Among patients with inflammatory bowel disease (IBD), about one-third have symptoms of anxiety and one-quarter have symptoms of depression, with the rates higher in patients with active disease compared with those who have inactive disease, according to a study in Lancet Gastroenterology & Hepatology.

Researchers conducted a systematic review and meta-analysis to assess the prevalence of symptoms of anxiety or depression in adult patients with IBD. Eligible studies had to have at least 90% of patients aged 18 years or older with histologically or radiologically confirmed IBD. A total of 77 studies with 30,118 patients in 23 countries were included.

The pooled prevalence of anxiety symptoms among patients with IBD was 32.1% (95% CI, 28.3-36.0; I² = 96.9%; P <.0001), based on 58 studies with 18,915 patients. The odds ratio (OR) for anxiety symptoms in patients with Crohn disease compared against those with ulcerative colitis (UC) was 1.2 (95% CI, 1.1-1.4), based on 19 studies that reported the prevalence of the 2 disorders within the same population.


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The pooled prevalence of depression symptoms in patients with IBD was 25.2% (95% CI, 22.0-28.5; I² = 97·6%; P <.0001), based on 75 studies with 29,438 patients. The OR for depression symptoms in patients with Crohn disease compared with those who had UC was 1.2 (95% CI, 1.1-1.4), based on 26 studies that reported the prevalence of the 2 disorders within the same population.

A total of 7 studies reported the prevalence of anxiety symptoms in patients with IBD according to sex, and the pooled prevalence in this cohort was higher in women (33.8%; 95% CI, 26.5-41.5), compared with men (22.8%; 95% CI, 18.7-27.2), with an OR of 1.7 (95% CI, 1.2-2.3).

Among 12 studies that reported the prevalence of depression symptoms in patients with IBD according to sex, the rate was higher in women with IBD (21.2%; 95% CI, 15.4-27.6), compared with men (16.2%; 95% CI, 12.6-20.3), with an OR of 1.3 (95% CI, 1.0-1.8).

For patients with active IBD, the pooled prevalence of anxiety symptoms was 57.6% (95% CI, 38.6-75.4) in 8 studies, and the pooled prevalence in patients with inactive IBD was 38.1% (95% CI, 30.9-45.7) in 15 studies. Regarding depression symptoms, the pooled prevalence in patients with active IBD was 38.9% (95% CI, 26.2-52.3) in 11 studies, and 24.2% (95% CI, 14.7-35.3) in patients with inactive IBD in 18 studies.

In the 8 studies that included patients with active and inactive IBD within the same cohort, the OR for anxiety symptoms in those with active versus inactive disease was 2.5 (95% CI, 1.5-4.1). The OR for depression symptoms in patients with active versus inactive IBD was 3.1 (95% CI, 1.9-4.9) in 11 studies that reported the prevalence rates in the same population.

The investigators noted certain weaknesses in their findings, including the considerable heterogeneity among the studies in all analyses, which was not explained by the subgroup analyses that was performed, as well as variation in the questionnaires used. In addition, cutoff values defining the presence of symptoms of anxiety or depression were not consistent among the studies.

“These data provide a useful primer for clinicians, as to which patients should be screened routinely for symptoms of common mental disorders, and suggest that there is a need to assess for symptoms of anxiety and depression using validated disease-specific screening tools,” the researchers commented. “Encouraging gastroenterologists to screen for and treat these disorders might improve outcomes for patients.”

Reference

Barberio B, Zamani M, Black CJ, et al. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. Published online March 12, 2021. doi: 10.1016/S2468-1253(21)00014-5

This article originally appeared on Gastroenterology Advisor