Anxiety and Depression in Eosinophilic Esophagitis: A Scoping Review and Recommendations for Future Research

Figures & data

Figure 1 PRISMA diagram for selection of sources of evidence.

Table 1 Relevant Studies Examining Depression in Adults with EoE

	Author Group	Year	Study Design	Sample Size	Assessments Used	Estimates Obtained
1	Leigh and Spergel^Citation10	2019	Retrospective Chart Review	34	ICD-9/ICD-10 code	12% Had diagnosis of Depression.
2	Wang et al^Citation19	2018	Cross-sectional	42	NIH-PROMIS Depression Scale	Depression scores higher in former users of SFED compared to current users.
3	Taft et al^Citation26	2011	Scale Development	201	EoE-QOL-A	Emotional Impact is a subscale on EoE-specific measure of QOL.
4	Lucendo et al^Citation11	2014	Cross-sectional	170	Hospital Anxiety & Depression Scale	9.8% Scored above cutoff for depression.
5	Guadagnoli and Taft^Citation12	2019	Cross-sectional	149	NIH-PROMIS Depression Scale	Stigma internalization is positively correlated with increased depression.
6	Guadagnoli et al^Citation16	2017	Cross-sectional	149	NIH-PROMIS Depression Scale	Stigma perception is positively correlated with increased depression.

Table 2 Relevant Studies Examining Anxiety in Adults with EoE

	Author Group	Year	Study Design	Sample Size	Assessments Used	Estimates Obtained
1	Wang et al^Citation19	2018	Cross-sectional	42	NIH-PROMIS Anxiety Scale	Diet-related anxiety may impact SFED adherence; Anxiety higher in former users of SFED compared to current users.
2	Stern et al^Citation18	2018	Prospective	167	EoE-QOL-A	Anxiety (measured under QOL), is associated with symptom severity but not endoscopy or histology results. Prior food impaction influences choking anxiety.
3	Safroneeva et al^Citation2	2018	Cross-sectional	109	EoE-QOL-A	Anxiety (measured under QOL) is associated with patient treatment goals.
4	Lucendo et al^Citation20	2018	Cross-sectional	170	EoE-QOL-A	Disease anxiety and choking anxiety were the highest scoring domains of QOL.
5	Taft et al^Citation17	2011	Qualitative	24	Semi-Structured Interview	Disease anxiety and choking anxiety are important aspects of QOL.
6	Taft et al^Citation26	2011	Scale development	201	EoE-QOL-A	Disease anxiety and choking anxiety are 2 subscales on EoE-specific measure of QOL.
7	Lucendo et al^Citation11	2014	Prospective	170	Hospital Anxiety and Depression Scale	31.1% of patients scored above the cutoff for anxiety.
8	Guadagnoli and Taft^Citation12	2019	Cross-sectional	149	NIH-PROMIS Anxiety Scale	Stigma internalization is positively correlated with increased anxiety.
9	Guadagnoli et al^Citation16	2017	Cross-sectional	149	NIH-PROMIS Anxiety Scale	Stigma perception is positively correlated with increased anxiety.
10	Leigh and Spergel^Citation10	2019	Retrospective chart review	34	ICD-9/ICD-10	9.3% Had diagnosis of anxiety.
11	Safroneeva et al^Citation48	2018	Cross-sectional	98	EoE-QOL-A	Symptoms severity was correlated with HRQOL scale and predicted HRQOL scores, including anxiety.

