LAS VEGAS – Symptoms of anxiety and depression in veterans with inflammatory bowel disease (IBD) often fluctuate substantially over time, a researcher said here.
Among 80 patients with IBD with at least three psychological evaluations in a longitudinal study, severity of depression in 24 crossed thresholds defining mild / moderate / severe (in both directions) between visits and 26% for patients with anxiety, reported Niharika Mallepally, MD, MPH, of the Baylor College of Medicine in Houston, at the Crohn & Colitis Congress.
Similarly, 21 of the 80 had symptoms of anxiety that went through mild / moderate / severe thresholds during follow-up, he said.
Persistent depressive symptoms – those remaining in the moderate-severe category through follow-up – were observed in 12 of the 80 veterans. The symptoms of anxiety that never progressed beyond the minimum, but never completely disappeared, were observed in 49 out of 80.
Psychological well-being is a critical aspect of IBD. The connection between IBD and psychological health is clinically evident. Conditions both need symptomatic control and time-varying drugs and require changes in management and constant adjustment by both the patient and the clinician, highlighted here by Mallepally.
Many studies have examined the relationship between psychological health and IBD. A systematic review indicated that 21% of patients with IBD had depressive symptoms during the IBD remission periods and 34% when IBD was active. As far as anxiety is concerned, as many as 30% experience symptoms when the disease is in remission, which can reach 80% during active periods, observed Mallepally.
"The current literature does not uniformly explain the relationship between IBD and psychological health. Most studies explore IBD and psychological health with a measure, or at some point in time, but the symptoms of depression and Anxiety is dynamic, changes are better captured through longitudinal study and through a multifactorial lens, "Mallepally said.
Veterans have a greater prevalence of anxiety and depression than the general population, but they have easy access to psychological resources and assessments, he continued.
Patients established at the Michael E. DeBakey VA Medical Center's IBD clinic were studied from 2014 to 2018, evenly divided between those with Crohn's disease (CD) and ulcerative colitis (UC).
Among patients with CD, the average age was 50.9 years and 87.4% were male. Patients with UC had a mean age of 50.5 years and were 86.1% males.
Researchers collected information on patient dietary restrictions, tobacco use, working status, IBD subtype and measures of anxiety and depression symptoms (GAD-7 and PHQ-8), respectively.
They assessed the persistence of atypical scores as indicated by two or more consecutive visits, maximum scores and percentage of visits with moderate to severe scores for PHQ-8 and GAD-7. For anxiety symptoms, a GAD-7 score of 10-14 was considered moderate; scores ≥15 were severe. For symptoms of depression, a moderate PHQ-8 score was ≥10 and a severe depression score was ≥20.
The colonic site was associated with a higher percentage of visits with moderate to severe depressive symptoms.
Changes in diet, as reported by the patient, have been associated with more severe symptoms of anxiety and depression and a greater proportion of visits with moderate to severe anxiety symptoms.
The state of work disability was linked to more severe symptoms of anxiety and depression and to a greater proportion of visits with symptoms of anxiety and moderate to severe depression.
The limitations of the study included his attention to veterans and his observational nature. Furthermore, the impact of antidepressants and anxiolytics on psychological health has not been evaluated.
2019-02-11T12: 00: 00-0500