Depression In Inflammatory Bowel Disease Research Articles

P747 Assessment of a microlearning programme for patients with Inflammatory Bowel Disease (The ADEII project) on ansiety/depression status and illness perception

Abstract Background Information and communication technologies (ICTs) represent a novel approach to chronic disease management. However, their use in Inflammatory Bowel Disease (IBD) is lacking and their results as far unknown, because no specific tools are available, The prevalence of anxiety and/or depression in IBD ranges from 30-35% in clinically inactive phases. Furthermore, negative perceptions of the disease in the dimensions of consequences and emotions have been related to depression and anxiety. We aim to evaluate the outcomes of a novel microlearning programme for IBD patients in.anxiety/depression status and illness perception. Methods Prospective cohort study in adult patients with IBD (18 to 70 years old) who underwent a microlearning programme over a 2-month period, throught 4-minute videos organised in individualised video pathways that were sent via mobile phone using a Telegram bot. All patients received the 4-video main pack, consisting of 2 videos with information about their disease (ulcerative colitis or Crohn's disease), 1 video on adherence and another one on steroid treatment. To these were added as many videos as the number of drugs used by the patient to control IBD. Before starting the programme and at 6 months, patients completed the Hospital Anxiety and Depression Scale (HADS) and the Brief Illness Perception Questionnaire (BIPQ). Results Between June and October 2022, 1226 videos were sent to 200 IBD patients: 51.5% female (103), UC 52.5% (105), mean age 46.1 (13.2) years (Table 1). Median number of videos per patient was 6 (6-7). Attendance to ADEII programme ranged between 78% and 90%.The median score on the HAD anxiety subscale was 8.1 (4.3), while the median score on the HAD depression subscale was 6(4-8), Initially, anxiety was diagnosed in 60 patients (30%) and depressión in 16 (8%) as subescales scores>11. We found significant differences between the pre-intervention versus post-intervention medians and IQR in anxiety score 8(5-11) vs 7(4-11) (p=0.008) but no in depression. Regarding BIPQ test post -intervention there were significant decreases in P8 negative emotions 6(3-8) vs. 5(3-7) (p=0,003) and P5 identity 6(4-8) vs 5(3-7) (p=0,003) as well as a significant increase in P7 comprehensibility of disease 7(5-9) vs. 8(7-9) (p=0,003). Conclusion An ICT-based educational program was widely accepted by IBD patients and showed a decrease in anxiety and negative emotions and representations, along with improvement in the understanding of disease.

Is there a connection between depression and inflammatory bowel disease? A systematic review

Background: Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the digestive tract, Crohn's disease and ulcerative colitis are the principal types. Among the many symptoms characteristic of IBD, it is worth noting the symptoms of psychiatric disorders, often neglected in the therapeutic process. IBD's impact on patients' assessment of quality of life has been proven. Aim of the study: The purpose of this article is to review the literature in regards to the inflammatory bowel diseases in which depression occured and whether there is a connection between them. We also discussed various ways of treatment depression in IBDs.Material and Methods: The analysis covers the papers found in the PubMeddatabase. The search was conducted using the followingkeywords: “Inflammatory bowel diseases AND depression” (1,598 results), “Crohn’s disease AND depression” (892 results), “ ulcerative colitis AND depression” (823 records). Articles were analized with a particular emphasis on the most recent publications.Results: A total of 51 articles out of 3313 qualified for the review. There is a significant connection between frequent occurance of depression in the course of IBDs. However, because of the similarity of the symptoms of both diseases the depression diagnostic process is difficult and thus the number of patients with diagnosed depression isundervalued.Conclusions: Depression in IBDs is a important problem, it can exacerbate the symptoms and lower patients’ quality of life. To improve the holistic care of IBD patients, physicians should implement screening, at least widely available short scales or a few additional questions during an interview.

A Holistic Perspective on How Photobiomodulation May Influence Fatigue, Pain, and Depression in Inflammatory Bowel Disease: Beyond Molecular Mechanisms.

