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      Prevalence of Anxiety and Depression in Patients with Inflammatory Bowel Disease

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          Abstract

          Background

          Inflammatory bowel disease (IBD) patients are not routinely screened for depression and anxiety despite knowledge of an increased prevalence in people with chronic disease and negative effects on quality of life.

          Methods

          Prevalence of anxiety and depression was assessed in IBD outpatients through retrospective chart review. The presence of anxiety and/or depression was determined using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 self-report questionnaires or by diagnosis through psychiatric interview. Patient demographics, disease characteristics, and medication information were also collected. Multivariable analysis was used to determine associations between patient factors and depression and anxiety.

          Results

          327 patient charts were reviewed. Rates of depression and anxiety were found to be 25.8% and 21.2%, with 30.3% of patients suffering from depression and/or anxiety. Disease activity was found to be significantly associated with depression and/or anxiety ( p = 0.01). Females were more likely to have anxiety ( p = 0.01).

          Conclusion

          A significant proportion of IBD patients suffer from depression and/or anxiety. The rates of these mental illnesses would justify screening and referral for psychiatric treatment in clinics treating this population. Patients with active disease are particularly at risk for anxiety and depression.

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          Most cited references22

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          Epidemiology and treatment of depression in patients with chronic medical illness

          There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
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            Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management.

            While there has been a great deal of speculation over the years on the importance of emotional factors in inflammatory bowel disease (IBD), it is only in the last decade or so that studies with stronger designs have been available to clarify the nature of this relationship. This review considers recent evidence on the prevalence of anxiety and depressive disorders in IBD, the role of these disorders as a risk factor for IBD onset, the degree to which they affect the course of the IBD, and the contribution of corticosteroid treatment to psychiatric symptom onset. There is evidence that anxiety and depression are more common in patients with IBD and that the symptoms of these conditions are more severe during periods of active disease. The few studies that address the issue of anxiety and depression as risk factors for IBD do not yet provide enough information to support definite conclusions. There is evidence, however, that the course of the disease is worse in depressed patients. Treatment with corticosteroids can induce mood disorders or other psychiatric symptoms. The second part of the review focuses on patient management issues for those with comorbid anxiety or depression. Practical approaches to screening are discussed, and are recommended for routine use in the IBD clinic, especially during periods of active disease. We review evidence-based pharmacological and psychological treatments for anxiety and depression and discuss practical considerations in treating these conditions in the context of IBD to facilitate overall management of the IBD patient.
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              Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence.

              To review the evidence for an association between depression and anxiety and the National Health Priority Area conditions -- heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis -- and for the effectiveness of treatments for depression and anxiety in these settings. Systematic literature search of systematic reviews, meta-analyses and evidence-based clinical practice guidelines published between 1995 and 2007, inclusive. Each review was examined and summarised by two people before compilation. Depression is more common in all disease groups than in the general population; anxiety is more common in people with heart disease, stroke and cancer than in the general population. Heterogeneity of studies makes determination of risk and the direction of causal relationships difficult to determine, but there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus. Antidepressants appear to be effective for treating depression and/or anxiety in patients with heart disease, stroke, cancer and arthritis, although the number of studies in this area is small. A range of psychological and behavioural treatments are also effective in improving mood in patients with cancer and arthritis but, again, the number of studies is small. The evidence for the association of physical illness and depression and anxiety, and their effects on outcome, is very strong. Further research to establish the effectiveness of interventions is required. Despite the limits of current research, policy and practice still lags significantly behind best evidence-based practice. Models of integrated care need to be developed and trialled.
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                Author and article information

                Contributors
                Journal
                Can J Gastroenterol Hepatol
                Can J Gastroenterol Hepatol
                CJGH
                Canadian Journal of Gastroenterology & Hepatology
                Hindawi
                2291-2789
                2291-2797
                2017
                18 October 2017
                : 2017
                : 6496727
                Affiliations
                1Department of Medicine, University of British Columbia, Vancouver, BC, Canada
                2Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
                3Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
                4Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
                Author notes

                Academic Editor: Yousuke Nakai

                Author information
                http://orcid.org/0000-0003-4193-1314
                http://orcid.org/0000-0002-8699-4370
                http://orcid.org/0000-0003-4740-8209
                Article
                10.1155/2017/6496727
                5664260
                29181373
                7367c0eb-4de7-48be-9994-24ee7f476c2d
                Copyright © 2017 Glynis Byrne et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 July 2017
                : 16 September 2017
                Categories
                Research Article

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