Authors: Kurina LM, Goldacre MJ, Yeates D, Gill LE.

Institution: Unit of Health-Care Epidemiology, Institute of Health Sciences, University of Oxford, Old Road, Oxford OX3 7LF, UK.

Objective: To determine whether depression or anxiety co-occurs with ulcerative colitis (UC) or Crohn's disease (CD) more often than expected by chance, and, if so, whether the mental disorders generally precede or follow the inflammatory bowel diseases (IBD).

Results: Both depression and anxiety preceded UC significantly more often than would be predicted from the control population's experience. The associations were strongest when the mental conditions were diagnosed shortly before UC, although the association between depression and UC was also significant when depression preceded UC by five or more years. Neither depression nor anxiety occurred before CD more often than expected by chance. However, depression and anxiety were significantly more common after CD; the associations were strongest in the year after the initial record of CD. UC was followed by anxiety, but not by depression, more often than expected by chance and, again, the association was strongest within one year of diagnosis with UC.

Conclusion: The concentration of risk of depression or anxiety one year or less before diagnosis with UC suggests that the two psychiatric disorders might be a consequence of early symptoms of the as yet undiagnosed gastrointestinal condition. The data are also, however, compatible with the hypothesis that the psychiatric disorders could be aetiological factors in some patients with UC. Most of the excess anxiety or depression diagnosed subsequent to diagnosis of IBD occurs during the year after IBD is diagnosed and the probable explanation is that the mental disorders are sequelae of IBD.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11553654&query_hl=69&itool=pubmed_docsum

Authors: Porcelli P, Zaka S, Centonze S, Sisto G.

Institution: Unita di Psicodiagnostica, Instituto Scientifico Gastroenterologico, Castellana Grotte, Italy.

Summary: The aim of this study was to evaluate the association between anxiety and depression, and levels of disease activity (LDA) in IBD patients. One hundred and fifty IBD patients (91 males and 59 females) were assessed by means of the Hospital Anxiety and Depression scale, and divided into three LDA groups according to standard clinical criteria: LDA1 = absence, LDA2 = mild, LDA3 = moderate and severe.

Using the analysis of variance and the Scheffe test, a significant difference was found in the anxiety score, but not in the depression score, between LDA1 and LDA3 (p < 0.005). The risk of developing anxiety and depression in relation to LDA was estimated by multiple logistic regression. A significant linear trend (p < 0.01) to develop anxiety was found in the highest LDA.

Our study showed that anxiety was significantly associated with a higher disease activity and suggested that anxiety should be appropriately evaluated and treated with the exacerbated symptoms in IBD patients.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8061336&query_hl=63&itool=pubmed_DocSum

Authors: Nordin K, Pahlman L, Larsson K, Sundberg-Hjelm M, Loof L.

Institution: Dept. of Public Health and Caring Sciences, University Hospital, Uppsala, Sweden. karin.nordin@pubcare.uu.se

Background: The chronicity of inflammatory bowel disease (IBD) and effects of medical and surgical treatments probably affect the daily lives of patients and may thus impair their health-related quality of life and psychological well-being.

Results: Patients with UC reported higher (superior) levels in all dimensions of health-related and disease-specific quality of life than did patients with CD.

Conclusions: Having an ileostomy does not seem to affect patients' quality of life, while having ileoanal anastomosis appears to reduce patients' quality of life in several of the dimensions assessed. CD patients reported more anxiety and depression than did patients with UC. The higher psychological distress in the CD group could be explained by more severe symptoms of the disease. Having ileoanal anastomosis may lead to more anxiety and depression, while having an ileostomy does not.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11989837&query_hl=60&itool=pubmed_docsum

Authors: Guthrie E, Jackson J, Shaffer J, Thompson D, Tomenson B, Creed F.

Institution: School of Psychiatry and Behavioural Sciences, University of Manchester, United Kingdom.

Objective: The determinants of health-related quality of life in inflammatory bowel disease are not completely understood. The present study aimed to assess two factors in patients with inflammatory bowel disease: a) whether health-related quality of life is independently associated with both bowel disease severity and psychological disorder, and b) whether Crohn's disease is associated with more marked psychological disorder than ulcerative colitis.

Conclusion: The presence of psychological disorder in inflammatory bowel disease contributes to poor health-related quality of life, regardless of the severity of the condition. Detection and treatment of psychological disorder in inflammatory bowel disease carries the potential to improve health-related quality of life for these patients.

Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12190166&query_hl=58&itool=pubmed_docsum