Introduction
Psychiatric manifestations in individuals with inflammatory bowel disease (IBD) have been the subject of extensive research. Still, uncertainties remain regarding its precise magnitude, its impact on intestinal disease, and the whole burden of psychiatric manifestations.
Aims & Methods
This systematic review aims to synthesize available evidence on the prevalence and impact of psychiatric symptoms, including depression, anxiety, bipolar disorders, and schizophrenia in IBD patients.
A systematic search was conducted in the PubMed/MEDLINE, EMBASE and SCOPUS databases to identify relevant studies published between January 2010 and January 2023. Cross-sectional, case-control, cohort, registry and population studies were selected that addressed the prevalence of depression, anxiety, bipolar disorder, and schizophrenia in people with IBD compared to the general population. A meta-analysis was also conducted to assess the strength of the association. Data extraction and quality assessment were performed.
Results
The search yielded a total of 3209 articles. Although 193 met the inclusion criteria, only 26 studies provided complete data. Overall, the prevalence of psychiatric comorbidities was found to be significantly higher in IBD patients compared to the general population. The analysis revealed a moderate but significant association between IBD and depression, with a calculated pooled odds ratio (OR) of 1.42 (p<.0001). Also, anxiety disorders emerged as a prevalent comorbidity in IBD with a calculated pooled OR of 1.3 (p<.0001). Evidence for the association between bipolar disorders and IBD was limited but significant, with a pooled OR of 1.64 (p<.0001), despite a substantial heterogeneity (I2=94.01%). Only 3 studies examined the association between schizophrenia and IBD, providing widely heterogeneous results, with an inconclusive OR (0.93, p= 0.73).
Conclusion
This systematic review with meta-analysis highlights that psychiatric comorbidities such as depression, anxiety, and bipolar disorders are more prevalent in IBD than in the general population. Depression and anxiety are particularly prevalent. Bipolar disorder is still an under-researched area in the context of IBD. Data on the association between schizophrenia and IBD is sparse and inconclusive and requires further research. Given the findings of this systematic review, there is a need for a deeper understanding of these associations and early detection in order to develop tailored mental health interventions for patients with IBD.
References
1. Jairath V, Feagan BG. Global burden of inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2020;5(1):2-3.
2. Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-70.
3. Piovani D, Armuzzi A, Bonovas S. Association of Depression With Incident Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis. 2023.