The relationship between symptoms of depression and anxiety and disease activity in IBD over time
Open accessAbstract
Brackground: We aimed to examine associations between elevated symptoms of depression and anxiety and disease activity in inflammatory bowel disease (IBD). Previous findings have been inconsistent and have not accounted for variability in the courses of these conditions over time. Methods: We followed 247 participants with IBD (153 Crohn’s disease [CD], 94 ulcerative colitis [UC]) for 3 years. Annually, participants underwent an abdominal examination, reported therapies used for IBD, and completed the Hospital Anxiety and Depression Scale (HADS) questionnaire. We evaluated associations of elevated symptoms (scores ≥11) of anxiety (HADS-A) and depression (HADS-D) with the presence of active IBD as measured using the Powell Tuck Index for UC and the Harvey-Bradshaw Disease Activity Index for CD. We employed logistic regression with generalized estimating equations, simultaneously estimating between-person and within-person effects. Results: Of 247 participants, 15 (6.1%) had elevated symptoms of depression (HADS-D ≥11) at enrollment, 41 (16.6%) had elevated symptoms of anxiety (HADS-A ≥11), and 101 (40.9%) had active IBD. On average, individuals with elevated symptoms of depression (odds ratio [OR], 6.27; 95% CI, 1.39–28.2) and anxiety (OR, 2.17; 95% CI, 1.01–4.66) had increased odds of active IBD. Within individuals, elevations in symptoms of depression over time were associated with increased odds of active IBD (OR, 2.70; 95% CI, 1.15–6.34), but elevated symptoms of anxiety were not. After adjustment for covariates (including disease activity), elevated symptoms of depression were also associated with increased odds of biologic therapy use (OR, 2.02; 95% CI, 1.02–4.00). Conclusion: Symptoms of depression and anxiety are associated with disease activity in IBD over time. Reducing these symptoms should be incorporated into the management of IBD.
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In the same Manitoba IBD cohort, elevated anxiety symptoms doubled the risk for active IBD (OR 2.17; 95% CI 1.01 to 4.66).
“In a study from Manitoba, Canada, which followed an IBD cohort of 247 individuals over three years, the risk of subsequent active IBD was increased sixfold with elevated depressive symptoms (OR: 6.27; 95% CI: 1.39, 28.2), and elevated symptoms of anxiety doubled the risk for active IBD (OR: 2.17; 95% CI: 1.01, 4.66) (21).”
From The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease (2023) · cites this paper as [21]
The Results report that participants with elevated anxiety symptoms had higher odds of active IBD on average (OR 2.17; 95% CI 1.01–4.66), matching the quoted estimate. They do not establish that anxiety predicted subsequent active IBD: the Results say that within-person elevations in anxiety over time were not associated with increased odds of active IBD. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn a Manitoba, Canada IBD cohort of 247 individuals followed over three years, elevated depressive symptoms increased the risk of subsequent active IBD sixfold (OR 6.27; 95% CI 1.39 to 28.2).
“In a study from Manitoba, Canada, which followed an IBD cohort of 247 individuals over three years, the risk of subsequent active IBD was increased sixfold with elevated depressive symptoms (OR: 6.27; 95% CI: 1.39, 28.2), and elevated symptoms of anxiety doubled the risk for active IBD (OR: 2.17; 95% CI: 1.01, 4.66) (21).”
From The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease (2023) · cites this paper as [21]
The Methods describe a Manitoba cohort of 247 people with IBD followed for three years, and the Results report an OR of 6.27 (95% CI, 1.39–28.2) for active IBD among those with elevated depressive symptoms. But that estimate is a between-person association with active disease, not a demonstrated sixfold increase in the risk of *subsequent* active IBD; the Methods describe measuring symptoms and disease activity at study visits. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe 13 eligible articles reported on 12 separate study populations containing 9192 patients.
“The 13 eligible articles reported on 12 separate study populations,[11, 20-30, 33] containing 9192 patients.”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [27]
Escalation of IBD therapy was more likely among those with symptoms of anxiety at baseline (RR = 1.68; 95% CI 1.18-2.40) in two studies containing 670 patients.
