Burden of comorbid anxiety and depression in patients with inflammatory bowel disease: a systematic literature review

Figures & data

Table 1. MEDLINE® and Embase® search strategy

Disease	Search terms
Psychosocial comorbidity	(MESH.EXACT(‘Anxiety’) OR MESH.EXACT(‘Depression’) OR EMB.EXACT(‘anxiety’) OR EMB.EXACT(‘depression’) AND (ti,ab(anxiety or depression or psychosocial)))
Inflammatory bowel disease	(EMB.EXACT(‘inflammatory bowel disease’)) OR (EMB.EXACT(‘ulcerative colitis’)) OR (EMB.EXACT(‘Crohn disease’)) OR (MESH.EXACT(‘Inflammatory Bowel Diseases’)) OR (MESH.EXACT(‘Colitis, Ulcerative’)) OR (MESH.EXACT(‘Crohn Disease’)) OR (TI,AB(‘crohns disease’ OR ‘crohn disease’ OR ‘crohn’s disease’ OR ‘crohns disorder’ OR ‘crohn disorder’ OR ‘crohn’s disorder’ OR ‘ulcerative colitis’ OR IBD OR ‘inflammatory bowel disease’))

Table 2. Inclusion and exclusion criteria for the systematic literature review (PICOS criteria)

PICOS criteria	Inclusion criteria	Exclusion criteria
Population	IBD (includes ulcerative colitis and Crohn’s disease) Psychological comorbidities (includes anxiety or depression) Adult or adolescent populations	Not IBD No psychological comorbidities Not adults or adolescents
Interventions	Not applicable	Not applicable
Comparators	Not applicable	Not applicable
Outcomes	Clinical outcomes (e.g. symptoms, severity) Non-pharmacologic interventions Resiliency to psychological comorbidities Epidemiology (e.g. prevalence, incidence) Social/quality of life (e.g. patient-rated outcomes, caregiver-rated outcomes) Economic (e.g. heathcare utilization; total, direct, and indirect costs; absenteeism or presenteeism in work/school) Disease-specific unmet needs	Outcomes not associated with disease burden, non-pharmacologic interventions, or unmet needs
Study design	Not applicable	Not applicable
Publication type	Studies including a study abstract Systematic reviews^a	No study abstract Press releases or editorials Non-systematic reviews
Location	All	No restriction
Language	English	Not English
Time period	1 January 2003 to 14 June 2018	Published before 2003

^aFour recently published SLRs pertaining to the outcomes of interest (anxiety or depression in patients with IBD) were examined for any articles that were not identified in the literature search to identify any missing original research.

IBD, inflammatory bowel disease; PICOS, patient/problem, intervention, comparison group, outcome, study; SLR, systematic literature review.

Figure 1. Summary of article and abstract screening (PRISMA diagram)

PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SLR, systematic literature review.

Figure 2. Prevalence (%) by country of psychological comorbidities in patients with IBD: [A] depression and [B] anxiety

Sources: [A] Australia [43]; Brazil [45]; Canada [7,46]; China [49]; France [50]; Iran [51]; Italy [52]; Netherlands [20]; New Zealand [54]; Singapore [55]; South Korea [53]; Spain [56]; UK [57,58]; USA [16,60]. Sources: [B] Australia [43,44]; Brazil [45]; Canada [46,47]; China [49]; France [50]; Iran [51]; Italy [52]; Netherlands [20]; New Zealand [54]; Singapore [55]; South Korea [53]; Spain [56]; UK [58]; USA [16,62]. IBD, inflammatory bowel disease; UK, United Kingdom; USA, United States of America.

Figure 3. Impact of psychological comorbidity on overall QoL in patients with IBD: [A] SIBDQ scores and [B] IBDQ scores

Note: [A] All the comparisons between depressed and non-depressed patients were statistically significant, except in patients with active CD (p-values not stated in the publication) [5]. Note: [B] IBDQ scores are reported for patients with IBD and major depressive disorder or any anxiety disorder in the Walker 2008 study. Mean IBDQ scores for Walker 2008 [7] and Luo 2017 [49]; median IBDQ scores for Mittermaier 2004 [77]. CD, Crohn’s disease; IBD, inflammatory bowel diseases; IBDQ, Inflammatory Bowel Disease Questionnaire; QoL, quality of life; SIBDQ, Short Inflammatory Bowel Disease Questionnaire; UC, ulcerative colitis.

Figure 4. CBT in the treatment of anxiety and depression in [A] adolescents and [B] adults with IBD

Note: [A] Szigethy 2006 [92] was a long-term extension of Szigethy 2004 [91]; improvement was sustained in the extension part of the study. Note: [B] Based on percentage of patients with HADS score ≥11, indicating probable anxiety or depression. ^a Reigada 2013 [90]; ^b Szigethy 2004 [91]; ^c Szigethy 2006 [92]; ^d Bennebroek Evertsz 2017 [93]. CBT, cognitive behavioral therapy; HADS, Hospital Anxiety and Depression Scale; IBD, inflammatory bowel disease.

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