Abstract
Comorbidity with anxiety or depression is common in patients with Inflammatory Bowel Disease (IBD) as Crohn Disease (CD) and Ulcerative Colitis (UC). Data suggest that the cognitive construct of alexithymia has high prevalence in people suffering from anxiety and mood disorders and even in people with IBD. Most studies have investigated mainly anxiety and depression, considering IBD population as a homogeneous group of patients. Little evidence shows the impact of alexithymia on the course of IBD. We evaluated a broad spectrum of psychopathological symptoms and alexithymia levels in a group of outpatients affected by IBD in clinical remission, comparing CD and UC and investigating the relationship with clinical and socio-demographic variables. One hundred and seventy IBD outpatients were screened by using the Hospital Anxiety Depression Scale (HADS), the Self-report Symptom Inventory-90-Revised (SCL-90-R) and the Toronto Alexithymia Scale (TAS-20). A high prevalence of anxious and depressive symptoms (42.35 and 25.8% respectively) together with alexithymia (31.76%) was confirmed. CD patients experienced high levels of depression (HADS Depression 35.2% p = 0.034; SCL-90-R mean 1.39 p < 0.001), somatisation (SCL-90-R mean 1.04 p < 0.001), obsessive-compulsive symptoms (SCL-90-R mean 1.2 p < 0.001), and global severity (SCL-90-R mean 1.15 p < 0.001). There is no statistical difference in the prevalence of alexithymia in both subpopulations. The levels of alexithymia are correlated to the levels of anxiety (HADS Anxiety rs = 0.516 p < 0.001), depression (HADS Depression rs = 0.556 p < 0.001; SCL-90-R rs = 0.274 p = 0.001), somatisation (SCL-90-R rs = 0.229 p = 0.005), obsessive-compulsive symptoms (SCL-90-R rs = 0.362 p < 0.001), and global severity (SCL-90-R rs = 0.265 p = 0.001). Furthermore, alexithymia is associated with a delay of diagnosis of IBD, poly-therapies and greater IBD extension. Older age, female gender, greater IBD extension, surgery, and delay of diagnosis seem to be related to a high prevalence of psychopathological symptoms such as anxiety, depression, somatisation, and obsessive-compulsive symptoms. Psychopathological symptoms and high levels of alexithymia are frequent in IBD patients and seem to be related to a high risk of poor clinical outcome. CD patients could be considered at higher risk of mental comorbidity. A more comprehensive psychiatric assessment, including alexithymia, and an integrated treatment of underlying conditions, must be taken into account in order to improve the global prognosis of the disease.
Highlights
Chronic Inflammatory Bowel Disease (IBD) mainly represented by Crohn Disease (CD) and Ulcerative Colitis (UC), are characterized by the occurrence of chronic inflammation with an unpredictable evolution distinguished by flares and remissions
The aim of this study is to evaluate a broad spectrum of psychopathological symptoms, psychological distress, and alexithymia levels in a group of Italian outpatients affected by IBD in clinical remission, analyzing possible differences between the two subpopulations of patients (CD and UC) and investigating possible links to specific clinical and sociodemographic variables
The prevalence of anxiety was comparable between the two groups (42.15% in UC and 42.63% in CD) while the prevalence of depressive symptoms was greater in CD patients (35.2% vs. 20.5% p = 0.034)
Summary
Chronic Inflammatory Bowel Disease (IBD) mainly represented by Crohn Disease (CD) and Ulcerative Colitis (UC), are characterized by the occurrence of chronic inflammation with an unpredictable evolution distinguished by flares and remissions. Patients who suffer from IBD frequently manifest extra-intestinal complications and need to undergo surgical conservative therapy or resective surgery, with different procedures between CD and UC [3, 4]. The chronic nature of IBD and its frequent onset in early adulthood (15–30 years old) [6] cause severe stress and worsening of quality of life [4, 7]. Low social support and high stress levels, as well as psychiatric comorbidities, usually worsen the quality of life [8] and increase the risk of mental distress when compared to the general population [9, 10]. A substantial quantity of data showed the comorbidity among anxiety, depression and IBD, whose prevalence is estimated to be around 30% in patients in clinical remission, while it reaches up to 60–80% during the active phase of the disease [11,12,13]
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