Numerous mechanisms, mostly molecular, have been tested and proposed for photobiomodulation. Photobiomodulation is finding a niche in the treatment of conditions that have no gold-standard treatment or only partially effective pharmacological treatment. Many chronic conditions are characterised by symptoms for which there is no cure or control and for which pharmaceuticals may add to the disease burden through side effects. To add quality to life, alternate methods of symptom management need to be identified. To demonstrate how photobiomodulation, through its numerous mechanisms, may offer an adjunctive therapy in inflammatory bowel disease. Rather than considering only molecular mechanisms, we take an overarching biopsychosocial approach to propose how existing evidence gleaned from other studies may underpin a treatment strategy of potential benefit to people with Crohn's disease and ulcerative colitis. In this paper, the authors have proposed the perspective that photobiomodulation, through an integrated effect on the neuroimmune and microbiome-gut-brain axis, has the potential to be effective in managing the fatigue, pain, and depressive symptoms of people with inflammatory bowel disease.

Correlations between the symptoms of insomnia, depression, sleep quality, antitumor necrosis factor therapy, and disrupted circadian clock gene expression in inflammatory bowel disease.

Inflammatory bowel disease (IBD) might be accompanied by emotional disturbances. Circadian rhythm genes, such as brain and muscle ARNT‑Like 1 (BMAL1), circadian locomotor output cycles kaput (CLOCK), neuronal PAS domain protein 2 (NPAS2), or nuclear receptor subfamily 1 group D member 1 (NR1D1) are related to inflammation and psychiatric symptoms that might modulate their expression. The study aimed to compare the expression of the BMAL1, CLOCK, NPAS2, NR1D1 mRNA in IBD patients and healthy controls (HCs). We evaluated the association between the gene expression and the disease severity, antitumor necrosis factor (TNF) therapy, sleep quality, insomnia, and depression. A total of 81 IBD patients and 44 HCs were recruited and classified according to the disease activity and IBD type (ulcerative colitis [UC] or Crohn disease [CD]). The participants filled out questionnaires assessing their sleep quality, daytime sleepiness, insomnia, and depression. Venous blood samples were collected, and the IBD patients on the anti‑TNF therapy had their blood drawn before and after 14 weeks of the treatment. In comparison with HCs, the IBD group had decreased expression of all studied genes apart from the BMAL1 gene. UC individuals with exacerbation had decreased expression of the CLOCK and the NPAS2 genes, as compared with the remission group. UC severity negatively correlated with the CLOCK, NPAS2, and NR1D1 mRNA levels. The IBD participants with depression symptoms had a decreased expression of the CLOCK and the NR1D1 genes, as compared with those without mood disturbances. Poor sleep quality was associated with a decreased expression of the NR1D1 gene. Biologic treatment decreased the expression of the BMAL1 gene. Disruption of the clock gene expression might constitute a molecular background of sleep disorders and depression in IBD and might contribute to UC exacerbation.

Identification and investigation of depression-related molecular subtypes in inflammatory bowel disease and the anti-inflammatory mechanisms of paroxetine.

Up to 40 per cent of people with active inflammatory bowel disease (IBD) also suffer from mood disorders such as anxiety and depression. Notwithstanding, the fundamental biological pathways driving depression in IBD remain unknown. We identified 33 core genes that drive depression in IBD patients and performed consensus molecular subtyping with the NMF algorithm in IBD. The CIBERSORT were employed to quantify the immune cells. Metabolic signature was characterized using the "IOBR" R package. The scoring system (D. score) based on PCA. Pre-clinical models are constructed using DSS. Using transcriptome data from the GEO database of 630 IBD patients, we performed a thorough analysis of the correlation between IBD and depression in this research. Firstly, the samples were separated into two different molecular subtypes (D. cluster1 and D. cluster2) based on their biological signatures. Moreover, the immunological and metabolic differences between them were evaluated, and we discovered that D. cluster2 most closely resembled IBD patients concomitant with depression. We also developed a scoring system to assess the IBD-related depression and predict clinical response to anti-TNF- therapy, with a higher D. score suggesting more inflammation and worse reaction to biological therapies. Ultimately, we also identified through animal experiments an antidepressant, paroxetine, has the added benefit of lowering intestinal inflammation by controlling microorganisms in the digestive tract. This study highlights that IBD patients with or without depression show significant variations and antidepressant paroxetine may help reduce intestinal inflammation.

