For many patients with chronic disease, battling illness and depression go hand-in-hand. This is especially true for patients with inflammatory bowel disease (IBD). Recent studies show that depression and/or anxiety are more common in patients with IBD than the general population or in patients who have other chronic diseases (1).
Crohn's disease and ulcerative colitis can be unpredictable. Flare-ups and relapses can occur at any time. Patients may have the perception that they have no control over their life which can lead to frustration and depression (2). Common psychological elements of the disease -- anxiety, isolation and embarrassment due to the nature of the disease -- can take an emotional toll on patients (3).
Typical Emotional Effects of Having IBD
- Isolation (3): IBD can create barriers to socialization. Patients may feel emotionally distant from healthy friends and family who can't really understand what they are going through. There is physical isolation, too. When symptoms are flaring, it becomes harder for patients to venture out. It is so much easier to withdraw to the security of home, close to a familiar, private bathroom where toilet, shower, medications and lavatory supplies are all at hand.
- Anxiety (3): The worries can be endless. Patients may fear incontinence and having an accident in public. They may worry about eating the wrong food, then paying a price with cramps and diarrhea. Patients with active symptoms may need to miss work, due to symptoms of pain, diarrhea and fatigue. They may need time off for doctor's appointments and recovery from medical procedures. Patients in remission may worry about having a relapse.
- Embarrassment (3): From childhood, we are taught to control our bowels and bladders. Being wracked with cramps and gas pains, plagued by recurring episodes of "the runs," can be humiliating for patients (2). Some IBD patients may need an ileostomy, with patients wearing a pouch on their abdomen, which can be hard to adjust to (4) and can be potential cause of further embarrassment.
Depression and IBD
Researchers have shown that depression itself can make some illnesses worse. There is growing evidence that suggest psychological factors including depression may play a role in the course of IBD as well (5). Depression and anxiety may be significant factors both before and after diagnosis of IBD.
Before Diagnosis
Researchers analyzing over 30 years of patient records in Southern England utilizing nested-case control studies of ulcerative colitis and Crohn's patients have found some associations between IBD, prior depression and anxiety. Before their diagnosis, ulcerative colitis patients had depression and anxiety significantly more often than the control population (1). In notable contrast, researchers did not find prior depression and anxiety in Crohn's patients to be significantly different from the control population (1).
After Diagnosis
Once the diagnosis of inflammatory bowel disease has been made, the risk of depression or anxiety is equally high (6) for both Crohn's and ulcerative colitis patients. One study showed that more than 80% of IBD patients with active disease suffered from anxiety, and approximately 60% had concomitant depression (5). Most of these mental disorders occured during the first year after diagnosis of IBD (1, 5).
Beyond being a result of the chronic disease, there is growing evidence that depression and anxiety may also aggravate Crohn's disease symptoms, influence response to therapy and otherwise affect the course of illness (7). A 2004 prospective, observational study of patients after relapse showed that depressed mood and anxiety may be risk factors for early clinical recurrence and for more active disease (5).
This information is intended for healthcare professionals only.
- Kurina, L., Goldacre, M., Yeates, D., and Gill, L., Depression and Anxiety in People with Inflammatory Bowel Disease, Journal of Epidemiology and Community Health, 2001; 55; 716-720. Available at: http://jech.bmjjournals.com/cgi/content/full/55/10/716. Accessed July 3, 2006.
- Depression, from Living with IBD, (n.d.), Crohn's and Colitis Foundation of America. Available at: http://www.ccfa.org/living/depression/?LMI=2.2. Accessed July 3, 2006.
- Mayo Clinic Staff. (August 10, 2005). Coping Skills. In Crohn's Disease Overview. Available at: http://www.mayoclinic.com/health/crohns-disease/DS00104/DSECTION=1. Accessed June 19, 2006.
- Crohn's Disease and Ulcerative Colitis: Emotional Factors. (2002). Crohn's and Colitis Foundation of America. Available at: http://www.ccfa.org/frameviewer/?url=/media/pdf/emotional.pdf&LMI=2.1. Accessed July 10, 2006.
- Mittermaier, C., Dejaco, C., Waldhoer, T., Oeferlbauer-Ernst, A., Miehsler, W., Beier, M., Tillinger, W., Gangl, A., and Moser, G. (2004). Impact of Depressive Mood on Relapse in Patients with Inflammatory Bowel Disease: A Prospective 18-month Follow-Up Study, Psychosomatic Medicine 66: 79 – 84 (2004). Available at: http://www.psychosomaticmedicine.org/cgi/content/full/66/1/79. Accessed July 2, 2006.
- Guthrie, E., Jackson, J., Shaffer, J., Thompson, D., Tomenson, B., and Creed, F., (2002) Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn's disease. American Journal of Gastroenterology, 97 (8), 1994-1999. Available at: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2002.05842.x. Accessed August 11, 2006.