Prevalence of depression and anxiety in people with inflammatory bowel disease and associated healthcare use: population-based cohort study

Abstract

Background: Inflammatory bowel disease (IBD) has a significant impact on quality of life for many people.

Objective: To assess the prevalence of common mental health conditions in IBD and the combined impact of IBD and mental health conditions on healthcare use and time off work.

Methods: A UK population-based primary care database (Royal College of General Practitioners Research and Surveillance Centre) was used to identify adults with IBD (n=19 011) (Crohn's disease (CD) or ulcerative colitis (UC)), and matched controls (n=76 044). Prevalences of anxiety, depressive episodes and depressive disorder recorded in primary care were assessed between 2016 and 2018. Outcomes comprised of rates of primary care visits, emergency secondary care visits, certificates for time off work, antidepressant and anxiolytic prescriptions.

Findings: Mental health conditions were more common in people with CD than controls: anxiety episodes (3.5% vs 3.0%; p=0.02), depressive episodes (5.7% vs 4.1%; p<0.001) and depressive disorder (17.5% vs 12.9%; p<0.001), and people with UC versus controls: depressive episodes (4.4% vs 3.6%; p<0.001) and depressive disorder (14.2% vs 12.4%; p<0.001). Healthcare utilisation rates were higher in people with IBD than controls (primary care visits incidence rate ratio 1.47 (95% CI 1.43 to 1.51); emergency secondary care visits 1.87 (1.79 to 1.95); fitness for work certificates 1.53 (1.44 to 1.62); antidepressant use 1.22 (1.13 to 1.32); anxiolytic use 1.20 (1.01 to 1.41)). In people with IBD, mental health conditions were associated with additional increases in healthcare use and time off work.

Conclusion: Depression and anxiety are more common in people with IBD than matched controls. Healthcare utilisation and prescribing of psychotropic medications are also higher in people with IBD. Mental health conditions in people with IBD are associated with additional healthcare use and time off work.

Clinical implications: Evidence-based mental health support programmes, including psychological treatments, are needed for people with IBD.

Keywords: adult psychiatry; anxiety disorders; depression & mood disorders.

Figure 1

Healthcare resource use in people with IBD and matched controls during 3 years of follow-up. Data are rates per person-year, with 95% CIs. The absolute rates are provided in online supplemental table 9. CD, Crohn’s disease; IBD, inflammatory bowel disease; UC, ulcerative colitis; SSRIs, selective serotonin reuptake inhibitors.

Figure 2

Association of common mental health conditions with rates of (A) primary care visits, (B) emergency secondary care visits and (C) fitness for work notes, in people with IBD. Estimates are adjusted incidence rate ratios (IRRs) with 95% CIs. For each mental health condition, IRRs represent the relative change in rate of the healthcare utilisation measure if the condition is present compared with if the condition is absent. An IRR greater than 1 indicates that the presence of a mental health condition is associated with an increased rate of healthcare utilisation. All estimates are adjusted for age at study entry, sex, duration of IBD, current use of systemic therapy, BMI and Index of Multiple Deprivation quintile (for full models see online supplemental table 11). Fitness for work notes are included as indicators of absenteeism from work due to ill health. BMI, body mass index; IBD, inflammatory bowel disease.