Gender Differences in Mental Health in Patients with Inflammatory Bowel Disease

Background:
Depression and anxiety are mental health disorders that are more prevalent in an inflammatory bowel disease (IBD) population than in the general population. These mental health comorbidities are associated with lower quality of life, longer hospital stays, higher healthcare costs, and a variety of other negative outcomes. Furthermore, within the general and IBD populations, women exhibit higher rates of depression and anxiety than do men. Here, we highlight gender differences in mental health and disease severity in 425 patients screened for depression and anxiety at our tertiary care center.
Methods:
Consecutive patients at our tertiary IBD clinic were asked to complete the validated General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) surveys during their appointments. We reviewed disease and patient characteristics. Categorical variables were assessed using Fisher’s exact test. Clinical remission status was determined by the senior author, blinded to the GAD-7 and PHQ-9 results.
Results:
A total of 425 patients participated in our study (239 women, 330 White, 261 Crohn’s). 223 patients had no prior diagnosis of anxiety or depression. 103 patients without a prior diagnosis were women (57% of all women) and 121 men (65% of all men). We identified 145 patients overall with anxiety (86 mild, 38 moderate, 21 severe) and 172 patients with depression (107 mild, 46 moderate, 19 severe). We identified 103 women with depression (43%) and 89 women with anxiety (37%). We identified 69 men with depression (36%) and 56 men with anxiety (29%). 25% of men had clinically active disease and 26% of women had clinically active disease. Gender differences in mental health scores were more pronounced in Crohn’s disease (CD). Women with CD were significantly more likely to have anxiety (p=.048) and depression (p= 0.79) than men with CD. Women with CD had an increased relative risk of having anxiety (RR 1.462, 95% CI 1.0021 to 2.1335). Women were more likely to be mildly or moderately depressed (p=0.098) and mildly or moderately anxious (p=.10) than men. Women with CD were significantly more likely to have active disease than men (0.04) and had an increased relative risk of having active disease (RR 1.797, 95% CI 1.0209 to 3.1641).
Conclusions:
In this study, we demonstrate gender differences in depression and anxiety among patients with IBD. We reaffirm that individuals with IBD have elevated rates of anxiety and depression as compared to the general population and furthermore that women with IBD are at a greater risk of developing mental health comorbidities than men despite similar rates of active disease. Future research must explore the biological and pathophysiological underpinnings of these results in order to determine causality. Such knowledge could help guide treatment for both IBD and psychological comorbidities.