The Incidence and Prevalence of Anxiety, Depression, and Post-traumatic Stress Disorder in a National Cohort of US Veterans With Inflammatory Bowel Disease

Thakur ER1,2,3, Sansgiry S1,2,4, Kramer JR2,4, Waljee AK5,6, Gaidos JK7, Feagins LA8, Govani SM9, Dindo L2,3, El-Serag HB2,4, Hou JK3,4. Inflamm Bowel Dis. 2019 Nov 15. pii: izz280. doi: 10.1093/ibd/izz280. [Epub ahead of print]


Author information

1 From theVA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.

2 VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.

3 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.

4 Department of Medicine, Baylor College of Medicine, Houston, TX, USA.

5 VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.

6 Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.

7 Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA.

8 Department of Internal Medicine, VA North Texas Health Care System, and The University of Texas Southwestern Medicine Center at Dallas, Dallas, TX, USA.

9 South Texas Veterans Health Care System and UT Health San Antonio, San Antonio, Texas USA.A


BACKGROUND: Patients with inflammatory bowel disease (IBD) are more susceptible to mental health problems than the general population; however, temporal trends in psychiatric diagnoses' incidence or prevalence in the United States are lacking. We sought to identify these trends among patients with IBD using national Veterans Heath Administration data.

METHODS: We ascertained the presence of anxiety, depression, or posttraumatic stress disorder among veterans with IBD (ulcerative colitis or Crohn's disease) during fiscal years 2000-2015. Patients with prior anxiety, depression, or posttraumatic stress disorder before their first Veterans Health Administration IBD encounter were excluded to form the study cohort. We calculated annual prevalence, incidence rates, and age standardized and stratified by gender using a direct standardization method.

RESULTS: We identified 60,086 IBD patients (93.9% male). The prevalence of anxiety, depression, and/or posttraumatic stress disorder increased from 10.8 per 100 with IBD in 2001 to 38 per 100 with IBD in 2015; 19,595 (32.6%) patients had a new anxiety, depression, and/or posttraumatic stress disorder diagnosis during the study period. The annual incidence rates of these mental health problems went from 6.1 per 100 with IBD in 2001 to 3.6 per 100 in 2015. This trend was largely driven by decline in depression.

CONCLUSIONS: The prevalence of anxiety, depression, and posttraumatic stress disorder is high among US veterans with IBD and increasing, given the chronicity of IBD and psychological diagnoses. Incidence, particularly depression, appears to be declining. Confirmation and reasons for this encouraging trend are needed.

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