The Relationship Between Anxiety and Depression Symptoms and Disease Activity in Patients with Inflammatory Bowel Disease

Abstract

Background: Anxiety and depression are common in inflammatory bowel disease (IBD) and may be associated with disease activity. Objectives: This study aimed to evaluate the association between psychological factors, specifically anxiety and depression, and disease activity in patients with IBD. Methods: In this cross-sectional study conducted between 2022 and 2024, 307 patients with IBD from Guilan Province were analyzed. Eligible participants were adults aged ≥ 18 years who were registered in the Iranian Registry of Crohn’s and Colitis (IRCC) and had diagnoses confirmed by gastroenterologists on the basis of clinical, endoscopic, and histopathological criteria. Patients were consecutively enrolled and classified as having active or inactive disease according to recent hospitalization and validated indices, including the Modified Truelove and Witts Severity Index (MTWSI)/Mayo score for ulcerative colitis (UC) and the Harvey-Bradshaw Index (HBI) for Crohn’s disease (CD). Anxiety and depression were assessed using the Generalized Anxiety Disorder 7-item (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Results: The mean age was 45.40 years; 32.90% of participants were male, and 67.10% were female. The mean disease duration was 11.30 years, and 73.00% had at least 1 comorbidity. Each 1-point increase in the GAD-7 and PHQ-9 scores was associated with 1.38-fold higher odds of active disease (95% CI, 1.24 - 1.54 and 1.25 - 1.54, respectively; P < 0.001). These associations remained significant after adjustment for confounders (adjusted OR for GAD-7, 1.44; 95% CI, 1.27 - 1.65; adjusted OR for PHQ-9, 1.37; 95% CI, 1.22 - 1.54; P < 0.001). These findings indicate that psychological distress is independently associated with IBD activity. Conclusions: These findings highlight an association between psychological distress and IBD activity. Given the cross-sectional design, the directionality of this association cannot be established, and reverse causation, whereby active disease may contribute to psychological distress, remains a plausible explanation.