Female gender increases the risk of anxiety and depression in patients with inflammatory bowel disease under anti-TNF alpha therapy

Abstract

Background Depression and anxiety are significant predictors of worst health-related qualify of life in inflammatory bowel disease (IBD) patients. Nevertheless, the role of anxiety and depression in IBD patients under treatment with anti-TNFα has been poorly investigated. The aim of the study was to evaluate the frequency of anxiety and depression symptoms in IBD patients under anti-TNFα therapy, and the potential factors influencing the development of these symptoms.

Methods A prospective observational cohort study was designed. All IBD patients older than or with 18 years under treatment with anti-TNFα were consecutively included. Prevalence of anxiety and depression was assessed in IBD outpatients using the Hospital Anxiety and Depression scale (HAD). When using this scale we considered scores of 8 or higher to be abnormal. Relapse was defined in Crohn’s disease (CD) as a Harvey and Bradshaw index higher than 4, and in ulcerative colitis (UC) as a Partial Mayo index higher than 2. Patient demographics and disease characteristics were also collected: age, sex, marital status, smoking habit, type of IBD, phenotype included in Montreal classification, extra-intestinal manifestations, clinical activity, prior surgery, perianal disease and steroid or immunosuppresant use. Results are shown as OR and 95% CI, and analysed by logistic regression.

Results One hundred and nineteen patients were included (50 male, mean age 40 years, range from 20 to 83). Seventy-seven patients (64%) had CD and 42 (36%) UC; 90 of them (75%) were under maintenance treatment with infliximab and 25% with adalimumab. Anxiety and depression symptoms were presented in 38.9% and 25.2% patients, respectively. Females were more likely to have anxiety (OR = 6.13; 95% CI: 2.47–14.63; p = 0.001) and depression (OR = 3.32; 95% CI: 1.26–8.73; p = 0.015). Patients with active disease were no more likely to have anxiety (OR = 1.001; 95% CI: 0.973–1.029; p = 0.972) or depression (OR = 1.013; 95% CI: 0.984–1.042; p = 0.389). None of the other socio-demographic and clinical parameters were significantly associated with the development of anxiety or depression.

Conclusions An important number of IBD patients under anti-TNFα present anxiety or depressive symptoms. Female gender is associated with more anxiety and depression in this group of patients. However, disease activity was not associated with neither anxiety nor depression.