“Escalation of IBD therapy was more likely among those with symptoms of anxiety at baseline (RR = 1.68; 95% CI 1.18-2.40) in two studies,[26, 27] containing 670 patients.”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [27]
Pooled from five studies including 1244 patients, the risk of developing a flare of disease activity was no higher among those with symptoms of anxiety at baseline (RR = 1.20; 95% CI 0.93-1.55), with moderate heterogeneity (I2 = 53.7%).
“When data were pooled from five studies,[20, 26, 27, 29, 30] containing 1244 patients, the risk of developing a flare of disease activity was no higher among those with symptoms of anxiety at baseline (RR = 1.20; 95% CI 0.93-1.55), with moderate heterogeneity between studies ( I 2 =53.7%).”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [27]
Pooled from eight studies including 7606 patients, symptoms of depression at baseline were associated with a significantly increased risk of flare of disease activity during longitudinal follow-up (RR = 1.60; 95% CI 1.21-2.12), with high heterogeneity (I2 = 73.5%).
“When data were pooled from eight studies,[20-23, 26, 27, 29, 30] which included 7606 patients, symptoms of depression at baseline were associated with a significantly increased risk of flare of disease activity during longitudinal follow-up (RR = 1.60; 95% CI 1.212.12), with high heterogeneity between studies ( I 2 =73.5%)”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [27]
Pooling data from four studies containing 6957 patients, there was an increased risk of escalation of therapy due to uncontrolled IBD activity in those reporting symptoms of depression at baseline (RR = 1.41; 95% CI 1.08-1.84), with low heterogeneity (I2 = 43.1%).
“Pooling data from four studies,[21, 22, 26, 27] containing 6957 patients, there was an increased risk of escalation of therapy due to uncontrolled IBD activity in those reporting symptoms of depression at baseline (RR = 1.41; 95% CI 1.08-1.84) (Figure 3b), with low heterogeneity ( I 2 =43.1%).”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [27]
Original investigators were contacted and additional data were obtained from six studies to maximise the number of eligible studies for analysis.
“We also contacted original investigators and obtained additional data from six studies,[26-30, 33] to maximise the number of eligible studies for analysis.”
From Bidirectional brain-gut axis effects influence mood and prognosis in IBD: A systematic review and meta-analysis (2022) · cites this paper as [27]
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · see citing works
Silverberg, M. S., Satsangi, J., Ahmad, T., Arnott, I. D., Bernstein, C. N., Brant, S. R., Caprilli, R., Colombel, J., Gasché, C., Geboes, K., et al. (2005) · Canadian Journal of Gastroenterology · doi:10.1155/2005/269076 · Cited by 3,408 · see citing works
Self-citationA SIMPLE INDEX OF CROHN'S-DISEASE ACTIVITY
Harvey, R. F., & Bradshaw, J. M. (1980) · The Lancet · doi:10.1016/s0140-6736(80)92767-1 · Cited by 2,974 · see citing works
Overadjustment bias and unnecessary adjustment in epidemiologic studies.
Schisterman, E. F., Cole, S. R., & Platt, R. W. (2009) · Epidemiology · doi:10.1097/ede.0b013e3181a819a1 · Cited by 2,096 · see citing works
The disaggregation of within-person and between-person effects in longitudinal models of change
Curran, P. J., & Bauer, D. J. (2011) · Annual Review of Psychology · doi:10.1146/annurev.psych.093008.100356 · Cited by 2,056 · see citing works
A prospective population-based study of triggers of symptomatic flares in IBD
Bernstein, C. N., Singh, S., Graff, L. A., Walker, J. R., Miller, N., & Cheang, M. (2010) · American Journal of Gastroenterology · doi:10.1038/ajg.2010.140 · Cited by 400 · see citing works
Self-citationMikocka-Walus, A., Pittet, V., Rossel, J.-B., von Känel, R., Anderegg, C., Bauerfeind, P., Beglinger, C., Begré, S., Belli, D., Bengoa, J. M., et al. (2016) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2015.12.045 · Cited by 348 · see citing works
