Persistence of Symptoms of Anxiety and Depression in Inflammatory Bowel Disease: A Longitudinal Follow-Up Study.

BACKGROUND Poor psychological health affects many patients with inflammatory bowel disease (IBD), but the persistence of these symptoms is unclear. METHODS We performed a longitudinal follow-up study of patients whose anxiety and depression trajectories were established by symptom data collected at 3-monthly intervals over the course of 1 year. We collected further anxiety and depression symptom data at yearly intervals over 2 years to determine the persistence of these symptoms in patients with IBD. Disease outcomes (flare/need for glucocorticosteroids, escalation of medical therapy, hospitalisation, or intestinal resection) were recorded to determine the effect of mood trajectories on the natural history of IBD. RESULTS Of 770 patients with established anxiety trajectories, 486 (63.1%) provided further anxiety symptom data at 12 months, and 358 (45.5%) at 24 months. Of the 777 patients with established depression trajectories, 491 (63.2%) provided further depression symptom data at 12 months, and 362 (45.6%) at 24 months. Participants with symptoms of anxiety at 24 months were more likely to have a fluctuating, or persistently abnormal or worsening, anxiety trajectory during the first year (p < 0.001 for trend). Participants with symptoms of depression at 24 months were more likely to have a fluctuating, or persistently abnormal or worsening, depression trajectory during the first year (p < 0.001 for trend). Adverse disease outcomes were no more likely according to anxiety or depression trajectories. DISCUSSION Poor psychological health persists for a substantial number of patients with IBD. Further work is needed to establish the long-term effect of mood trajectories on disease outcomes.