Assessment of Comorbid Depression and Anxiety in Inflammatory Bowel Disease Using Adaptive Testing Technology

Abstract

Background: Depression and anxiety are comorbidities of inflammatory bowel disease (IBD), and it is now recommended to screen IBD patients for these conditions. We screened patients using a novel computerized adaptive testing technology and compared the screening results to measures of disease activity. Methods: Consecutive patients at our tertiary IBD clinic were asked to complete the validated CAT-MH survey (Adaptive Testing Technologies, Chicago, IL); we then reviewed disease and patient characteristics. Clinical remission status was determined based on clinical, laboratory, endoscopy, and imaging results. Statistical methods included Fisher exact test and Pearson chi-square tests to assess association. Univariable and multivariable analyses were performed. Results: We included 134 patients, of which 34 (25.3%) screened positive for depression and 18 (13.4%) screened positive for anxiety. We identified 19 (55.9%) and 10 (55.5%) patients who were previously undiagnosed for depression and anxiety, respectively. Patients in clinical remission were less likely to screen positive for depression (odds ratio 0.19; 95% confidence interval 0.07-0.50) and for anxiety (odds ratio 0.30; 95% confidence interval 0.10-0.91). Compared to patients with negative C-reactive protein values, patients with positive C-reactive protein were more likely to also screen positive for depression (P = 0.025) and anxiety (P = 0.15). Conclusions: We demonstrate the utility of a novel testing technology for screening patients with IBD for depression and anxiety. We found a large number of patients with previously undiagnosed anxiety or depression and a significant positive association between clinically active IBD and these mental health conditions. This work supports and informs recommendations for mental health screening in the IBD population.