SYSTEMATIC REVIEW OF THE PREVALENCE OF ANXIETY AND DEPRESSION DISORDERS AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Background: Mental health is an important but often disregarded part of inflammatory bowel disease (IBD) patient care, with difficulties defining effective medications and psychological health services. Anxiety and sadness are the most frequent psychosocial problems among IBD patients. The rising frequency of these mental problems calls for mental screening of all IBD patients at the initial appointment. Objective: A growing number of research on anxiety and depression in IBD have been undertaken nevertheless, there is no clear consensus on the prevalence of anxiety and depression in this group. The goal of this systematic review was to consolidate current data on the prevalence of depression and anxiety disorders in individuals with IBD. Methods: Authors began with recognizing the important examination proof that spots light on the prevalence of anxiety and depression among IBD patients. We led electronic writing look in the accompanying data sets: Ovid Medline (2010 to present), Ovid Medline Daily Update, Ovid Medline in process and other non-filed references, Ovid Embase (2010 to present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language will be incorporated. The precise selection was acted in close collaboration with a clinical examination curator. Results: There were 10 articles found, with a total of 26097 participants. The pooled prevalence estimate for anxiety disorders was 20.3%, and 13.3% for depression. When compared to those in remission, IBD patients in active illness showed a 75.6% greater prevalence of anxiety. Depressive symptoms were more common in Crohns disease than in UC (P0.001), and more common in active illness than in IBD patients in remission (P= 0.004). Conclusion: Results from this systematic review indicate that patients with IBD have about a 20.3% prevalence rate of anxiety and a 13.3% prevalence rate of depression.

P2Y12\xa0receptor as a new target for electroacupuncture relieving\xa0comorbidity of visceral pain\xa0and\xa0depression of inflammatory bowel disease

BackgroundThe P2Y12 receptor is a kind of purinoceptor that is engaged in platelet aggregation, and P2Y12 inhibitors have been used in clinical antithrombotic therapy. The P2Y12 receptor in microglia induces interleukin-1β (IL-1β) expression, which is a key mediator of depression in the brain. Although peripheral P2Y12 is involved in neuropathic pain, whether P2Y12 expression in the medial prefrontal cortex (mPFC) is associated with comorbidities of visceral pain and depression remains unclear. Accumulating evidence suggests that electroacupuncture (EA) is effective in treating inflammatory bowel disease (IBD), but its mechanism is unknown. This study aimed to determine whether P2Y12 expression in the mPFC is associated with comorbidities of visceral pain and depression in IBD and whether EA treats IBD by targeting the P2Y12 receptor.MethodsWe used 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced IBD mice. P2Y12 short hairpin RNA (shRNA) was stereotaxically injected into the bilateral mPFC. EA was performed on bilateral “Dachangshu” (BL25) acupoints once a day for 7 days. Von Frey filaments and colorectal distension were used to detect the mechanical pain threshold and visceral pain sensitivity. The sucrose preference test, tail suspension test and forced swimming test were used to evaluate depression in mice. Western blotting was used to test the expression of P2Y12 and IL-1β. Immunofluorescence staining was used to assess microglial activity.ResultsWe found that IBD mice presented visceral pain and depression associated with increased P2Y12 expression in the mPFC. P2Y12 shRNA significantly attenuated visceral pain and depression in IBD mice. P2Y12 shRNA significantly downregulated IL-1β expression and inhibited the activation of microglia in the mPFC of IBD mice. Meanwhile, EA played a similar role of P2Y12 shRNA. EA significantly downregulated P2Y12 expression, weakened the activation of microglia, and then inhibited IL-1β expression in the mPFC, thus relieving visceral pain and depression in IBD mice.ConclusionThe present study provided new ideas that the P2Y12 receptor in the mPFC could be a new target for the treatment of comorbid visceral pain and depression by EA. This may not only deepen our understanding of the analgesic and antidepressant mechanisms of EA but also promote the application of EA to treat IBD.

