Journal Article Annotations
2023, 3rd Quarter

GI Psychiatry

Annotations by Ashwini Nadkarni, MD
October, 2023

Effects of cognitive behavioral therapy on mental health and quality of life in inflammatory bowel disease patients: A meta-analysis of randomized controlled trials.
Fatigue in patients with inflammatory bowel disease-strongly influenced by depression and not identifiable through laboratory testing: a cross-sectional survey study.

PUBLICATION #1 — GI Psychiatry

Effects of cognitive behavioral therapy on mental health and quality of life in inflammatory bowel disease patients: A meta-analysis of randomized controlled trials.

Chen Wang, Yingyue Sheng, Leilei Yu, Fengwei Tian, Yuzheng Xue, Qixiao Zhai.

Abstract: Behav Brain Resj.bbr.2023.114653. Epub 2023 Aug 30.

We aim to assess the roles of cognitive behavioral therapy (CBT) in improving quality of life (QoL) and mental health in inflammatory bowel disease (IBD) patients. In this study, PubMed, Web of Science, PsycINfO, and the Cochrane Library databases were used for locating proper randomized controlled trials (RCTs) (to October 2022). IBD Questionnaire (IBDQ), Hospital Anxiety and Depression Scale-Anxiety Scale (HADS-A), and Hospital Anxiety and Depression Scale-Depression Scale (HADS-D) were selected for analysis. Finally, nine eligible RCTs were included in this study. The analysis of these RCTs showed that CBT significantly increased IBDQ scores (standardized mean difference (SMD): 0.26, 95% confidence interval (CI): [0.05, 0.47], p = 0.02), decreased HADS-A (SMD: -0.25, 95% CI: [-0.45, -0.05], p = 0.01), HADS-D (SMD: -0.17, 95% CI: [-0.31, -0.02], p = 0.02) scores. The result of subgroup analysis, based on treatment duration, showed that long-term CBT (≥ 12 weeks; SMD: 0.23, 95% CI: [0.05, 0.41]; p = 0.01; I² = 28%) increased IBDQ scores. Thus, CBT is helpful for alleviating anxiety, depression and enhancing QoL in IBD patients.

Annotation

The finding:
This research team performed a meta-analysis of recently published randomized control trials to analyze the clinical outcomes of CBT treatment in IBD patients. Changes in IBDQ score, treatment duration, follow-up duration, and type of CBT treatment were considered as the primary indicators for assessing QoL in IBD patients. They found 9 eligible RCTS and found that CBT alleviates anxiety and depression in patients with IBD and improves quality of life.

Strength and weaknesses:
This study validates the importance of utilizing CBT to address mood disorders in IBD. However, this particular meta-analysis only took into account 9 studies; RCTs with larger sample sizes and use of more QoL indicators need to be completed to provide sufficient empirical support for CBT as a standard of care treatment for patients with IBD and co-morbid mood disorder.

Relevance:
Psychiatrists evaluating patients with IBD in outpatient or inpatient settings may consider therapy to supplement psychopharmacological treatment to achieve improved outcomes. However, while supportive psychotherapy may be more accessible, CBT should be preferred as the empirically-supported therapy for such patients.

PUBLICATION #2 — GI Psychiatry

Fatigue in patients with inflammatory bowel disease-strongly influenced by depression and not identifiable through laboratory testing: a cross-sectional survey study.

Victoria Uhlir, Andreas Stallmach, Philip Christian Grunert.

Abstract: BMC Gastroenterol. 2023 Aug 22;23(1):288. doi: 10.1186/s12876-023-02906-0.

Background:
Fatigue is a debilitating and highly relevant symptom in patients with inflammatory bowel disease (IBD). However, awareness of fatigue and treatment options remains limited. This study was aimed at elucidating the influence of disease activity and common complications (pain, anemia, depression, anxiety and quality of life) on fatigue in patients with IBD to identify potential interventional targets for treating physicians.

Methods:
A cross-sectional survey including five questionnaires (HADS, Fatigue Assessment Scale, McGill Pain Questionnaire, IBDQ and general well-being) was performed on patients with IBD (n = 250) at a university IBD clinic. Additionally, demographic data, laboratory data, IBD history, treatment and current disease activity (Harvey-Bradshaw Index, partial Mayo Score, calprotectin and CRP) were recorded.

Results:
A total of 189 patients were analyzed (59.8% with Crohn’s disease (CD) and 40.2% with ulcerative colitis (UC)). A total of 51.3% were fatigued, and 12.2% were extremely fatigued. Multiple factors showed significant correlations in univariate analysis. Multivariate analysis revealed that fatigue was correlated with depression (CD, p = 0.002; UC, p = 0.02), diminished quality of life (CD, p = 0.015), female sex (CD, p = 0.015) and younger age (UC, p = 0.024), whereas the influence of anemia or disease activity was non-significant.

Conclusions:
Fatigue is burdensome and highly prevalent in patients with active and inactive IBD. Considerations for fatigue treatment, beyond targeting inflammation and anemia, should include investigation of underlying sub-clinical depression

Annotation

The finding:
In this cross-sectional survey, the researcher investigated the association between fatigue and medical and psychiatric symptoms (e.g. anemia, pain, depression, anxiety and quality of life). The prevalence of fatigue in this cohort was 64%. Multivariable analyses revealed fatigue to be correlated with depression, female sex, and younger age but not disease activity, anemia, or pain.

Strength and weaknesses:
The strengths of the study include its broad assessment of possible factors influencing fatigue through a range validated questionnaires as well as clinical and para-clinical data in almost 200 patients with IBD. Limitations included generalizability of the findings to the entire IBD population, given that patients were from an outpatient tertiary care medical center. Also, laboratory values were recorded not numerically but only nominally (increased or not increased). Because laboratory values were recorded up to 4 weeks before or after completion of the questionnaires, therapeutic interventions or flares might have occurred during the period between sample collection and assessment of fatigue. Moreover, most surveyed patients were in remission (52%) or had only mild symptoms (26%). Another key limitation is that the instrument used to assess fatigue, the FAS, is reliable in assessing fatigue but is unidimensional, preventing these findings from being compared to multidimensional fatigue scores from previous IBD studies.

Relevance:
Fatigue is a challenging symptom to treat in patients with IBD and significantly affects quality of life. This study offers C-L psychiatrists emerging data on the need to consider diagnosing and treating depression when they evaluate patients with IBD and impairing fatigue.