FOOD ACCESS AND MENTAL HEALTH IN PEDIATRIC INFLAMMATORY BOWEL DISEASE

Abstract

Abstract PURPOSE It has been estimated that about 25% of patients with inflammatory bowel disease (IBD) are diagnosed before the age of 18. Food insecurity, limited or lack of access to enough food, has been associated with poor outcomes in childhood health including mental health problems. United States Department of Agriculture (USDA) defines a food desert as a census tract that meets criteria for low access to a grocery store and low income. Depression and anxiety have been well documented in pediatric patients with IBD. Functional Disability Inventory (FDI) is a measure of limitations in both physical and psychosocial functioning secondary to physical health. Our hypothesis is that patients in low access areas to healthy food will have more evidence of depression, anxiety and higher disability scores. METHODS This study is a retrospective chart review of patients diagnosed with Crohn's Disease (CD) or ulcerative colitis (UC) between 2019 to 2022. Patient’s addresses were entered into the USDA food access atlas to determine if they lived in an area of low access. Psychology screening included depression screening (PHQ-9), anxiety screening (GAD-7), and functional disability inventory (FDI). Screening questionnaires including PHQ-9, GAD-7, FDI were completed if patients were 12 years of age or old. If 11 years of old or less, parents completed FDI screening forms. RESULTS Our study consisted of 57 patients with an average age of 12.8 years at diagnosis. Thirty-three patients (58%) were non-Hispanic white, 19 (33%) were African American, and 3 were Hispanic (5%). Depression screening was positive in 22 patients (48%) and anxiety screening was positive in 25 patients (60%). Of those living in low access areas, 45% met criteria for depression, 53% met criteria for anxiety. There were comparable rates of depression between the low access group compared to the adequate access group (45% vs 50%, respectively) and rates of anxiety (53% vs. 61%, respectively). Patients in areas of low access had higher disability scores (9.88±11.9) than those in adequate access (5.88±6.1). When considering those who lived in a food desert (11 total), 8 patients were African American, 2 were non-Hispanic white, and 1 was self-described as other. Patients in the food desert group had higher rates of depression (78%) and anxiety (70%) compared to the low access group. Patients in the food desert group had the highest FDI scores (12.7 ±9.7). CONCLUSION Pediatric IBD patients had higher rate of depression and anxiety; However, there was no relationship between food access and depression or anxiety. When considering those in a food desert, the rate of depression increased to 78% and anxiety increased to 70%. Patients living in a food desert had the highest FDI scores. More information is needed on how multiple psychosocial factors might affect depression in children with IBD.