Depression and anxiety in people with inflammatory bowel disease

Study objective-To determine whether depression or anxiety co-occurs with u lcerative colitis (UC) or Crohn's disease (CD) more often than expected by chance, and, if so, whether the mental disorders generally precede or follo w the inflammatory bowel diseases (IBD). Design-Nested case-control studies using a database of linked hospital reco rd abstracts. Setting-Southern England. Main results-Both depression and anxiety preceded UC significantly more oft en than would be predicted from the control population's experience. The as sociations were strongest when the mental conditions were diagnosed shortly before UC, although the association between depression and UC was also sig nificant when depression preceded UC by five or more years. Neither depress ion nor anxiety occurred before CD more often than expected by chance. Howe ver, depression and anxiety were significantly more common after CD; the as sociations were strongest in the year after the initial record of CD. UC wa s followed by anxiety, but not by depression, more often than expected by c hance and, again, the association was strongest within one year of diagnosi s with UC. Conclusions-The concentration of risk of depression or anxiety one year or less before diagnosis with UC suggests that the two psychiatric disorders m ight be a consequence of early symptoms of the as yet undiagnosed gastroint estinal condition. The data are also, however, compatible with the hypothes is that the psychiatric disorders could be aetiological factors in some pat ients with UC. Most of the excess anxiety or depression diagnosed subsequen t to diagnosis of IBD occurs during the year after IBD is diagnosed and the probable explanation is that the mental disorders are sequelae of IBD.