Review article
Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review

https://doi.org/10.1016/j.jpsychores.2017.07.001Get rights and content

Highlights

  • The prevalence of psychiatric disorders in IBD clinical cohorts is higher than in general population.

  • A systematic literature review on prevalence and efficacy of psychopharmacological treatment and psychotherapy for IBD

  • Although a high rate of psychoactive drug use, a low proportion of IBD patients have access to psychiatric referral.

  • Psychotherapy effective on QoL, coping, stress, anxiety and depression as well as disease activity in 1/3 of the studies

  • Antidepressants proved effective in reducing disease activity, gastrointestinal symptoms, anxiety and depression.

Abstract

Objectives

Higher prevalence of psychiatric disorders, such as anxiety and depression, has been found in people with Crohn's disease and Ulcerative Colitis compared to the general population. Nowadays, international guidelines advocate psychotherapy and psycho-pharmacological treatments as playing an important role in IBD care.

The main goal of this systematic literature review was summarize the evidence on the utilization and effectiveness of treatments for depression and anxiety in persons with IBD.

Methods

A systematic literature review was conducted using three different electronic databases: MEDLINE, PsychINFO, and EMBASE to identify studies reporting the prevalence and efficacy of psycho-pharmacological and psychotherapeutic treatments for IBD. A quality appraisal was conducted using several scales as appropriate for each study design. A narrative synthesis was also performed.

Results

Forty-three studies were included. Although a high rate of psychoactive drug use was found in people with IBD, a low proportion of IBD patients have access to psychiatric referral. 1/3 of the studies found that psychotherapy was effective for improving the quality of life, perception of stress, anxiety and depression as well as disease. Antidepressants proved effective in reducing disease activity, gastrointestinal symptoms, anxiety and depression.

Conclusion

Our results suggest that psychiatric treatment should be implemented in IBD care. However, further studies are needed to confirm the findings of our systematic review.

Introduction

The two main inflammatory bowel diseases (IBD), Crohn's disease (CD) and Ulcerative Colitis (UC), consist of chronic relapsing and remitting conditions and account for high levels of individual and social impairment and substantial costs to the health care system. The etiology of these diseases is multifactorial and depends on both genetic and environmental factors [1].

Clinical studies have shown that the prevalence of psychiatric disorders, such as anxiety and depression, is higher in IBD cohorts than in the general population, being around 30% [2]. Furthermore, patients with CD seem to have a slightly higher prevalence (up to 50%) of psychiatric disorders and a lower quality of life than patients with UC or those with other chronic diseases [3], [4]. The high rates of anxiety and depression found in IBD patients, particularly when the disease is active, warrant a systematic approach to screening and treatment [5].

Even though psychiatric disorders are considered important causes of functional impairment and reduced quality of life in people with IBD, controversy still exists as to their role. Some studies suggest that these psychiatric disorders are among the risk factors that may cause and precede the onset of IBD; other evidence shows that psychiatric disorders are a consequence of the disability associated with IBD [6], [7]. According to several authors, anxiety, depression and stress may influence the course of the disease leading to a greater number of relapses and use of medications such as steroids [8], [9], [10], [11]. However, other studies do not confirm any influence of these factors on the course of IBD [12].

Based on available evidence, current guidelines for the treatment of IBD recommend implementing psychiatric/psychological interventions when depressive or anxiety disorders are present [6], [7].

The goal of this systematic literature review is to summarize the evidence on the utilization and effectiveness of treatments for depression and anxiety in persons with IBD.

Section snippets

Methods

The systematic literature review was conducted in July 2016 and April 2017 using three different electronic databases: MEDLINE, PsychINFO, and EMBASE. Following Macer et al. [13], studies published before 1990 were not included.

We included primary studies if the following criteria were met:

  • a)

    The sample included adult patients (≥ 18 years old);

  • b)

    The study sample included patients with IBD disorders (diagnosed according to clinical, radiologic, endoscopic and histological criteria);

  • c)

    Primary research

Characteristics of studies included

The literature search identified 828 papers, of which 749 papers non duplicate titles and 123 were selected after screening titles and abstracts. Fig. 1 shows a Prisma Diagram [16] of studies included and excluded. Out of the 123 papers retrieved, 4 studies were excluded because of not reporting results; 15 because they included data on children and/or adolescents; 21 because they reported data on prevalence of psychiatric disorders, stress and quality of life of people with IBD; 13 because

Discussion

Our systematic literature review showed that at present only a limited number of studies have been conducted on the prevalence and effectiveness of psycho-pharmacological and psychotherapeutic treatments in people with IBD.

Despite the limited amount of evidence available, the studies we identified on the prevalence of psycho-pharmacological treatment in people with IBD suggested a high prevalence of AD, anxiolytic, hypnotic and sedative consumption. The largest study conducted to date also

Competing interest

The authors declare that they have no competing interests to report. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

The authors are pleased to acknowledge the suggestions of Prof Giovanni Barbara, Prof Franco Bazzoli, Prof Davide Festi, Dr. Angelo Fioritti, Prof Marco Zoli and the patient encouragement of the AMICI Onlus association.

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