GI Psychiatry

Course and predictors of somatic symptom disorder in irritable bowel syndrome and ulcerative colitis: A longitudinal analysis from the SOMA.GUT-RCT
Luisa Peters, Anna Matysiak, Sina Hübener, Ansgar W Lohse, Bernd Löwe, Kerstin Maehder

Abstract:

Background: Longitudinal data on somatic symptom disorder (SSD) in ulcerative colitis (UC) and irritable bowel syndrome (IBS) are lacking. Understanding SSD trajectories and predictors in these conditions may clarify clinical relevance and guide psychological treatment decisions. This study examined the 12-month course and biopsychosocial predictors of interview-based SSD in patients with UC or IBS participating in a randomised controlled trial (RCT).

Methods: Longitudinal data from an RCT targeting gastrointestinal symptom persistence was analysed. SSD was assessed using DSM-5-based structured interviews at baseline and 12 months. SSD Criteria A (presence of distressing somatic symptom(s)) and B (excessive symptom-related distress) were operationalised with the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder - B Criteria Scale-12 (SSD-12), respectively. Further variables included gastrointestinal symptom severity, inflammatory markers, depression and gender, illness perceptions, and neuroticism. Logistic and linear regression models identified baseline predictors of SSD diagnosis and Criteria A and B at 12 months.

Results: The sample included 213 patients (73.7% female; M_age = 40.5, SD = 13.98) with UC (n = 110) or IBS (n = 103). SSD frequency was 42.3% (95% CI: 35.2-49.3) at baseline and 15.5% (95% CI, 11.3-20.7) at follow-up. Interview-based SSD diagnosis at 12 months was predicted by baseline symptom-related distress, whereas gastrointestinal symptom severity, depression severity and gender showed no independent predictive value. Dimensionally assessed Criterion A was predicted by baseline somatic symptom severity and female gender, and Criterion B by symptom-related distress, somatic symptom severity, and negative illness perceptions, while gastrointestinal symptom severity and inflammatory markers added no predictive value.

Conclusion: Structured interview-based SSD was prevalent in patients with UC or IBS at baseline and declined over time. Psychosocial rather than disease-related variables predicted SSD, highlighting modifiable targets for early detection and tailored interventions. Results should be interpreted cautiously due to the interventional study context, which may have influenced both baseline SSD frequency and change over time.

Annotation

The finding:  SSD diagnosis was highly prevalent at baseline, affecting over half of patients with IBS and nearly one third of those with UC. Over 12 months, SSD frequency declined substantially in both groups, accompanied by a descriptive decrease in moderate and severe SSD cases and a relative increase in mild cases. A notable subgroup showed persistent SSD, while around one third remitted and few developed SSD at follow-up. The results emphasise the relevance of psychosocial factors in predicting SSD in UC and IBS. 

Strength and weaknesses:  This is the first study to examine the longitudinal course and predictors of SSD in patients with IBS or UC using structured diagnostic interviews. The study highlighted the need to identify at-risk patients early and offer tailored interventions addressing modifiable factors such as excessive symptom-related responses or dysfunctional illness perceptions. Limitations included 1) selection bias with recruitment within an RCT involving psychological interventions predisposing to individuals with higher psychological burden; 2) patients lost to follow-up reported higher gastrointestinal symptom severity at baseline, suggesting that more severely affected individuals were less likely to complete the study (although the dropout group was small and comparable between groups); and 3) the study combined clinician-rated and self-reported data.

Relevance: The high baseline frequency, subsequent decline, and identified psychosocial predictors of SSD have relevant implications for its diagnosis and management in UC and IBS. C/L psychiatrists should systematically consider symptom-related distress, when patients report persistent suffering related to somatic symptoms. 

Anxiety and depression in newly diagnosed patients with inflammatory bowel disease (the IBSEN III study) compared with the general population in Norway
Ingunn Johansen, Milada C Hagen, Stine T Løkkeberg, Tone B Aabrekk, Øyvind Asak, May-Bente Bengtson, Raziye Boyar, Trond Espen Detlie, Svein Oskar Frigstad, Kristina I Aass Holten, Øistein Hovde, Gert Hüppert-Hauss, Charlotte Lund, Asle W Medhus, Bjørn C Olsen, Vibeke Strande, Roald Torp, Simen Vatn, Marte L Høivik, Vendel Kristensen, Lars-Petter Jelsness-Jørgensen, Randi Opheim

Abstract:

Background and aims: Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD); the aim of this study was to assess the proportion of anxiety and depression in patients newly diagnosed with IBD, compare the rates with the Norwegian general population (NGP), and examine associations with selected sociodemographic, psychological, and disease-related factors.

Methods: This prospective cohort study included newly diagnosed patients with IBD, and data from the HUNT4 survey of the NGP. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Crude statistical comparisons were performed using t-tests, Mann-Whitney U test, chi-square tests, or Fisher's exact tests. Adjusted associations were modeled using multiple robust linear regression and multiple logistic regression.

Results: In total, 938/1562 (62.1%) patients with IBD completed the Hospital Anxiety and Depression Scale (Crohn's disease [CD]: n = 297, ulcerative colitis [UC]: n = 641). The proportion of anxiety was 37.4% in CD and 32.1% in UC, while depression was reported by 21.9% and 16.8%, respectively. Both rates were significantly higher than those observed in the NGP (17.5% for anxiety and 9.4% for depression). Compared with the NGP, males with CD had significantly higher levels of anxiety and depression, males with UC had elevated anxiety only, while females with CD and UC showed increased anxiety and depression. Both substantial fatigue and general self-efficacy were significantly associated with anxiety and depression in IBD.

Conclusions: Newly diagnosed patients with IBD experienced significant psychological challenges compared with the NGP. Early identification of anxiety and depression may enable targeted interventions.

Annotation

The finding:  This study aimed to determine the proportion of anxiety and depression in patients newly diagnosed with CD and UC, and stratified by gender, to compare these patients with the general Norwegian population (NGP). The secondary aim was to explore the potential associations between anxiety, depression, and selected sociodemographic, psychological, and disease-related factors. The study found that among newly diagnosed patients with IBD, there was a significantly higher proportion of symptoms of anxiety and depression compared with the NGP. The study also revealed gender-related differences. Compared to the NGP, newly diagnosed females with IBD had significantly higher proportion of both anxiety and depression, whereas males with IBD had a significantly higher proportion of anxiety symptoms, but not depression. 

Strength and weaknesses:  A major strength of this study is its large, population-based sample and the comparison of newly diagnosed patients with IBD with age- and gender-adjusted cohorts from the known NGP of HUNT4, providing a novel and unique insight into this patient population. Limitations included recall bias associated with PROMS. However, the large number of patients included in the IBSEN III study, and the similarity between HADS responders and non-responders across most background variables strengthen the findings and support the representativeness of the study population with IBD. Furthermore, no data on symptoms of anxiety and depression among the IBSEN III patients prior to inclusion were available. Finally, the limited sample size of patients with CD and depression may limit the generalization of these results to the general CD patient population. 

Relevance: This study provides valuable insights into the psychological challenges faced by patients newly diagnosed with IBD, emphasizing the importance of comprehensive care that addresses both the physical and psychological aspects of this chronic disease. Recognizing the gender-specific aspects of IBD is important for C/L psychiatrists to help patients to improve disease management and promote personalized care. Such interventions may include addressing substantial fatigue, enhancing self-efficacy, and providing psychosocial support.