P035 Decrease in Severity of Psychiatric Comorbidities in the IBD Population During the COVID-19 Pandemic

Abstract

BACKGROUND: The COVID-19 pandemic has greatly increased the rate of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) in the general population (Czeisler, 2020). We used a computerized adaptive testing technology to measure how inflammatory bowel disease (IBD) patients’ mental health has changed during this time. METHODS: We enrolled patients with IBD of a single provider (DTR) in a longitudinal study that assesses mental health. CAT-MH is an adaptive testing tool that has been validated in multiple populations, has been previously studied in IBD (Gibbons et al., 2012; Karpin and Rodriguez et al., 2020), and provides scores which correlate with MDD and GAD diagnosis and severity. We sent the survey to our patients every 3 months and included those with at least one completed survey both before and after March 11, 2020 (the date the World Health Organization (WHO) declared COVID a pandemic) (WHO website). Disease activity was determined by clinical notes, biomarkers and HBI/SCCAI scores. Patient characteristics were reviewed. In April, DTR updated all his patients about COVID and IBD via a well-attended zoom meeting. RESULTS: We included 23 patients and a total of 72 surveys (median 3 surveys per patient). Six patients screened positive for MDD before WHO declared a pandemic (pre-PAN). After WHO declared a pandemic (post-PAN), 4 of these patients remained positive for MDD, 2 patients went from positive to negative and 1 new patient screened positive. The median depression severity pre-PAN was 21 and post-PAN was 20.75. Seven patients screened positive for GAD pre-PAN. 5 of these patients remained positive post-PAN and 2 went from positive to negative. The median anxiety severity pre-PAN was 17.1 and post-PAN was 16.4. Four patients in the study were taking psychiatric medication at time of enrollment. Two of these patients screened negative for both MDD and GAD at both time points but reported an increase in depression and anxiety severity. One patient went from negative pre-PAN to positive post-PAN for MDD, remained positive for GAD, and reported an increased severity in both depression and anxiety. The final patient was positive for both MDD and GAD at both time points yet reported a decrease in severity for depression and anxiety. Six (26%) patients had increased IBD activity and 9 had decreased IBD activity during the pandemic. None of these patients had increased depression or anxiety severity post-PAN. Nine had decreased depression severity and 9 had decreased anxiety severity which did not correlate with change in disease activity. CONCLUSION: In this longitudinal study we found a decrease in median anxiety and depression severity in IBD after COVID-19 was declared a national emergency, and these findings were unrelated to IBD activity. Despite the incredible challenges of the pandemic there was no obvious increase in depression or anxiety among our patients with IBD, distinctly different from the general population. These findings require further study but may reflect access to our IBD center and reassuring educational updates that tempered reactive anxiety and depression.