Anxiety and Depression Are Associated with Poor Long-term Quality of Life in Moderate-to-Severe Ulcerative Colitis: Results of a 3-Year Longitudinal Study of the MOSAIK Cohort

Abstract

Background/aims: We previously reported that patients with moderate-to-severe ulcerative colitis (UC) often experience common mental disorders (CMDs) such as anxiety and depression, necessitating immediate psychological interventions within the first 4 weeks of diagnosis. In this 3-year follow-up study of the MOSAIK cohort in Korea, we examined the effects of CMDs at initial diagnosis on clinical outcomes and health-related quality of life (HRQoL).

Methods: We examined differences in clinical outcomes (evaluated based on clinical response, relapse, hospitalization, and medication use) and HRQoL (assessed using the Inflammatory Bowel Disease Questionnaire [IBDQ] and Short Form 12 [SF-12]) according to Hospital Anxiety and Depression Scale (HADS) scores at diagnosis.

Results: In a study involving 199 UC patients, 47.7% exhibited significant psychological distress (anxiety and/or depression) at diagnosis. Clinical follow-up showed no major differences in outcomes, including remission rates, response rates, or hospitalization rates, between patients with anxiety or depression at diagnosis and patients without anxiety or depression at diagnosis. The HRQoL at the end of follow-up was notably lower in those with baseline CMDs, particularly anxiety, across all domains of the IBDQ and SF-12. Linear mixed-effect models revealed that higher HADS scores, as well as higher Mayo scores, were independently associated with lower IBDQ scores and both summary domains of the SF-12. Additionally, regular attendance at follow-up visits during the study period was also related to improvements in HRQoL (all p<0.05).

Conclusions: While CMDs present at the time of UC diagnosis did not influence long-term clinical outcomes, they persistently impaired HRQoL. Our findings support the routine incorporation of psychological interventions into the long-term management of moderate-to-severe UC.

Keywords: Anxiety; Depression; Disease outcomes; Quality of life; Ulcerative colitis.

Fig. 1

Flowchart describing the MOSAIK cohort follow-up. UC, ulcerative colitis.

Fig. 2

Inflammatory Bowel Disease Questionnaire (IBDQ) scores after a 3-year follow-up according to common mental disorders present at baseline. (A) Total IBDQ score. (B) Association of the IBDQ subscore with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score. (C) Association of the IBDQ subscore with the HADS-Depression (HADS-D) score. *p<0.05.

Fig. 3

The 12-Item Short Form (SF-12) summary score after a 3-year follow-up according to the common mental disorders present at baseline. (A) Physical component summary. (B) Mental component summary. HADS-A, Hospital Anxiety and Depression Scale-Anxiety; HADS-D, Hospital Anxiety and Depression Scale-Depression. *p<0.05.