LAS VEGAS — Anxiety and depression symptoms in veterans with inflammatory bowel disease (IBD) often fluctuate substantially over time, a researcher said here.
Among 80 IBD patients with at least three psychological evaluations in a longitudinal study, depression severity in 24 crossed thresholds defining mild/moderate/severe illness (in either direction) between visits, and by 26% for patients with anxiety, reported Niharika Mallepally, MD, MPH, of Baylor College of Medicine in Houston, at the Crohn’s & Colitis Congress.
Similarly, 21 of the 80 had anxiety symptoms that crossed mild/moderate/severe thresholds during follow-up, she said.
Persistent depressive symptoms — those remaining in the moderate-severe category through follow-up — were seen in 12 of the 80 veterans. Anxiety symptoms that never progressed beyond minimal-mild, but never fully abated, were seen in 49 of 80.
Psychological well-being is a critical aspect of IBD. The connection between IBD and psychological health are clinically evident. The conditions both need symptomatic control and medications that vary over time requiring changes in management and constant adjustment on the part of both the patient and the clinician, Mallepally highlighted here.
Many studies have looked at the relationship between psychological health and IBD. One systematic review indicated that 21% of IBD patients had depressive symptoms during periods of IBD remission, and 34% when IBD was active. As for anxiety, as many as 30% experience symptoms when the disease is in remission, which can reach 80% during active periods, Mallepally noted.
“Current literature does not uniformly explain the relationship between IBD and psychological health. Most studies explore IBD and psychological health with one measure, or at one point in time. But depression and anxiety symptoms are dynamic; changes are best captured through longitudinal study and through a multifactorial lens,” Mallepally said.
Veterans have a higher prevalence of anxiety and depression than the general population, but they have easy access to psychological resources and evaluations, she continued.
Established patients at the Michael E. DeBakey VA Medical Center’s IBD clinic were studied from 2014 to 2018, about evenly split between those with Crohn’s disease (CD) and ulcerative colitis (UC).
Among the CD patients, mean age was 50.9 years and 87.4% were male. UC patients averaged age 50.5 years and were 86.1% male.
They evaluated persistence of atypical scores as indicated by two or more consecutive visits, maximum scores, and proportion of visits with scores that were moderate to severe for PHQ-8 and GAD-7. For anxiety symptoms, a GAD-7 score of 10-14 was considered moderate; scores ≥15 were severe. For depression symptoms, a moderate PHQ-8 score was ≥10 and a severe depression score was ≥20.
Colonic site was linked with a greater proportion of visits with moderate to severe depressive symptoms.
Changes in diet, as reported by the patient, were linked with more severe anxiety and depression symptoms, and a greater proportion of visits with moderate to severe anxiety symptoms.
Work disability status was linked with more severe anxiety and depression symptoms, and a greater proportion of visits with moderate to severe anxiety and depression symptoms.
Study limitations included its focus on veterans and its observational nature. Also, the impact of antidepressants and anxiolytics on psychological health was not evaluated.