Introduction: Inflammatory burden shapes the natural history of inflammatory bowel disease (IBD), but psychological health may contribute substantially. However, before holistic care can be provided for patients, a better understanding of the prevalence, persistence, impact, identification, and treatment of poor psychological health in IBD is required.
Methods: Model-based clustering techniques to subclassify patients with IBD according to measures disease activity and psychological health have been performed. To ascertain the prevalence of symptoms of anxiety and depression throughout the disease course, these symptoms have been examined in patients with established disease and in an inception cohort. Using mood trajectories, the persistence of these symptoms been examined over a 2-year period. Across these observational studies, the impact on disease outcomes has been studied longitudinally. Finally, a systematic review and meta-analysis of randomised controlled trials examining the efficacy of psychological therapies in IBD was performed.
Results: Symptoms of anxiety and depression are highly prevalent at the point of an IBD diagnosis, affecting 39% of patients. The only factor significantly associated with symptoms of anxiety or depression during 24 months of longitudinal follow up is a fluctuating, or persistently abnormal or worsening baseline trajectory (p<0.001 for both trends). Rates of adverse disease outcomes are highest in patients with disease activity and poor psychological health. Patients with disease activity and psychological health have higher healthcare utilisation and experience more adverse disease events. Psychological therapies improve psychological health in the short-term, particularly in patients with evidence of poor psychological health, but have no impact on disease activity.
Conclusions: In addition to being highly prevalent amongst patients with established disease, poor psychological health is highly prevalent at the point of diagnosis suggesting genuine gut-brain effects. Symptoms of anxiety and depression persist for many patients and negatively impact the natural history of IBD, suggesting that addressing the inflammatory aspect of the disease in isolation fails to meet the needs of these patients. Gut-brain axis directed therapies may be of value in patients with evidence of poor psychological health.
