Persistence of Symptoms of Anxiety and Depression in Inflammatory Bowel Disease: A Longitudinal Follow-Up Study.

Abstract

BACKGROUND: Poor psychological health affects many patients with inflammatory bowel disease (IBD), but the persistence of these symptoms is unclear. METHODS: We performed a longitudinal follow-up study of patients whose anxiety and depression trajectories were established by symptom data collected at 3-monthly intervals over the course of 1 year. We collected further anxiety and depression symptom data at yearly intervals over 2 years to determine the persistence of these symptoms in patients with IBD. Disease outcomes (flare/need for glucocorticosteroids, escalation of medical therapy, hospitalisation, or intestinal resection) were recorded to determine the effect of mood trajectories on the natural history of IBD. RESULTS: Of 770 patients with established anxiety trajectories, 486 (63.1%) provided further anxiety symptom data at 12 months, and 358 (45.5%) at 24 months. Of the 777 patients with established depression trajectories, 491 (63.2%) provided further depression symptom data at 12 months, and 362 (45.6%) at 24 months. Participants with symptoms of anxiety at 24 months were more likely to have a fluctuating, or persistently abnormal or worsening, anxiety trajectory during the first year (p < 0.001 for trend). Participants with symptoms of depression at 24 months were more likely to have a fluctuating, or persistently abnormal or worsening, depression trajectory during the first year (p < 0.001 for trend). Adverse disease outcomes were no more likely according to anxiety or depression trajectories. DISCUSSION: Poor psychological health persists for a substantial number of patients with IBD. Further work is needed to establish the long-term effect of mood trajectories on disease outcomes.