Anxiety is Associated With Increased Inflammatory Bowel Disease Disorder Disease Activity: Use of Retrospective Health Assessment Data and Generalized Anxiety Disorder Can Identify High-Risk Populations of Inflammatory Bowel Disease

Background:
Psychological factors like anxiety and depression may influence disease activity and outcomes in patients with inflammatory bowel diseases (IBD) and significantly impact unplanned healthcare utilization. We examined the association between symptoms of anxiety and depression, systematically assessed using screening questionnaires, and clinical disease activity in consecutive IBD patients enrolled in SonarMD, a technology-enabled care coordination platform providing value-based care for gastroenterology practices. The platform’s key attributes include enrollment risk assessment, proactive patient engagement, and remote monitoring of disease activity.
Methods:
We included patients with IBD who enrolled in the SonarMD care coordination platform between December 1, 2023, and August 30, 2024. All patients completed screening questionnaires for anxiety (Generalized Anxiety Disorder [GAD]-2]) and depression (Patient Health Questionnaire [PHQ]-2) at enrollment, along with evaluation of IBD severity and complications. Patients were classified as having anxiety symptoms if their GAD-2 score was 3 or more, and as having depressive symptoms if their PHQ-2 score as 3 or more. We examined IBD disease severity at baseline based on presence of IBD-related complications including abscess, bowel obstruction and fistula which have been associated with high risk of unplanned healthcare utilization. Patients were classified as having high disease severity (80th to 100th percentile of disease severity score), medium (79 to 34th percentile) and low (0-33rd percentile) disease severity at enrollment. These patients were followed with a monthly assessment of patient-reported outcomes using the “SonarScore”—a proprietary composite of these values—remotely collected via monthly text. SonarScore includes symptoms of bowel urgency, rectal bleeding and stool frequency. The score ranges from 0-120, and scores of >40 on follow-up, or with a 20-point increase from baseline, are considered increased disease activity suggestive of flare. We examined the cross-sectional association between anxiety symptoms at baseline and presence of comorbid depression symptoms and IBD disease severity, as well as longitudinal association of anxiety symptoms and risk of IBD flare within 6 months.
Results:
We included 643 patients with IBD in our cohort. Of these, 76 patients (11.8%) screened positive for symptoms of anxiety. Patients with anxiety were slightly younger than those without anxiety. Patients with anxiety were 5-times more likely to experience depressive symptoms also based on PHQ-2 screening. Patients with anxiety were also significantly more likely to be classified as having high disease severity based on disease complications. On longitudinal follow-up over 6 months, patients with anxiety were significantly more likely to experience disease flare compared to those without anxiety (25% vs 13%).
Conclusions:
Approximately 1 in 10 patients with IBD enrolled in a community-based technology-enabled care coordination platform experience anxiety symptoms. These patients are 5-times more likely to experience comorbid depressive symptoms, have high burden of disease severity, and are significantly more likely to flare during follow-up. These findings underscore the importance of routinely monitoring for anxiety symptoms in patients with IBD. This has major implications for value-based care programs with bidirectional risk models and need for integrated care approaches that include mental health support to improve patient outcomes in IBD management.