ANXIETY, DEPRESSION AND PERSONALITY TYPES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: COMPARISONS WITH PEPTIC ULCER AND THE GENERAL POPULATION

To explore corellation of anxiety, depression ant type of personality in inflammatory bowel disease (IBD) and compare with peptic ulcer (PU). In this study, prevalence of anxiety, depression and type of personality was investigated in 362 cases divided into three groups: 112 of IBD patients, 122 of peptic ulcer patients and 128 of control group who didn't have any gastrointestinal or psychic complaints. IBD and peptic ulcer diagnosis were established by standard diagnostic procedures (anamnesis, clinical manifestations, laboratory, endoscopy and biopsy in IBD and upper endoscopy in peptic ulcer). Anxiety and depression were established by Hamilton anxiety rating scale (HAM-A) and Hamilton rating test for depression (HAM-D). Type of A/B personality was established by Bortner scale and D type of personality by Denollet scale (DS14). Anxiety was found in 47 (41.9%) and depression in 44 (38.3%) of a total of 112 IBD cases. In group with peptic ulcer anxiety was found in 40 (32.8%) and depression aalso in 40 (32.8%) of total 122 cases. In control group anxiety was diagnosed in 21 (16.4%) and depression in 20 (15.6%) of total 128 cases. Anxiety and depresson were significantly higher in both groups than in control group but anxiety and depression were significantly higher in IBD group than peptic ulcer group. D type of personality was statistically significant in peptic ulcer group. Anxiety and depression in IBD and peptic ulcer cases have a greater prevalence compared to the normal population and surprisingly are higher in IBD than peptic ulcer group. D type of personality is associated with peptic ulcer.

Association between brain-derived neurotrophic factor and symptoms of insomnia and depression in inflammatory bowel disease (IBD) patients

IntroductionBrain-derived neurotrophic factor (BDNF) plays an important role in depression and sleep disorders. It influences the inflammatory process and may affect the interactions between psychological state and gastrointestinal symptoms.ObjectivesThe study aimed to compare BDNF concentrations in the group of Crohn’s disease (CD), ulcerative colitis (UC) patients, and healthy control (HC), as well as to correlate it with the severity of depression and insomnia.MethodsThe study included 94 inflammatory bowel disease patients (IBD, 57 CD, and 37 UC) and 26 HC. Each participant completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Athens insomnia scale (AIS), and Beck Depression Inventory (BDI). BDNF protein concertation measurements were performed using ELISA. Funding: National Science Centre, Poland-2018/31/N/NZ5/03715.ResultsCD patients had a higher serum level of BDNF (22.5 ng/mL, IQR:17.5-28.5) than UC patients (19.1 ng/mL, IQR:12.3-24.6; p=0.045). CD group had higher BDNF concentrations than HC (17.5 ng/mL, IQR:13.2-23.8; p=0.010), but no such differences were found between UC and HC groups (p=0.544). A positive correlation was found between AIS and BDNF among IBD (r=0.22, p=0.035). Additionally, patients, who obtained high BDI scores (>7 points) had lower BDNF concentrations than others (p=0.004). The patients with long sleep latency (>10 min) achieved a higher BDNF level than others (p=0.038). However. BDNF level did not correlate with PSQI results.ConclusionsBDNF serum level is increased in CD, but not in UC patients. Overall, the severity of insomnia symptoms correlates positively with BDNF levels. Future research should focus on the further explanation of those observations.

Treating anxiety and depression in inflammatory bowel disease: a systematic review

Objective Inflammatory Bowel Disease (IBD) is associated with higher rates of clinically significant anxiety and depression than in healthy populations. Psychosocial interventions targeting anxiety and depression in IBD have variable efficacy and disparate treatment approaches, making treatment recommendations difficult. The current study aimed to identify effective treatment components across psychosocial treatment approaches for anxiety and depression in IBD. Design A systematic review of psychosocial treatments for anxiety and depression in IBD was conducted. Based on the Distillation and Matching Model, treatments were coded and data aggregated by intervention components, or practice elements (PE), to elucidate replicable clinical techniques. Main Outcome The percentage of studies utilizing a given PE was the primary outcome. Measures Among all included studies, as well as among those finding favorable, significant effects on anxiety or depression, the percentage utilizing each PE and number of PEs utilized was determined. Results The most utilized PEs among included interventions were relaxation, IBD psychoeducation, cognitive restructuring, distraction, and social skills. Examining only interventions with favorable differences on specified outcomes (HRQoL, Anxiety, Depression, and/or Coping) indicated that relaxation, education, cognitive restructuring, and mindfulness were most utilized. Conclusion Implications for clinical practice are discussed, including the development and dissemination of treatment recommendations.

