Anxiety and depression in adult patients with celiac disease on a gluten-free diet

Abstract

To compare anxiety and depression levels in adult patients with celiac disease (CD) on a gluten-free diet (GFD) with controls. The levels of anxiety, depression and of a probable anxiety or depressive disorder were assessed by the Hospital Anxiety and Depression Scale in 441 adult patients with CD recruited by the German Celiac Society, in 235 age- and sex-matched patients with inflammatory bowel disease (IBD) in remission or with slight disease activity, and in 441 adult persons of a representative German general population sample (GP). Potential demographic (age, sex, social class, family status) and disease-related (latency to diagnosis, duration of GFD, compliance with GFD, thyroid disease) predictors of anxiety and depression in CD were tested for by regression analyses. The level of anxiety in CD patients was predicted (R(2) = 0.07) by female gender (P = 0.01). Female sex (OR = 3.6, 95% CI: 1.3-9.4, P = 0.01) was associated with a probable anxiety disorder. Living alone (OR = 0.5, 95% CI: 0.2-0.9, P = 0.05) was associated with a reduced risk of an anxiety disorder. The level of depression and a probable depressive disorder were not predicted by any of the demographic and medical variables tested for. The levels of anxiety in patients with CD (6.6 +/- 3.4) and with IBD (6.9 +/- 3.7) were higher than those of persons in the GP (4.6 +/- 3.3) (both P < 0.001). The levels of depression in persons with CD (4.2 +/- 3.4), IBD (4.6 +/- 3.4) and of the GP (4.2 +/- 3.8) did not differ (P = 0.3). The prevalence of a probable anxiety disorder in persons with CD (16.8%) and IBD (14.0%) was higher than that of the GP (5.7%) (P < 0.001). The prevalence of a probable depressive disorder did not differ significantly between the three groups (P = 0.1). Anxiety in adult German female celiacs on a GFD is higher than in persons of the GP. Female celiacs on a GFD should be screened for anxiety.