Managing Mental Health in Patients with IBD, with Sara Horst, MD, MPH

Mental health disorders are common among individuals with chronic diseases, with anxiety and depression affecting as many as 1 in 3 people with inflammatory bowel disease (IBD).1

New research presented at Digestive Disease Week (DDW) 2025 suggests such psychological comorbidities may negatively impact drug survival, especially in patients with ulcerative colitis (UC) initiating JAK inhibitors, posing important implications for the role of mental health awareness in optimizing advanced treatment for IBD.1

Like many chronic disease, individuals with IBD suffer from high rates of depression and anxiety. According to the University of Chicago, as many as 40% of IBD patients are diagnosed with depression during their lives, and up to 30% with anxiety.2

“When you're thinking about someone with chronic disease, it’s always important to try to help them manage their mental health, but we also see some consequences of that with their disease,” Sara Horst, MD, a professor in the division of gastroenterology, hepatology, and nutrition and associate vice chair of the department of medicine at Vanderbilt University Medical Center, explained to HCPLive.

Acknowledging the known negative impact of mental health disorders on various aspects of IBD and the hypothesized impacts on medication adherence, Horst and colleagues conducted a looking at patients with UC (n = 426) or Crohn’s disease (CD; n = 569) from the CorEvitas IBD Registry who initiated an advanced therapy at or after enrollment, had a baseline visit with anxiety and/or depression assessed, and had ≥ 1 follow-up visit.1

Self-reported anxiety and depression from PROMIS short forms were categorized as normal (<55) or higher than normal (≥55), and modeled as only anxiety, only depression, or both, compared to normal levels. Drug survival was defined as the interval from initiation to discontinuation, last registry visit, or 24 months, whichever occurred first.1

Among the cohort, investigators noted higher than normal anxiety (47% for UC; 45% for CD) and depression (29% for UC; 28% for CD) was common. While co-occurrence (26% for UC; 24% for CD) and only anxiety (21% for UC; 21% for CD) were frequent, depression (3% for UC; 5% for CD) was not.1

In patients with UC, drug survival was lowest among those with both anxiety and depression and highest among those with normal anxiety and depression levels, but investigators could not calculate all survival estimates for those with only depression due to small sample sizes.1

In adjusted regression models, a significant interaction was observed among patients with UC. Specifically, those who initiated a JAK inhibitor, those with only anxiety (hazard ratio [HR], 7.55; 95% CI, 2.24, 25.42) and those with anxiety and depression (HR, 5.70; 95% CI, 1.81-17.97) were significantly more likely to discontinue treatment than those with normal anxiety and depression levels.1

In contrast, anxiety and depression were not associated with drug survival among subjects with UC who initiated a biologic, or among any subjects with CD.1

Horst goes on to describe steps clinicians can take to support their patients’ mental health, including prioritizing screening when they have the capacity to do so, lean on primary health providers, and ensuring patients are aware of the importance of acknowledging and taking care of their mental health.

References

1. Horst SN, Marchese M, Gurola M, et al. ANXIETY, DEPRESSION, AND ADVANCED THERAPY DRUG SURVIVAL AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE (IBD) IN THE COREVITAS IBD REGISTRY. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

2. Wood M. Searching for links between IBD and mental health, through the gut microbiome. University of Chicago. June 14, 2023. Accessed May 8, 2025. https://www.uchicagomedicine.org/forefront/gastrointestinal-articles/searching-for-links-between-ibd-and-mental-health-through-the-gut-microbiome