People with IBD experience higher anxiety risk compared to peers without IBD

People who have inflammatory bowel disease (IBD), such as Crohn's disease or ulcerative colitis, have twice the odds of having a generalized anxiety disorder at some point in their lives when compared to peers without IBD, according to a new study published by University of Toronto researchers.

"Patients with IBD face substantial chronic physical problems associated with the disease," said lead-author Professor Esme Fuller-Thomson, Sandra Rotman Endowed Chair at the University of Toronto's Factor-Inwentash Faculty of Social Work. "The additional burden of anxiety disorders makes life much more challenging so this 'double jeopardy' must be addressed."

Investigators reported that female IBD sufferers were particularly vulnerable to anxiety disorders. Women with IBD had four times the odds of anxiety when compared to men with IBD, said Fuller-Thomson.

Data were drawn from a representative sample of more than 22,000 Canadians, the 2012 Canadian Community Health Study: Mental Health. A total of 269 respondents reported that they had been diagnosed by a health professional with Crohn's disease or ulcerative colitis.

"The study draws attention to the need for routine screening and targeted interventions for anxiety disorders," said co-author and adjunct lecturer Joanne Sulman. "Particularly among the most vulnerable patients with IBD: women, individuals who are in chronic pain and those with a history of childhood sexual abuse."

Co-author and former graduate student, Rusan Lateef, noted two other factors that were associated with anxiety disorders among those with IBD. "Of particular interest was the six-fold odds of anxiety disorders we found among those with IBD who had a history of childhood sexual abuse. Not surprisingly, we also found that those who reported moderate or severe chronic pain had twice the odds of anxiety disorders in comparison to those with only mild or no chronic pain."

Patrick McGowan, an assistant professor of biological sciences at the University of Toronto Scarborough, says one of the reasons this study is so significant is because it underlines the important link between physical and mental health.

"We sometimes think of the two as if they are entirely separate entities but the reality is they are intimately linked," said McGowan. "Both involve genuine physical changes in the body and affect each other." McGowan was not directly involved with the study.

McGowan notes that although the study was not designed to determine the biological mechanisms of anxiety disorders or inflammatory bowel diseases, adverse life experiences and chronic anxiety can hijack the stress response system, potentially affecting a whole host of bodily processes, including chronic inflammation.

"This study asks about the association between these processes, so we don't know cause-and-effect, but treatment options are likely to expand if the options are broader than physical or mental health alone."

The study was published online this week in the journal Inflammatory Bowel Diseases.