalisation or surgery 1. Furthermore, the aforementioned deleterious effects that poor psychological health infers on quality of life and healthcare utilisation should not be underestimated 7, 8. As the authors have alluded to, to truly disentangle the origins and influence of poor psychological health on the natural history of IBD, future randomised controlled trials examining drug efficacy on inflammatory activity should look to embed psychological screening tools to quantify the role of inflammatory burden on psychological health, and the impact of psychological health on future adverse disease outcomes 2. Furthermore, inception cohorts examining the role of poor psychological health in patients prior to the onset of disease complications may further delineate the complex relationship with disease activity, and we welcome the addition of such studies. Christy Riggott: writing – original draft. Christopher J. Black: writing – review and editing. Elspeth A. Guthrie: writing – review and editing. Christian P. Selinger: writing – review and editing. Keeley M. Fairbrass: writing – review and editing. David J. Gracie: writing – review and editing. Alexander C. Ford: writing – review and editing. The authors have nothing to report. This article is linked to Riggott et al. papers. To view these articles, visit https://doi.org/10.1111/apt.70431 and https://doi.org/10.1111/apt.70641. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Riggott et al. (Fri,) studied this question.