# Inflammatory Bowel Disease and Mental Health: The Complex Relationship Between Gut and Brain

## TL;DR

This study found that severe inflammatory bowel disease in Pakistani patients is linked to higher rates of anxiety and depression, especially in women and younger adults.

## Contribution

The study identifies specific predictors of mental health issues in IBD patients in Pakistan, emphasizing the need for integrated care.

## Key findings

- 62% of severe IBD patients had clinically significant anxiety or depression, compared to 43% in moderate and 10% in normal cases.
- Higher mental health burden was predicted by severe disease, female gender, younger age, and IBD type.
- Integrated gastroenterology-psychiatry care is recommended to improve outcomes for IBD patients.

## Abstract

Background: The study sought to determine the association between IBD severity and mental health impact as measured by anxiety, depression, and QOL in our Pakistani patients.

Design and Methods: A cross-sectional study was conducted with 400 IBD patients from clinics and community healthcare centres in Faisalabad, Dera Ismail Khan, and Karachi. Data were collected using the Short IBD Questionnaire (SIBDQ) and Hospital Anxiety and Depression Scale (HADS). Spearman correlations, chi-square tests, Mann-Whitney U, Kruskal-Wallis, and multiple regression analyses (SPSS v26) were performed.

Results: Of 400 participants, 240 (60%) were female, and most were aged 25-34 years (126, 31%). A total of 190 (47%) scored ≥11 on the HADS, indicating clinically significant anxiety or depression. SIBDQ and HADS scores were negatively correlated (ρ = −0.33, 95% CI −0.40 to −0.26, p < 0.001). Multiple regression showed that higher HADS scores were predicted by greater disease severity (B = 0.19, 95% CI 0.08-0.29, p = 0.001), female gender (B = 0.89, 95% CI 0.25-1.53, p = 0.007), younger age (B = −0.21, 95% CI −0.37 to −0.05, p = 0.011), disease activity (B = 0.44, 95% CI 0.14-0.74, p = 0.004), IBD type (B = 0.53, 95% CI 0.16-0.90, p = 0.006), and family history (B = 0.69, 95% CI 0.08-1.30, p = 0.026). Patients with severe IBD had the highest rates of clinically significant anxiety or depression (62% vs 43% in moderate and 10% in normal; χ²(4) = 81.9, p < 0.001). Females and younger participants reported greater disease severity and mental health burden (p < 0.01).

Conclusions: Anxiety and depression are prevalent among Pakistani IBD patients, particularly in women, younger adults, and those with severe disease. These findings highlight the need for integrated gastroenterology-psychiatry care with routine mental health screening and psychosocial support to improve long-term outcomes and quality of life.