A Comparison of Oral Prednisolone Given as Single or Multiple Daily Doses for Active Proctocolitis
Powell-Tuck, J., Bown, R. L., & Lennard‐Jones, J. E. (1978) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365527809182199 · Cited by 338 · see citing works
Levis, B., Benedetti, A., Ioannidis, J. P. A., Sun, Y., Negeri, Z., He, C., Wu, Y., Krishnan, A., Bhandari, P. M., Neupane, D., et al. (2020) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2020.02.002 · Cited by 217 · see citing works
Self-citationIncreased incidence of psychiatric disorders in immune-mediated inflammatory disease
Marrie, R. A., Walld, R., Bolton, J. M., Sareen, J., Walker, J. R., Patten, S. B., Singer, A. G., Lix, L. M., Hitchon, C. A., El-Gabalawy, R. M., et al. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.07.015 · Cited by 183 · see citing works
Self-citationDepression, comorbidities and the TNF-α system
Himmerich, H., Fulda, S., Linseisen, J., Seiler, H., Wolfram, G., Himmerich, S., Gedrich, K., Kloiber, S., Lucae, S., Ising, M., et al. (2008) · European Psychiatry · doi:10.1016/j.eurpsy.2008.03.013 · Cited by 181 · see citing works
Depression is associated with more aggressive inflammatory bowel disease
Kochar, B., Barnes, E. L., Long, M. D., Cushing, K. C., Galanko, J., Martin, C. F., Raffals, L. E., & Sandler, R. S. (2018) · American Journal of Gastroenterology · doi:10.1038/ajg.2017.423 · Cited by 178 · see citing works
Targownik, L. E., Sexton, K. A., Bernstein, M. T., Beatie, B., Sargent, M., Walker, J. R., & Graff, L. A. (2015) · American Journal of Gastroenterology · doi:10.1038/ajg.2015.147 · Cited by 157 · see citing works
Self-citationBernstein, C. N., Zhang, L., Lix, L. M., Graff, L. A., Walker, J. R., Fisk, J. D., Patten, S. B., Hitchon, C. A., Bolton, J. M., Sareen, J., et al. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izy068 · Cited by 120 · see citing works
Self-citationLewis, K., Marrie, R. A., Bernstein, C. N., Graff, L. A., Patten, S. B., Sareen, J., Fisk, J. D., Bolton, J. M., CIHR Team in Defining the Burden and Managing the Effects of Immune-Mediated Inflammatory Disease, Marrie, R. A., et al. (2019) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izz045 · Cited by 115 · see citing works
Self-citationSzigethy, E. M., Allen, J. I., Reiss, M., Cohen, W., Perera, L. P., Brillstein, L., Cross, R. K., Schwartz, D. A., Kosinski, L. R., Colton, J. B., et al. (2017) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2017.02.037 · Cited by 107 · see citing works
Limsrivilai, J., Stidham, R. W., Govani, S. M., Waljee, A. K., Huang, W., & Higgins, P. (2016) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2016.09.012 · Cited by 102 · see citing works
Click, B. H., Rivers, C. R., Κoutroubakis, I. E., Babichenko, D., Anderson, A. J. M., Hashash, J. G., Dunn, M. A., Schwartz, M. B., Swoger, J. M., Baidoo, L., et al. (2016) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000763 · Cited by 94 · see citing works
Antidepressants in Inflammatory Bowel Disease: A Systematic Review
Macer, B. J. D., Prady, S. L., & Mikocka-Walus, A. (2017) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000001059 · Cited by 92 · see citing works
Lores, T., Goess, C., Mikocka-Walus, A., Collins, K. L., Burke, A. L. J., Chur-Hansen, A., Delfabbro, P., & Andrews, J. M. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.01.030 · Cited by 88 · see citing works
Langhorst, J., Hofstetter, A., Wolfe, F., & Häuser, W. (2013) · Inflammatory Bowel Diseases · doi:10.1097/mib.0b013e3182a192ba · Cited by 85 · see citing works
Sexton, K. A., Walker, J. R., Graff, L. A., Bernstein, M. T., Beatie, B., Miller, N., Sargent, M., & Targownik, L. E. (2017) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000001040 · Cited by 79 · see citing works
