Assessment of Comorbid Depression and Anxiety in Inflammatory Bowel Disease Using Adaptive Testing Technology

Background: Depression and anxiety are comorbidities of inflammatory bowel disease (IBD), and it is now recommended to screen IBD patients for these conditions. We screened patients using a novel computerized adaptive testing technology and compared the screening results to measures of disease activity. Methods: Consecutive patients at our tertiary IBD clinic were asked to complete the validated CAT-MH survey (Adaptive Testing Technologies, Chicago, IL); we then reviewed disease and patient characteristics. Clinical remission status was determined based on clinical, laboratory, endoscopy, and imaging results. Statistical methods included Fisher exact test and Pearson chi-square tests to assess association. Univariable and multivariable analyses were performed. Results: We included 134 patients, of which 34 (25.3%) screened positive for depression and 18 (13.4%) screened positive for anxiety. We identified 19 (55.9%) and 10 (55.5%) patients who were previously undiagnosed for depression and anxiety, respectively. Patients in clinical remission were less likely to screen positive for depression (odds ratio 0.19; 95% confidence interval 0.07-0.50) and for anxiety (odds ratio 0.30; 95% confidence interval 0.10-0.91). Compared to patients with negative C-reactive protein values, patients with positive C-reactive protein were more likely to also screen positive for depression (P = 0.025) and anxiety (P = 0.15). Conclusions: We demonstrate the utility of a novel testing technology for screening patients with IBD for depression and anxiety. We found a large number of patients with previously undiagnosed anxiety or depression and a significant positive association between clinically active IBD and these mental health conditions. This work supports and informs recommendations for mental health screening in the IBD population. Lay Summary We demonstrate the utility of a novel rapid testing technology to screen patients with inflammatory bowel disease (IBD) for mental health comorbidities. We found that active IBD is a significant risk factor for depression/anxiety indicating the need for routine mental health screening.