Physicians inconsistently screen for depression in Inflammatory Bowel Disease patients

Inflammatory bowel disease (IBD) is associated with a variety of complex comorbidities. Research suggests that depression and anxiety are more common in IBD. Furthermore, recent research suggests that the course of IBD is worsened by underlying depression and, conversely, that the depressive episodes are worse during periods of active IBD. Factors that independently influence development of depression include age, gender, marital status and concomitant steroid use. It is uncertain if individuals with IBD are consistently and adequately screened for depression. This study evaluated the frequency of physicians' screening for depression in patients with IBD. Medical records of consecutive patients with inflammatory bowel disease referred to an urban university gastroenterology practice in a one year period were reviewed. There were no exclusion criteria. Patient age, gender, ethnicity, marital status, steroid use and physician documentation of depression were obtained. A database was created using Microsoft Excel. Statistical analysis was performed using Fisher's Exact tests with significance set at p<0.05. The study was approved by the university IRB. 207 medical records of IBD patients were reviewed. There were 125 (60.4%) women and 82 (39.6%) men, with a mean age of 40.6 years. The primary ethnicities were white (42.5%) and African-American (26.1%). 83 (40.1%) were documented to be single, divorced or widowed and 35 (21.7%) married. 124 (58.9%) reported prior or present steroid administration. Depression screening was documented in 67 (32.4%) patients (32 reported, 35 denied), but was not documented or addressed for the remaining 140 (67.6%) patients. There was no statistically significant difference in the rate at which IBD patients were screened for depression based upon gender (p= 0.544), marital status (p= 0.35), or steroid use (p= 0.117). Recent evidence suggests that IBD patients are at increased risk of developing depression. Independent risk factors, including age, gender, marital status and steroid use, can influence the development of depression. Additionally, it has been reported that depression may negatively impact clinical course. This study revealed that physicians inconsistently screened for depression, evaluating less than one-third of IBD patients for symptoms. Additionally, independent risk factors did not influence the rate of physicians' screening for depression in IBD patients. Notably almost half of the patients screened admitted to a history of depression. It is critical that physicians recognize and address depressive symptoms in IBD patients to optimize care. Improved efforts are needed to encourage physicians to screen IBD patients for depression to enhance clinical outcomes.