Psychological Disorders May Adversely Impact IBD Prognosis

TOPLINE:

Among patients with active inflammatory bowel disease (IBD), those with both clinical and biochemical disease activity and two common mental disorders had a more than sixfold increased risk for adverse outcomes, including flares, glucocorticosterioid use, hospitalisations, and death.

METHODOLOGY:

• Researchers assessed the impact of psychological comorbidity and disease activity on IBD prognosis in a longitudinal follow-up study conducted between September 2014 and October 2023.
• They included 717 patients with an established IBD diagnosis (mean age, 44 years; 55.1% women; 57.3% with Crohn’s disease) who provided data on psychological health (depression and anxiety symptoms) and clinical disease activity for both Crohn’s disease and ulcerative colitis, which were assessed using established scales.
• Participants were grouped according to the presence or absence of clinical activity. Those with clinical activity or in remission were further subgrouped according to the presence or absence of symptoms of one or more common mental disorders at baseline.
• Faecal calprotectin levels were assessed, with biochemical remission defined as levels < 100 mcg/g of stool. Using biological remission criteria, patients were grouped into those with combined clinical and biochemical remission or activity, further stratified on the basis of whether they exhibited symptoms of common mental disorders.
• Adverse outcomes were assessed over a mean follow-up of 8.1 years and included disease flares, glucocorticosteroid prescriptions, therapy escalation, hospitalisations, intestinal resections, and a composite of hospitalisations and intestinal resections — each due to uncontrolled IBD activity — as well as mortality, with comparisons across groups.

TAKEAWAY:

• The likelihood of experiencing flares or requiring glucocorticosteroid prescriptions was more than twice as high in patients with clinical activity, both in those with symptoms of either anxiety or depression (adjusted hazard ratio [aHR], 2.06; P = .0020) and in those with symptoms of both anxiety and depression (aHR, 2.89; P < .001) at baseline.
• Patients with combined clinical and biochemical activity plus both anxiety and depression symptoms had an increased likelihood of disease flares or glucorticosteroid prescriptions (aHR, 7.26), escalation of medical therapy (aHR, 3.62), and death (aHR, 57.3; P < .001 for all).
• Patients with combined clinical and biochemical activity plus both anxiety and depression symptoms had an increased likelihood of hospitalisation (aHR, 6.20; P = .0030) and a composite of hospitalisation and intestinal resection due to uncontrolled IBD activity (aHR, 7.46; P < .001).
• Younger age was associated with a reduced likelihood of glucocorticosteroid use, medical therapy escalation, hospitalisation, and intestinal resection.

IN PRACTICE:

“There are ever-expanding options to identify and treat persistent mucosal inflammation, but strategies to identify and manage coexisting poor psychological health are also needed if we are to provide holistic care for patients with IBD,” the authors wrote.

SOURCE:

The study was led by Christy Riggott, Leeds Gastroenterology Institute, Leeds, United Kingdom. It was published online on March 9, 2025, in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

Multiple physicians managed patients throughout the study and different assessors reviewed medical records, which may have introduced interobserver variation. Data on medications that could affect IBD activity or prognosis, such as opioids or non-steroidal anti-inflammatory drugs, were not collected.

DISCLOSURES:

This study was supported by the Leeds Teaching Hospitals Charitable Foundation, with unrestricted research monies provided by Tillots Pharma UK Ltd. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.