Poor mental health tied to worse prognosis, outcomes in IBD

Psychological problems, such as anxiety or depression, can negatively affect prognosis and eventual outcomes in patients with inflammatory bowel diseases (IBD), according to a recent study.

“[M]ental disorders are common in inflammatory bowel disease and are associated with adverse outcomes, but relative contribution of symptoms of a common mental disorder, vs disease activity, on prognosis is unknown,” the researchers said, adding that as per the current findings, “there is a cumulative effect of poor psychological health and inflammatory bowel disease activity on prognosis; poor psychological health should be screened for and, if present, considered as a therapeutic target.”

The study included 760 adult IBD patients (mean age 44.0 years, 55.2 percent women) in whom baseline information about depression and anxiety symptoms had been measured using the Hospital Anxiety and Depression Scale (HADS), while somatization was assessed through the Patient Health Questionnaire-15.

Disease outcomes were evaluated according to the following endpoints: glucocorticosteroid prescription or physician-determined disease flare, drug escalation for uncontrollable IBD activity, hospitalization, intestinal resection, and death.

Over a mean follow-up of 4.0 years, 53.8 percent (n=308) of participants with available data eventually experienced disease flares or needed a glucocorticosteroid prescription. Multivariate Cox regression analysis revealed that this endpoint was significantly more likely to occur in patients with symptoms of mental disorders at baseline, particularly those in clinical remission (hazard ratio [HR], 1.57, 95 percent confidence interval [CI], 1.08–2.27) or with clinical activity (HR, 2.36, 95 percent CI, 1.58–3.54). [Gastroenterology 2022;163:190-203.e5]

Some 345 patients (54.7 percent) needed medication escalation due to uncontrolled disease activity over a mean follow-up of 3.8 years. Baseline symptoms of mental disorders in patients with clinically active disease was significantly correlated with this endpoint (HR, 1.65, 95 percent CI, 1.14–2.40; p=0.008).

Similarly, mortality risk was significantly elevated in patients with clinical activity and baseline symptoms of common mental disorder (HR, 4.99, 95 percent CI, 1.80–13.88; p=0.002).

In contrast, while hospitalization, intestinal resection, and healthcare utilization during follow-up were more common among patients with symptoms of mental disorders, regression analysis did not identify significant interactions.

“The possibility that psychological health may have a greater impact on IBD prognosis than disease activity raises important questions as to how patients are managed,” the researchers said, suggesting that training for psychological resilience could also lead to improved outcomes in this patient population. The present findings likewise indicate that clinicians should go beyond clinical or mucosal benchmarks when treating IBD patients.

“There remains a need for further randomized controlled trials of psychological therapies and antidepressants in more selected groups of patients with IBD, after appropriate screening for common mental disorders and objective quantification of inflammatory burden, as well as studies examining the trajectories of common mental disorders in IBD, and whether this influences prognosis,” they added.