Prevalence of Anxiety and Depression in Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

Background: Inflammatory bowel disease (IBD) is a lifelong condition without a cure. Due to bidirectional communication, via the gut-brain axis, as well as the chronicity of symptoms, impaired quality of life, and reduced social functioning, patients with IBD may experience common mental disorders, including anxiety and depression. However, uncertainties remain about the magnitude of this problem. We conducted a systematic review and meta-analysis examining this issue. Methods: MEDLINE, EMBASE, and EMBASE Classic were searched (until September 2020) to identify cross-sectional or case-control studies that reported prevalence of anxiety or depression according to validated questionnaires in adult (≥18 years old) IBD patients. Pooled prevalence, odds ratios (OR), and 95% confidence intervals (CIs) were calculated. Findings: Of 5544 citations evaluated, 77 studies fulfilled eligibility criteria, containing 30,118 subjects. Overall, pooled prevalence of anxiety was 32.1% (95% CI 28.3%-36.0%) in 58 studies and depression 25.2% (95% CI 22.0%-28.5%) in 75 studies. The OR for either anxiety or depression were 1.24 times higher in patients with CD. Overall, women were more prone to common mental disorders, in particular the OR for anxiety in women with CD versus men was 2.37 (95% CI 1.45-3.87). The prevalence of anxiety or depression was increased in patients with active IBD (57.6% and 38.9%, respectively), compared with those with inactive disease (38.1% and 24.2%, respectively). The OR for anxiety in patients with active CD versus patients with inactive disease was 5.58 (95% CI 1.20-26.0). Interpretation: We demonstrated a high prevalence of common mental disorders in patients with IBD, with up to one-in-three patients affected by anxiety and one-in-four depression. Prevalence increased in active disease; one-in-two and one-in-three patients with active disease met criteria for anxiety or depression. Encouraging gastroenterologists to detect and treat these disorders might improve outcomes, leading to improved symptom control, better quality of life, and reduced health service and societal costs of managing IBD. Funding Statement: None. Declaration of Interests: Brigida Barberio: none. Mohammad Zamani: none. Christopher J. Black: none. Edoardo V. Savarino: none. Alexander C. Ford: none.

Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients.

Patients with inflammatory bowel disease (IBD) are diagnosed with anxiety/depression at higher rates than the general population. We aimed to determine the frequency of anxiety/depression among IBD patients and the temporal association with abdominal surgery and stoma formation. We conducted a retrospective cohort study in adult patients with IBD using difference-in-difference methodology and a large commercial claims database (2003-2016). Outcomes were anxiety/depression diagnoses before and after major abdominal surgery or stoma formation. We identified 10481 IBD patients who underwent major abdominal surgery, 18.8% of whom underwent stoma formation, and 41924 nonsurgical age- and sex-matched IBD controls who were assigned random index dates. Rates of anxiety and depression increased among all cohorts (P<0.001). Surgical patients had higher odds of anxiety [one surgery, adjusted OR 6.90 (95% CI 6.11-7.79), P<0.001; two or more surgeries, 7.53 (5.99-9.46), P<0.001] and depression [one surgery, 6.15 (5.57-6.80), P<0.001; two or more surgeries, 6.88 (5.66-8.36), P<0.001] than nonsurgical controls. Undergoing multiple surgeries was associated with a significant increase in depression from 'pre' to 'post' time periods [1.43 (1.18-1.73), P<0.001]. Amongst surgical patients, stoma formation was independently associated with anxiety [1.40 (1.17-1.68), P<0.001] and depression [1.23 (1.05-1.45), P=0.01]. New ostomates experienced a greater increase in postoperative anxiety [1.24 (1.05-1.47), P=0.01] and depression [1.19 (1.03-1.45), P=0.01] than other surgical patients. IBD patients who undergo surgery have higher rates of anxiety and depression than nonsurgical patients. Rates of anxiety and depression increase following surgery. Stoma formation represents an additional risk factor. These findings suggest the need for perioperative psychosocial support services.

Depression Predicts Prolonged Length of Hospital Stay in Pediatric Inflammatory Bowel Disease.