Table 3 Relevant Studies Examining Anxiety in Children/Adolescents with EoE

	Author Group	Year	Study Design	Sample Size	Assessments Used	Estimates Obtained
1	Jose et al^Citation41	2016	Cross-sectional (Abstract)	8	Screen for Child Anxiety-Related Disorders	38% Met criteria for anxiety.
2	Harris et al^Citation33	2013	Retrospective chartrReview	64	1-hr Pediatric Behavioral Health Assessment	41% Reported anxiety, anxiety symptoms increased with age.
3	Franciosi et al^Citation36	2012	Qualitative	42	Semi-Structured Interview	Worry about symptoms and EoE were specific themes.
4	Cortina et al^Citation40	2010	Cross-sectional	108	Multidimensional Anxiety Scale for Children	Compared to healthy controls, children and adolescents with EOE reported more physical symptoms of anxiety and autonomic arousal.
5	Case et al^Citation38	2017	Cross-sectional	46 families	Revised Children’s Anxiety and Depression Scale, Pediatric Quality of Life Scale for EoE	50% of participants reported high frequency worry related to special diets, measured by PedsQL-EoE Feelings subscale.
6	Chehade et al^Citation29	2018	Prospective	705	Self-Reported History of Anxiety or Depression	24.0% in subjects ≥18 years of age, 9.0% in those 11–17 years of age, 9.3% in children <11 years of age.
7	Jose et al^Citation41	2017	Cross-sectional	20	Screen for Child Anxiety-Related Disorders	Caregivers of children with EoE report more symptoms of anxiety disorder, panic disorder, and school avoidance; compared to general population.
8	Lynch et al^Citation35	2018	Review		N/A	Higher rates of anxious symptoms in youth with EoE are associated with sleep problems and pain, all of which impact HRQOL (no study has yet examined these four constructs at once).
9	Lynch et al^Citation43	2017	Cross-sectional	50	Pediatric Quality of Life Scale for EoE	Caregiver reports rated children with EoE and persistent pain as having more anxiety symptoms compared to controls.

Table 4 Relevant Studies Examining Depression in Children/Adolescents with EoE

	Author Group	Year	Study Design	Sample Size	Assessments Used	Estimates Obtained
1	Chehade et al^Citation29	2018	Cross-sectional	705	Self-Reported History of Anxiety or Depression	24.0% in subjects ≥18 years of age, 9.0% in those 11–17 years of age, 9.3% in children <11 years of age
2	Hommel et al^Citation42	2012	Cross-sectional	96	Behavior Assessment System for Children, 2nd Edition	Depressed patients being more likely (OR=7.27) to be non‐adherent than non‐depressed patients
3	Lynch et al^Citation35	2018	Cross-sectional	50	Pediatric Quality of Life Scale for EoE	Caregivers of children with EoE and persistent pain reported significantly more depressive symptoms in their children compared to healthy controls
4	Case et al^Citation38	2017	Cross-sectional	20	Revised Children’s Anxiety and Depression Scale, Pediatric Quality of Life Scale for EoE	50% of participants reported high frequency anger and sadness related to special diets, measured by PedsQL-EoE Feelings subscale
5	Cortina et al^Citation40	2010	Cross-sectional	108 (Mothers & Children)	Children’s Depression Inventory	Children and adolescents with EoE reported greater overall depressive symptoms compared to controls, and more symptoms on three subscales: anhedonia, negative mood, negative self-esteem
6	Lynch et al^Citation43	2018	Review			Higher rates of depressive symptoms in youth with EoE are associated with sleep problems and pain, all of which impact HRQOL (no study has yet examined these four constructs at once)

Table 5 Common Screening Tools for Anxiety and Depression

Measure Title	Anxiety	Depression	Number of Items
Adults 18 years+
Hospital Anxiety and Depression Scale (HADS)	✓	✓	8
Generalized Anxiety Disorder – 7 (GAD-7)	✓		7
Patient Health Questionnaire – 9 (PHQ-9)		✓	9
NIH-PROMIS Mental Health – Anxiety	✓		7
NIH-PROMIS Mental Heath – Depression		✓	8
Kessler 10	✓	✓	14
Children 17 years or Younger
Patient Health Questionnaire for Adolescents (PHQ-A)		✓	9
Mood & Feelings Questionnaire – Short Form (MFQ-SF)	✓		13
Childhood Anxiety Sensitivity Index (ASI)		✓	16
Screen for Child Anxiety-Related Disorders (SCARED)^a		✓	41

Note: ^aCompleted by parent.

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