Table 1.
Impact of mental health concerns on healthcare utilization in IBD
| Study characteristics | Region | Type of study | Sample size | outcomes |
|---|---|---|---|---|
| Anxiety and depression at baseline, adjusted for multiple variables including severity of disease at baseline and prior IBD-related surgeries; followed four years (29). | Canada | Prospective cohort two tertiary GI referral centres |
414 (IBD) | Anxiety: risk factor for poorer IBD outcomes defined as IBD-related ED visits, IBD-related hospitalization, or two or more courses of systemic steroids within one year (OR: 3.36; 95% CI: 1.51, 7.48) Depression: aOR not significant; however only 4% of the sample had elevated depressive symptoms at baseline, suggesting potential floor effects. |
| Depression at baseline adjusted for sex, disease status; followed two years (30). | United States | Prospective cohort seven tertiary IBD referral centres |
4,314 (IBD) | CD: increased risk for disease relapse (RR: 2.3; 95% CI: 1.9, 2.8), surgery or hospitalization (RR: 1.3; 95% CI: 1.1, 1.6); UC: increased risk for surgery or hospitalization (RR: 1.3; 95% CI: 1.1, 1.5). |
| Anxiety and depression at initial encounter; study period 20 months (31). | United States | Retrospective cohort Tertiary IBD referral centre |
432 (IBD) | Higher rates of utilization for comorbid anxiety, depression compared to IBD only: Imaging studies (53.6% vs. 36.7%, P < 0.05), ED visits (30.7% vs. 20.8%, P < 0.05) Hospitalized (31.7% vs. 21.7%, P < 0.05), Prescribed corticosteroids (50.5% vs. 36.7%, P < 0.01) Prescribed biologic medications (62.5% vs. 51.3%, P < 0.05). |
| Comorbid anxiety, depression, bipolar disorder using validated case definitions (32). | Canada | Retrospective cohort Provincial health administrative database |
8,459 (IBD), 40,375 (matched controls) |
Higher rates of utilization for those with IBD comorbid psychiatric disorders: Active psychiatric comorbidity was associated with >10 more physician visits, 3.1 more hospital days, used >6.3 more drugs. There was a synergistic effect of IBD (vs. no IBD) and psychiatric comorbidity (vs. no psychiatric comorbidity). Higher rates remained, after accounting for mental health-related healthcare utilization |
| IBD hospitalization during six-month period; evaluated for comorbid anxiety, depression, bipolar disorder; followed for up to 10 months (33). | United States | Retrospective cohort: Nationwide Readmissions Database |
40,177 (IBD) | Higher utilization and costs for comorbid psychiatric disorders compared to IBD only: Hospital days (median 7 days vs. 5 days, P < 0.01), Readmission rates—30-day (31.3 vs. 25.4%; P < 0.01); 90-day (42.6 vs. 35.3%; P < 0.01) Hospitalization-related costs (median $41,418 vs. $39,242, P < 0.01). Risk of readmission (HR: 1.16; 95% CI: 1.13, 1.20) Risk of severe IBD-related hospitalization (HR: 1.13; 95% CI: 1.08, 1.16). |
| Comorbid depression (34). | United States | Retrospective cohort, National health administrative claims database |
331,772 (IBD) | Higher utilization and costs for comorbid depression compared to IBD only: IBD-related healthcare costs mean annual $17,706 (95% CI: $16,892, 18,521) ED visits (aIRR: 1.5; 95% CI: 1.5, 1.6) In the subset of IBD patients with ED visits or hospitalized, higher likelihood of: Repeated CT scans [1–4 scans] (aOR: 1.6; 95% CI: 1.5, 1.7) IBD-related surgery (aOR: 1.2; 95% CI: 1.1, 1.2).LATED |
Abbreviations: aIRR, Adjusted incidence rate ratio; aOR, Adjusted odds ratio; CD, Crohns disease; CI, Confidence interval; ED, Emergency department; IBD, Inflammatory bowel disease; OR, Odds ratio; RR, Relative risk; UC, Ulcerative colitis.