Abstract Background Psychological distress, particularly anxiety and depression, is increasingly recognized as a critical component of the inflammatory bowel disease (IBD) burden. Mental health may influence systemic inflammation, disease activity, and treatment responsiveness through the gut-brain axis 1,2. However, routine mental health screening remains underutilized in IBD care, even though ECCO guidelines recommend its integration 4. This study aimed to assess the prevalence, determinants, and clinical consequences of psychological distress in a large, real-world IBD cohort. Methods Between June 2023 and June 2025, 1,000 consecutive adult IBD patients (ulcerative colitis, n = 700; Crohn’s disease, n = 300) were prospectively enrolled at a tertiary referral center. Psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS) 3. Disease activity was measured using the partial Mayo score (UC) or the Harvey-Bradshaw Index (CD). Health-related quality of life was evaluated using the Inflammatory Bowel Disease Questionnaire (IBDQ). The primary endpoint was moderate-to-severe psychological distress, defined as a HADS-A or HADS-D subscale score ≥11. Secondary endpoints included corticosteroid use, hospitalization, and treatment escalation, defined as the initiation or intensification of biological or immunomodulator therapy. Multivariable logistic regression (adjusted for age, sex, and disease type) was used to identify independent predictors. Results Moderate-to-severe psychological distress was present in 43.6% (n = 436) of patients. Compared to those without distress, affected patients had: • Higher disease activity (mean 7.3 vs. 4.1; p0.001) • Lower IBDQ scores (162 ± 22 vs. 192 ± 25; p0.001) • Greater corticosteroid use (41% vs. 21%; p=0.006) • Higher hospitalization rate (28% vs. 13%; p=0.004) • Increased treatment escalation (27% vs. 13%; p=0.01) In the multivariable analysis, depression independently predicted hospitalization (OR 2.8; 95% CI: 1.6–4.7; p0.001), while anxiety was associated with corticosteroid use (OR 2.3; 95% CI: 1.3–4.1; p=0.003). These results are summarized in Table 1. Conclusion Psychological distress is common in IBD and is independently associated with higher disease activity, increased healthcare utilization, and treatment escalation. These findings support the need for routine mental health screening and integration of psychological care into IBD management, in line with ECCO recommendations 4. References: 1. Mikocka-Walus A, et al. The mind–gut connection in IBD. J Neuroinflammation. 2022;19(1):45. 2. Gracie DJ, et al. Psychological comorbidity and outcomes in IBD. Lancet Gastroenterol Hepatol. 2018;3(3):216–226. 3. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–370. 4. Raine T, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: 2024 Update. J Crohn’s Colitis. 2024;18(S1):i1–i137. Conflict of interest: Dr. Özden, Yavuz: the sole author of this abstract, declare that I have no conflicts of interest to disclose. I have received: No grants or personal fees, No consulting income or honoraria, No support for travel or meetings related to this study, No shares or equity in any related company, No involvement in data monitoring boards or endpoint committees, No payments for writing or reviewing activities, No non-financial support such as provision of medication, equipment, or writing assistance.
Y Özden (2026) studied this question.