Anxiety Screening in Pediatric Patients With Inflammatory Bowel Disease

Background:
Inflammatory bowel disease (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) is a chronic inflammatory disease of the gastrointestinal tract that is associated with an increased risk for psychiatric comorbidities specifically depression and anxiety. Previous studies indicate pediatric patients with IBD having had annual screening for depression using the PHQ-9 (screening for depression and severity) and receiving treatment for depression had higher quality of life scores 1. However, few studies have evaluated screening for generalized anxiety disorder in pediatric IBD patients. This study aims to assess the importance of regular screening for generalized anxiety disorder using the GAD 7 questionnaire and whether the GAD7 score correlates with IBD activity.
Methods:
From January 2021 to May 2024, the QI team designed a project using the Model for Improvement and completed Plan Do Study Act cycles to test rate of Generalized Anxiety Disorder in pediatric patients between the ages of 11-18 with a diagnosis of inflammatory bowel disease at the University of New Mexico Hospital Pediatric Gastroenterology outpatient clinic. QI team used the Generalized Anxiety Disorder 7 screening method for anxiety, and continued to use PHQ 9 for depression screening. Diagnosis, medications, Pediatric Crohn’s Disease Activity Index (PCDAI) or the Pediatric Ulcerative Colitis Activity score, and endoscopic remission were also collected.
Results:
Baseline data from 3 pediatric gastroenterologists indicated no GAD-7 screenings were done and yearly PHQ-9 screenings were routinely done during clinic visits with pediatric patients with IBD. 56 pediatric patients with IBD had chart reviews, 41 had GAD-7 screenings assessed (73%). GAD-7 screening increased from baseline (0) to cycle 1 (n = 8) to cycle 2 (n = 12) to cycle 3 (n = 15). 4 patients in cycle 4 included in analysis as cycle 4 is not complete yet. Anxiety (46%) was more common than depression (20%); 47% of patients having scored mild to severe anxiety had an active IBD disease, 26% with no endoscopic remission, and 37% of these were already receiving behavioral health services; the remaining were referred to behavioral health. Anxiety did not/did ??? correspond with disease activity index scores or depression.
Conclusions:
Screening for depression in IBD patients is recommended however there is no data evaluating screening for anxiety. Our data showed 46% of patients had mild to severe anxiety on GAD7 and 47% of those were considered to have active IBD. This is the first study to investigate routine screening for anxiety in pediatric patients with IBD. Patients with psychiatric comorbidities are at higher risk for disease relapse and medication non-adherence. Early detection of anxiety could improve outcomes among these patients.