The Manitoba IBD Cohort Study: A Population-Based Study of the Prevalence of Lifetime and 12-Month Anxiety and Mood Disorders
Abstract
BACKGROUND AND AIMS: Given the impact of anxiety and mood disorders on health, it is important to consider these disorders in persons with inflammatory bowel disease (IBD). We assessed the prevalence of anxiety and mood disorders in a population-based IBD cohort. METHODS: A structured diagnostic interview was administered to participants in the cohort (N = 351), and rates were compared to age-, gender-, and region-matched controls drawn from a national survey (N = 779). RESULTS: A comparison of lifetime prevalence suggests higher rates of panic, generalized anxiety, and obsessive-compulsive disorders and major depression and lower rates of social anxiety and bipolar disorders in the IBD sample than in national samples in the United States and New Zealand. Direct comparisons with matched controls (with data available for three anxiety disorders) found lifetime prevalence (IBD vs controls) as follows: social anxiety disorder lower in IBD (6%vs 11%, OR 0.52, 95% CI 0.32-0.85), panic disorder not significantly different (8.0%vs 4.7%, OR 1.59, 95% CI 0.96-2.63), agoraphobia without panic not significantly different (1.1%vs 0.6%, OR 1.44, 95% CI 0.37-5.55), and major depression higher (27.2%vs 12.3%, OR 2.20, 95% CI 1.64-2.95). Comparing IBD respondents with and without lifetime anxiety or mood disorder, those with a disorder reported lower quality of life and earlier onset of IBD symptoms and there was a trend toward earlier IBD diagnosis. CONCLUSIONS: Clinicians should be aware of the increased prevalence of depression and possibly other anxiety disorders in persons with IBD as these disorders may influence response to treatment and quality of life.
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Comorbid psychological difficulties in IBD are associated with disease activity, flares, treatment response, and the necessity of surgical intervention.
“Indeed, comorbid psychological difficulties are associated with disease activity, flares, treatment response, and the necessity of surgical intervention [2,6,8,9,10,11,12,13,14,15].”
From Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies (2022) · cites this paper as [6]
The Discussion (p. 14) reports associations between depressive symptoms and earlier, more frequent relapses, later disease activity, and failure to achieve remission with infliximab. It does not link psychological difficulties to a need for surgical intervention; its reference to an earlier need for reinitiation of treatment is not surgery. (LLM, conf=0.88)
Experimental — accuracy not yet measuredApproximately two-thirds of patients who had both anxiety disorder and IBD developed psychiatric symptoms predating the IBD diagnosis by over 2 years.
“The report showed that approximately two-thirds of patients who had both anxiety disorder and IBD actually developed psychiatric symptoms predating the IBD diagnosis by over 2 years.”
From Stress triggers flare of inflammatory bowel disease in children and adults (2019) · cites this paper as [75]
IBD patients with lifelong anxiety or mood disorders displayed an earlier onset of IBD symptoms than those without such disorders, with a tendency for early diagnosis of IBD.
“Moreover, IBD patients with lifelong anxiety or mood disorders displayed an earlier onset of IBD symptoms than those without the above disorders, and there was a tendency for an early diagnosis of IBD (75).”
From Stress triggers flare of inflammatory bowel disease in children and adults (2019) · cites this paper as [75]
More than half of IBD patients with mood disorders had a more than 2-year time interval for diagnosis.
“This more than 2-year time interval for diagnosis was also present in more than half of IBD patients with mood disorders.”
From Stress triggers flare of inflammatory bowel disease in children and adults (2019) · cites this paper as [75]
Eleven of 13 studies measuring anxiety in controversy 1 found significantly higher rates or levels of anxiety in IBD than in healthy controls.
“Eleven of the 13 studies measured anxiety, with seven of these reporting either significantly higher rates (% or levels (mean scores) of anxiety in those with IBD than in healthy control participants (n=3,262 IBD; n=12,024 controls) (9, 15, 20-22, 24, 26).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
The pooled mean rate of anxiety symptoms in all IBD samples reporting proportions was 19.1% (95% CI ±3.63) compared to 9.6% (±1.94) in healthy controls.
“A pooled mean rate of anxiety symptoms in all IBD samples reporting proportions (study n=3 (9, 18, 23); total IBD n=448) was 19.1% (± 3.63, 95% CI) compared to 9.6% (± 1.94, 95% CI) in healthy controls (n=887).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
Nine of 13 studies found significantly higher rates and/or levels of depression in IBD participants than in healthy controls.
“Nine found significantly higher rates and/or levels of depression in IBD participants than in healthy controls (n=3,517 IBD; n=12,212 controls) (9, 15, 16, 19-22, 24, 26).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
For adult IBD participants, rates of anxiety ranged from 15.1% (95% CI ±3.75) based on diagnostic criteria to 40% (±14.1) in a small case-control study measuring anxiety symptoms for CD only.
“For adult IBD participants, the rates of anxiety ranged from 15.1% (± 3.75, 95% CI) [all anxiety combined] based on diagnostic criteria in the population-based study by Walker (9), to 40% (±14.1, 95% CI), reported in a small case control study measuring anxiety symptoms for those with CD only (18).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
A sizeable proportion of individuals with IBD have been identified as experiencing co-morbid anxiety and/or depression.