Self-citationAlexakis, C., Kumar, S., Saxena, S., & Pollok, R. (2017) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14171 · Cited by 69 · see citing works
Mood and nonmood components of perceived stress and exacerbation of Crohnʼs disease
Cámara, R. J. A., Schoepfer, A. M., Pittet, V., Begré, S., & von Känel, R. (2011) · Inflammatory Bowel Diseases · doi:10.1002/ibd.21623 · Cited by 67 · see citing works
Marrie, R. A., Graff, L. A., Walker, J. R., Fisk, J. D., Patten, S. B., Hitchon, C. A., Lix, L. M., Bolton, J. M., Sareen, J., Katz, A., et al. (2018) · JMIR Research Protocols · doi:10.2196/resprot.8794 · Cited by 54 · see citing works
Self-citationIntegrated care models: Optimizing adult ambulatory care in inflammatory bowel disease
Schoenfeld, R., Nguyen, G. C., & Bernstein, C. N. (2020) · Journal of the Canadian Association of Gastroenterology · doi:10.1093/jcag/gwy060 · Cited by 42 · see citing works
Self-citationManagement of the Psychological Impact of Inflammatory Bowel Disease
Marín‐Jiménez, I., Montoya, M. G., Panadero, A., Cañas, M., Modino, Y., de Santos, C. R., Guardiola, J., Carmona, L., & Acosta, M. B. (2017) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000001205 · Cited by 41 · see citing works
Jani, B., Purves, D. G., Barry, S., Cavanagh, J., McLean, G., & Mair, F. S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0074610 · Cited by 39 · see citing works
Shafer, L., Walker, J., Chhibba, T., Ivekovic, M., Singh, H., Targownik, L. E., Peyrin‐Biroulet, L., Gower‐Rousseau, C., Sarter, H., & Bernstein, C. N. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izx063 · Cited by 27 · see citing works
Self-citationAlexakis, C., Saxena, S. K., Chhaya, V., Cecil, E. V., Majeed, A., & Pollok, R. (2018) · The American Journal of Gastroenterology · doi:10.1038/s41395-018-0273-7 · Cited by 22 · see citing works
Shafer, L. A., Walker, J. R., Chhibba, T., Ivekovic, M., Singh, H., Targownik, L. E., Peyrin‐Biroulet, L., Gower‐Rousseau, C., Sarter, H., & Bernstein, C. N. (2017) · Gastroenterology · doi:10.1016/s0016-5085(17)30455-9 · Cited by 19 · see citing works
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Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment
Bisgaard, T. H., Allin, K. H., Keefer, L., Ananthakrishnan, A. N., & Jess, T. (2022) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-022-00634-6 · Cited by 572 · see citing works
Fairbrass, K. M., Lovatt, J., Barberio, B., Yuan, Y., Gracie, D. J., & Ford, A. C. (2022) · Gut · doi:10.1136/gutjnl-2021-325985 · Cited by 225 · see citing works
Arp, L., Jansson, S., Wewer, V., & Burisch, J. (2022) · Journal of Crohn's and Colitis · doi:10.1093/ecco-jcc/jjac095 · Cited by 38 · see citing works
Graff, L. A., Geist, R., Kuenzig, M. E., Benchimol, E. I., Kaplan, G. G., Windsor, J. W., Bitton, A., Coward, S., Jones, J. L., Lee, K., et al. (2023) · Journal of the Canadian Association of Gastroenterology · doi:10.1093/jcag/gwad012 · Cited by 30 · see citing works
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- Authors
- Marrie, R. A., Graff, L. A., Fisk, J. D., Patten, S. B., & Bernstein, C. N.
- Affiliations
- University of Manitoba (CA)
- Dalhousie University (CA)
- University of Calgary (CA)
- Corresponding author
- Bernstein, Charles N
- Venue
- Inflammatory Bowel Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-01-04
- Volume
- 27
- Issue
- 8
- Pages
- 1285-1293
- ISSN
- 1078-0998 (ISSN-L)
- 1536-4844
- PMC
- PMC8314114
- OpenAlex
- W3120034954
- Cited by
- 128
- References
- 32
- Citations by year
- 2026: 18 · 2025: 22 · 2024: 27 · 2023: 32 · 2022: 16 · 2021: 12
- FWCI
- 12.29
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Inflammatory Bowel Diseases (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- CIHR (#333252)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- inflammatory bowel disease, depression
- MeSH terms
- Anxiety, Chronic Disease, Colitis, Ulcerative, Crohn Disease, Depression, Humans
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