Use of psych meds common in kids with IBD, despite without counselling for many

Children with inflammatory bowel disease (IBD) were more likely to use psychotropic medications than those without the disease, according to a study presented at AIBD 2019 Conference.

“Many IBD patients are diagnosed as children, and childhood disease is often more aggressive with increased need for surgery, nutritional supplementation, and steroid use, all of which can increase psychological stress,” said lead author Natalie Conboy from Auburn University in Auburn, Alabama, US.

In the retrospective study, medical records of 400 paediatric IBD patients (mean age 11.5 years, 57 percent male, 78 percent Crohn’s disease) in the University of Rochester Medical Center were reviewed. Information on use of psychotropic medications (except those for chronic migraine, attention deficit disorder, and attention deficit hyperactivity disorder) and mental health visits were collected. [AIBD 2019, abstract P086]  

More than a quarter (28.5 percent) of children with IBD had exposure antidepressants and other psychotropic drugs, a rate 10-fold higher than the general paediatric population, Conboy pointed out.

The most common psychiatric disorders reported among the paediatric IBD patients were anxiety (23 percent) and depression (14 percent), which were most often treated with selective serotonin reuptake inhibitors (22 percent).   

Of concern, 43 percent of the patients who received psychotropic medications did not seem to have received any mental health counselling based on their medical records.

“These findings suggest that more anxiety and depression screening is needed for paediatric IBD patients and that mental health services are being underutilized in the paediatric IBD population,” said Conboy.

In addition, about three-quarter of psychotropic medication and mental health service use began after IBD diagnosis, which according to Conboy, indicates “that IBD may contribute to the development of psychopathology.”

“These results [show that] there are higher levels of anxiety and depression in children with IBD, and resulting mental health treatment often starts after initial IBD diagnosis,” she stated.

“Future directions include developing mental health screening measures specifically for paediatric IBD patients and evaluating whether pre-emptive mental health interventions lessen the risk of developing psychopathology,” suggested Conboy.

HRQoL* also affected

In a separate study comparing 59 adolescent and young adult (AYA; aged 13–25 years) IBD patients vs 60 healthy AYA healthy controls in tertiary hospitals in Brazil, HRQoL was significantly lower for patients with IBD than healthy controls. [AIBD 2019, abstract P006]

AYAs with IBD reported having lower state of health in the “general health perception” domain in SF-36** compared with healthy subjects (p<0.05). They also scored lower in the “school/work” domain in PedsQL4.0*** and “health change” in SF-36 than the healthy controls (p<0.05 for both).    

According to the researchers, autoimmune sclerosing cholangitis and use of prednisone were more common among patients with ulcerative colitis while those with Crohn’s disease were more likely to have prior gut surgery.

“These results highlight areas to focus clinical attention in AYA patients with IBD for assessment and future interventions,” according to the researchers.