Few studies report the impact of depression on inflammatory bowel disease (IBD)-related hospitalizations. We evaluated the association between depression and pediatric IBD-related hospitalizations. Our primary aim was to test the hypothesis that depression is associated with hospital length of stay (LOS); our secondary goal was to evaluate if patients with depression are at higher risk for undergoing additional imaging and procedures. Data were extracted from the 2012 Kids Inpatient Database (KID), the largest nationally representative publicly available all-payer pediatric inpatient cross-sectional database in the United States. Hospitalizations for patients less than 21 years with a primary diagnosis Crohn disease (CD) or ulcerative colitis (UC) by ICD-9 code were included. Multivariable logistic regression was used to predict long LOS controlling for patient- and hospital-level variables and for potential disease confounders. For primary IBD-related hospitalizations (N = 8222), depression was associated with prolonged LOS (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.19-1.90) and total parenteral nutrition use (OR 1.54; 95% CI 1.04-2.27). Depression was not associated with increased likelihood of surgery (OR 0.97; 95% CI 0.72-1.30), endoscopy (OR 0.91; 95% CI 0.74-1.14), blood transfusion (OR 0.85; 95% CI 0.58-1.23), or abdominal imaging (OR 1.15; 95% CI 0.53-2.53). Depression is associated with prolonged LOS in pediatric patients with IBD, even when controlling for gastrointestinal disease severity. Future research evaluating the efficacy of standardized depression screening and early intervention may be beneficial to improving inpatient outcomes in this population.

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease.

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease.

Limited Health Literacy Is Associated With Worse Patient-Reported Outcomes in Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) face complex health tasks and decisions. Limited health literacy is a risk factor for poor health outcomes, but this has not been examined in IBD. This study aims to assess the role of health literacy for patients with IBD. We prospectively enrolled adults with IBD receiving care from the Section of Gastroenterology at the Boston Medical Center. In-person, standardized questionnaires were administered to measure health literacy with the Newest Vital Sign, self-efficacy with the Medication Use and Self-Efficacy Scale, quality of life with the 10-question Short Inflammatory Bowel Disease Questionnaire, depression with the Patient-Reported Outcomes Measurement System Short Form, and clinical disease activity for patients with Crohn's disease with the Harvey-Bradshaw Index and for patients with ulcerative colitis with the Simple Clinical Colitis Activity Index (SCCAI). The relationships between health literacy and these variables were subsequently examined. Of 112 patients invited to participate, 99 enrolled and completed the interview. Limited health literacy was identified in 40% (n = 40) of patients. Patients with limited health literacy reported significantly worse overall health (P = 0.03) and more depressive symptoms (P = 0.01). Of the 56 patients with Crohn's disease, those with adequate health literacy were more likely to be in clinical remission (mean Harvey-Bradshaw Index score < 5), compared with those with limited health literacy (odds ratio, 4.15; 95% confidence interval, 1.37 to 13.45; P = 0.01). There was no significant association between health literacy and clinical disease activity (SCCAI) in patients with ulcerative colitis. Limited health literacy is associated with lower ratings of subjective health and depression in IBD and more symptoms of active disease in patients with Crohn's disease.

Vitamin D Decreases Beck Depression Inventory Score in Patients with Mild to Moderate Ulcerative Colitis: A Double-Blind Randomized Placebo-Controlled Trial

ABSTRACTThe prevalence of depression in inflammatory bowel disease (IBD) is significantly more than in controls. Some studies assessed the link between vitamin D and depression. The aim of this study was to assess the effect of vitamin D on Beck Depression Inventory (BDI) score in ulcerative colitis (UC) patients. In this double-blind randomized controlled trial, 90 mild to moderate UC patients were assigned to receive a single injection of 300,000 IU vitamin D3 or 1 ml normal saline as placebo. At baseline and 3 months later, measurements of BDI score and serum 25-OH-vitamin D3 were done. Data were compared by independent sample t test, Mann–Whitney U test, and analysis of covariance (ANCOVA). Baseline BDI scores were not statistically different between the two groups (p = .4); scores decreased in the vitamin D group after the intervention (p = .023). Further subgroup analysis regarding baseline serum vitamin D levels and adjusted for baseline BDIs revealed lowering effect of vitamin D on BDI scores only in subgroup with baseline serum vitamin D levels equal to or higher than 30 ng/ml (p < .001). In this study, there was a statistically significant reduction in BDI score in mild to moderate UC patients 3 months after 300,000 IU vitamin D3 injection. Subgroup analysis showed that patients with sufficient baseline vitamin D may benefit from supplementation more than vitamin D–deficient patients, which indicates that higher serum vitamin D levels may be needed for its antidepressant effect.

