Abstract Background Inflammatory bowel disease (IBD) is thought to arise from a complex interaction of genetic, environmental and immune factors, with the biopsychosocial model further recognising the role of psychological and social factors on disease outcomes. Anxiety and depression are commonly reported in patients with IBD and are associated with increased rates of relapse and poor treatment response. This is thought to be via symptom perception, treatment adherence and the bidirectional nature of the brain-gut-microbiota axis1. However, there remains uncertainty regarding the prevalence of depressive symptoms in IBD, particularly whether depressive symptoms are predominant in Crohn’s disease (CD) versus ulcerative colitis (UC) and in females versus males. Methods We aimed to assess the prevalence and severity of depression, as well as specific depressive symptoms in IBD patients attending our Patient Infusion Unit (PIU), comparing rates between CD and UC, and between males and females. Consecutive patients attending the PIU at a large UK tertiary IBD centre completed the Patient Health Questionnaire-9 (PHQ-9). Questionnaires with at least 7 of 9 items completed were included. Scores were categorised into standard severity bands: 1-4 (minimal), 5-9 (mild), 10-14 (moderate), 15-19 (moderately severe), and 20-27 (severe). Scores of 10 or more were taken as being indicative of major depressive disorder 2. Between-group proportions were compared using chi-square tests with a significance level of 5%. Results Valid PHQ-9 scores were obtained from 208 patients (median age 36; 133 male, 73 female). The cohort included 68 patients with UC, 135 with CD and 5 with IBD-U. The overall rate of major depression was 31% (score ≥10). The prevalence of depression was higher in CD than UC (41% vs 13%, p 0.001), greater than pooled prevalence estimates reported at 21-25%3. There was no difference in the prevalence of depression between gender (p = 0.54). The highest scoring PHQ-9 items were fatigue/low energy (mean 1.5) and sleep disturbance (mean 1.4). Conclusion The prevalence of depressive symptoms in this cohort of IBD patients attending our PIU was high at 31%. Strikingly, the prevalence of depression was much higher in CD than UC but there was no increased prevalence in female patients with IBD as has been reported in other studies. Our data suggests that, given the usually limited availability of psychological interventions, it may be appropriate to undertake targeted screening within infusion units and treatment strategies which improve fatigue and quality of sleep may be most helpful. The fact that some studies specifically report poor outcomes to advanced therapies in patients with concomitant depression may further support this strategy. References: 1. Persoons P, Vermeire S, Demyttenaere K, Fischler B, Vandenberghe J, Van Oudenhove L, Pierik M, Hlavaty T, Van Assche G, Noman M, Rutgeerts P. The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Aliment Pharmacol Ther. 2005;21(10):1181-1191. doi:10.1111/j.1365-2036.2005.02552 2. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606 3. Bisgaard TH, Kjeldsen J, Kjeldsen J, et al. Prevalence of depression and anxiety in adult patients with inflammatory bowel disease: a systematic review with meta-analysis. J Crohns Colitis. 2022;16(11):1803–1817. doi:10.1093/ecco-jcc/jjac088 Conflict of interest: Dr. Patel, Priyanka: No conflict of interest Abuan, Ehrlich Ross: No conflict of interest Sastrillo, Marlene: No conflict of interest Hare, Naomi: No conflict of interest Calum, Moulton: No conflict of interest Mawdsley, Joel: No conflict of interest
Patel et al. (Thu,) studied this question.