Psychological Health Affects Inflammatory Bowel Disease Activity

Patients with active inflammatory bowel disease (IBD) and symptoms of a common mental health disorder are more likely to have adverse outcomes, according to a study in Gastroenterology.

The cross-sectional study assessed the influence of psychological factors and clinical or biochemical disease activity on the prognosis of IBD. Researchers enrolled eligible participants aged 16 years and older, who had a radiological, endoscopic, or histological diagnosis of Crohn disease (CD) or ulcerative colitis (UC), from November 2012 to June 2015. Prospective longitudinal follow-up occurred from September 2014 to November 2021.

Clinical disease activity was measured with the Harvey-Bradshaw index for CD and the Simple Clinical Colitis Activity Index (SCCAI) for UC. Data were also obtained for anxiety or depression symptoms using the Hospital Anxiety and Depression Scale (HADS).

A total of 760 patients were included in the study, and 718 provided complete clinical activity data at baseline. Among the study participants, 55.2% were women, the mean age at baseline was 44.0 years, 57.4% had CD, and 49.9% provided a fecal calprotectin (FC) sample.

Among study participants with clinical activity data available, the number of those who provided longitudinal follow-up data varied between 79.7% (flare of disease activity or need for glucocorticosteroids) and 97.9% (death), with a mean follow-up of 6.5 years. Among the group who provided an FC sample, the number of participants who provided longitudinal follow-up data varied between 85.2% (flare of disease activity or need for glucocorticosteroids) and 98.4% (death), with a mean follow-up 6.7 years.

According to multivariate Cox regression analysis, patients with clinical activity and symptoms of a common mental health disorder at baseline had a significantly increased need for glucocorticosteroid prescription or flare (hazard ratio [HR], 2.36; 95% CI, 1.58-3.54; P <.001 for trend), escalation (HR, 1.65; 95% CI, 1.14-2.40; P =.008), and death (HR, 4.99; 95% CI, 1.80-13.88; P =.002).

In patients with biochemical activity and symptoms of a common mental health disorder at baseline, the rates of glucocorticosteroid prescription or flare (HR, 2.48; 95% CI, 1.38-4.46, P =.002), escalation (HR, 2.97; 95% CI, 1.74-5.06; P <.001), hospitalization due to uncontrolled IBD activity (HR, 3.10; 95% CI, 1.43-6.68; P =.004), and death (HR, 6.26; 95% CI, 2.23-17.56; P <.001) were significantly increased.

Among several study limitations, some endpoints were based on the physician’s interpretation of patient-reported symptoms, and evaluation of common mental health disorders was based on the HADS, not a physician’s diagnosis.

“Our results suggest that aiming for clinical or biochemical remission alone is an inadequate therapeutic target in IBD,” the study authors wrote. “Psychological health is also an important driver of disease activity and may even be more important than clinical or biochemical disease activity in determining outcomes.”

Disclosure: This research was supported by Tillotts Pharma UK Ltd. Please see the original reference for a full list of disclosures.


Fairbrass KM, Gracie DJ, Ford AC. Relative contribution of disease activity and psychological health to prognosis of inflammatory bowel disease during 6.5 years of longitudinal follow-upGastroenterology. Published online March 23, 2022. doi:10.1053/j.gastro.2022.03.014