“In particular, a sizeable proportion of individuals with IBD have been identified as experiencing co-morbid anxiety and/or depression (8, 9).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
A population-based IBD study using a structured clinical diagnostic interview reported that 27.2% (95% CI ±4.7) of cases met criteria for lifetime depression illness.
“A populationbased IBD study which used the gold standard of a structured clinical diagnostic interview reported that 27.2% (± 4.7, 95% CI) of cases met criteria for lifetime depression illness (9).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
For adults with IBD and a lifetime history of an anxiety or mood disorder, 70% had a first episode of an anxiety disorder 10 years or more before the IBD diagnosis, while 8% developed anxiety two or more years after IBD onset.
“For adults, 70% of those with IBD and a lifetime history of an anxiety or mood disorder, had a first episode of an anxiety disorder 10 years or more before the IBD diagnosis, while just 8% developed anxiety two or more years after IBD onset, suggesting anxiety is much more likely to predate the IBD.”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
Two studies were relevant to controversy 5, examining incidence of anxiety and depression post-diagnosis in children, and retrospective evaluation of timing of onset in relation to IBD in adults.
“However, two studies were relevant to this controversy, examining incidence of anxiety and depression post-diagnosis in children, and retrospective evaluation of timing of onset in relation to IBD in adults (9, 22).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
In adults, mean age of IBD onset with lifetime anxiety or mood disorder was 29.1 years compared to 33.1 years in those with IBD and without an anxiety or mood disorder (p=0.012).
“In adults, mean age of IBD onset with lifetime anxiety or mood disorder was 29.1 years as compared to 33.1 years in those with IBD and without an anxiety or mood disorder (p=0.012) (9).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
For adults with IBD and a lifetime history of an anxiety or mood disorder, 54% had an onset of depression two years or more before IBD onset while 23% developed depression two or more years after IBD onset.
“With regard to depression in adults, 54% of those with IBD and a lifetime history of an anxiety or mood disorder had an onset of depression two years or more before the IBD onset while 23% developed depression two or more years after IBD onset, suggesting risk both before and after disease onset.”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
Overall lifetime prevalence of anxiety was 15.1% (±3.7, 95% CI) versus 16.3% (±2.6, 95% CI) for age and gender-matched controls.
“Overall, the lifetime prevalence of anxiety was 15.1% (± 3.7, 95% CI) versus 16.3% (± 2.6, 95% CI) for age and gender-matched controls (9).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
The Walker study was population-based, had age and gender-matched controls, and used a structured diagnostic interview, the gold-standard for clinical diagnosis.
“the Walker study (9), which was population-based, had age and gender-matched controls, and used a structured diagnostic interview, the gold-standard for clinical diagnosis”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
The Walker study clearly indicated elevated rates of depression for individuals with IBD.
“clearly indicated elevated rates of depression for individuals with IBD.”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
The vast majority of studies used a cross-sectional design and were unable to shed light on whether mental disorders precede or develop after IBD onset, with only 2 of the 210 studies which met general inclusion criteria having applicable data.
“The vast majority of studies used a cross-sectional design and were unable to shed light on this question, with only 2 of the 210 studies which met general inclusion criteria having applicable data (9, 22).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
The timelines in the adult study were established retrospectively through structured clinical interviews to determine lifetime prevalence of mental disorders, so there is potential for recall bias.
“However, the timelines were established retrospectively through structured clinical interviews to determine lifetime prevalence of mental disorders, so there is potential for recall bias.”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [9]
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- Authors
- Walker, J. R., Ediger, J. P., Graff, L. A., Greenfeld, J. M., Clara, I., Lix, L., Rawsthorne, P., Miller, N., Rogala, L., McPhail, C. M., & Bernstein, C. N.
- Affiliations
- University of Manitoba (CA)
- Corresponding author
- Bernstein, Charles N.
- Venue
- The American Journal of Gastroenterology
- Published
- 2008-08
- Volume
- 103
- Issue
- 8
- Pages
- 1989-1997
- ISSN
- 0002-9270 (ISSN-L)
- 1572-0241
- OpenAlex
- W2093986077
- Cited by
- 437
- References
- 47
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 24 · 2023: 25 · 2022: 42 · 2021: 43 · 2020: 32 · 2019: 30 · 2018: 29 · 2017: 27 · 2016: 36 · 2015: 28 · 2014: 18 · 2013: 21 · 2012: 17
- FWCI
- 7.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Mspace (University of Manitoba) (submittedVersion)
- Funders
- University of Manitoba
- Crohn's and Colitis Foundation
- Crohn's and Colitis Foundation of Canada
- Canadian Institutes of Health Research
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- inflammatory bowel disease, anxiety disorders, mood disorders, depression, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, agoraphobia, lifetime prevalence, 12-month prevalence, quality of life
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anxiety Disorders, Chronic Disease, Female, Health Surveys, Humans, Male, Manitoba, Middle Aged, Inflammatory Bowel Diseases, Cohort Studies, Prevalence, Case-Control Studies, Mood Disorders
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