Mental Disorders and Correlated Factors in Patients With Inflammatory Bowel Disease

Background:
Individuals with IBD experience a greater psychological burden compared to the general population, strongly impacting their quality of life. The course of IBD increases the risk of onset and persistence of mental disorders. Considering the high prevalence of mental disorders among IBD patients, the limited knowledge about the frequency of these conditions in developing countries, along with the scarcity of studies concurrently assessing multiple clinical variables, we aimed to evaluate the prevalence of depression, anxiety, and suicidal thoughts in IBD patients within a Brazilian cohort. Additionally, we investigated the potential associated independent factors.
Methods:
IBD patients were assessed for depression, suicidal thoughts, and anxiety using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). Depression was defined by PHQ-9 scores of ≥10 and positive suicidal ideation when the answer to the ninth question was other than “never”. Anxiety was considered present by GAD-7 scores of ≥10. Sociodemographic data and disease-related variables-potential associated factors-were collected from the electronic medical records. Statistical analyses were performed, with a significance level of 5%.
Results:
A total of 194 IBD patients were evaluated, including 93 patients with CD and 101 with UC. The majority were female (63.4%), married (55.2%), and reported a monthly income of up to 3 minimum wages (77.9%). Only 44.3% had a high school education. The most prevalent location of CD was the ileocolonic (54.8%) and pancolonic extension in the UC (33.7%). Additionally, 41.2% of the patients were in clinical remission based on HBI score. The prevalence of depression among IBD patients was 32%, with a higher prevalence in those with CD (41.9%) (OR=1.98, 95% CI: 1.08-3.62, p=0.026) compared to those with UC (26.7%, OR=1.00). Depression was more frequent in women (p=0.024), in patients with lower income (OR=0.29, 95% CI: 0.17-0.79, p=0.014), and in those with lower hemoglobin (p=0.022). Patients with active disease had a twofold increase in the odds of experiencing depression than those in remission (p=0.032). The prevalence of anxiety among IBD was 41.2%, with a higher rate in those with CD (48.4%) (OR=1.77, 95% CI: 0.99-3.15, p=0.052) compared to those with UC (34.7%) (OR=1). Factors associated with higher odds of experiencing anxiety were: female (OR=3.13, 95% CI: 1.57-6.24, p=0.001) older or younger current age (OR=0.97, 95% CI 0.95-1.00, p=0.017); where each additional year at the time of diagnosis reduced the chance of anxiety by 3%; lower monthly income (p=0.045); patients with previous surgery (p=0.033) and biological users were more likely to have anxiety (OR=2.64, 95% CI: 1.25-5.56, p=0.011). The prevalence of suicidal thoughts among IBD patients was 16% among IBD, with a higher prevalence in those with CD (22.6%) compared to those with UC (9.9%) (OR=2.65, 95% CI: 1.18-5.99, p=0.016). Other factors associated with suicidal thoughts were lower current age (p=0.018), lower income (p=0.016), lower hemoglobin (p=0.013). The odds of suicidal thoughts decreased by 33% for each 1-g/dL increase in current hemoglobin levels.
Conclusions:
Our Brazilian sample confirmed high rates of mental disorders and suicidal ideation in IBD patients. These findings reinforce the need for screening for mental disorders in the care of patients with IBD. Additionally, there is a need to focus on controlling the severity of the IBD specially in patients with depression, aiming at achieving clinical remission.