Common psychological disorders in inflammatory bowel disease and implications for disease management

Objective: To review and describe the relationship between mood disorders and inflammatory bowel disease (IDB), considering the evidence for prevalence and comorbidity, as risk factors for disease course, and for psychological interventions in IBD disease management. Methods: Review of the clinical literature, with a primary focus on human studies and English language reports in the last decade to serve as an update to prior reviews. Results: Studies suggest that mood disorders are more prevalent in IBD. Anxiety and depression that pre-date IBD onset may be a risk factor for disease. Mood disorders can adversely affect the course of IBD, including more frequent relapses and greater risk of surgery. Active or more severe disease and poorer socioeconomic status are risk factors for the development of a mood disorder in IBD. Antidepressant medication and psychological therapy can improve anxiety and depression in IBD, but the evidence for direct improvement of IBD outcomes with these 2 therapy approaches is still preliminary. Conclusion: The psychological health of the IBD patient is relevant in disease management given the relationship of mood disorders with disease outcomes. GI practitioners are encouraged to screen for depression and anxiety and to initiate or refer for pharmacologic or psychological treatment when indicated. There is potential for these interventions to positively affect disease course directly in addition to mitigating distress and improving quality of life.