P236 Symptoms of anxiety and depression in inflammatory bowel disease

Treatment of Crohn’s disease (CD) and ulcerative colitis (UC) is usually directed at organic aspects of the disease, often disregarding psychosocial factors. A comprehensive strategy including identification of anxiety and depression are possible therapeutic targets to increase quality of life in inflammatory bowel disease (IBD). The present study aims to test the association between anxious and depressive symptoms with IBD activity and course. Of 221 patients followed in outpatient setting in October and November of 2017, 64 patients with confirmed IBD who accepted to participate in the study were selected. Patients with known mental illness followed by Psychiatry were excluded. Anxiety symptoms were quantified by Spielberg's Anxious State Inventory (STAI) and symptoms of depression by the Beck II Depression Scale (BDI-II). Sixty-four patients were included, of which 75% with CD and 25% with UC. The mean age was 40 ± 13.99 years and 53.1% were female. Clinical remission rate was 87.5% in CU and 75% in CD, with an endoscopic remission rate of 25% in CU and 50% in CD. The correlation between anxiety and depression symptoms was significant (p <0.001, r = 0.73). There was no statistically significant difference in anxiety and depression scores between patients with CD and CU. The correlation of number of disease flairs with STAI and BDI-II scores was significant (STAI p = 0.023; BDI-II p = 0.017). In IBD patients, there was also a statistically significant association between STAI score (anxiety) and clinical remission, endoscopic remission and need for therapy step-up (p <0.05). In CD patients there was a significant association between anxiety and the presence of perianal disease (p = 0.035). In UC patients, there was a significant association between anxiety and recent flair (p = 0.021), use of emergency room (p = 0.029), hospitalisation (p = 0.029) and therapy step-up (p = 0.013). In this group of patients a significant association between depressive symptoms and immunosuppressant or anti-TNF therapy was seen (p = 0.009). In the analysed patients there was an association of anxious and/or depressive symptoms with frequency of disease flairs and disease activity. Screening for anxious and depressive symptoms may have a significant impact on the quality of life of patients with IBD.

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease

Faecal incontinence, anxiety and depression in inflammatory bowel disease

It is estimated that 24% of those diagnosed with inflammatory bowel disease (IBD) will experience faecal incontinence, which is 1.5 times greater than the general population. While higher levels of anxiety and depression are associated with faecal incontinence generally, IBD patients are more likely to report higher levels of these than the general population. A quantitative survey examined the relationship between faecal incontinence and levels of anxiety and depression in 117 IBD patients. The results revealed statistically significant differences between the levels of anxiety (p&lt;0.001) and depression (p=0.005) reported in patients who had recent experience of incontinence and those who did not. The study also raised concerns that incontinence is often concealed by patients and unidentified by health professions.

Antidepressants in Inflammatory Bowel Disease: A Systematic Review.

Antidepressants are commonly used to treat symptoms of anxiety and depression in inflammatory bowel disease (IBD). Recent studies suggest a link between IBD activity and an individual's emotional state which raises the possibility that antidepressants may potentially modify the disease course of IBD. This systematic review thus primarily aims to evaluate the efficacy of antidepressants on IBD activity, and secondarily, on anxiety and depression. MEDLINE, EMBASE, Cochrane (IBD Group), CINAHL, AMED, PsycINFO, and OpenGrey were searched from 1990 onward with no restrictions on study design. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also conducted. Fifteen eligible studies included in the review (1 randomized controlled trial, 2 cohorts, 1 case-control, 1 cross-sectional survey, 1 qualitative, 2 audits, 1 case series, and 6 case reports) examined a range of antidepressants. Twelve studies suggested that antidepressants have a positive impact on IBD course. Nine studies reported anxiety and depression as an outcome, of these 8 reported beneficial effects of antidepressants. Most of the studies were deemed to be at low risk of bias, apart from the case reports, which were at high risk of bias. This research indicates that antidepressants may have a beneficial effect on IBD course. However, it is currently not possible to determine their efficacy for certain because of the lack of randomized trials. Further trials using objective measures of IBD activity, longer follow-up periods, and larger sample sizes are needed.