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.