Graff Lesley A, Geist Rose, Kuenzig M Ellen, Benchimol Eric I, Kaplan Gilaad G, Windsor Joseph W, Bitton Alain, Coward Stephanie, Jones Jennifer L, Lee Kate, Murthy Sanjay K, Peña-Sánchez Juan-Nicolás, Targownik Laura E, Jannati Nazanin, Jones May Tyrel, Akhtar Sheekha Tasbeen, Davis Tal, Weinstein Jake, Dahlwi Ghaida, Im James H B, Amankwah Osei Jessica, Rohatinsky Noelle, Ghandeharian Sara, Goddard Quinn, Gorospe Julia, Gertsman Shira, Louis Michelle, Wagner Richelle, Brass Colten, Sanderson Rhonda, Bernstein Charles N
Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
J Can Assoc Gastroenterol. 2023 Sep 5;6(Suppl 2):S64-S75. doi: 10.1093/jcag/gwad012. eCollection 2023 Sep.
Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.
炎症性肠病（IBD）患者中精神疾病的患病率比普通人群高1.5至2倍，临床焦虑症的合并患病率估计为21%，抑郁症为15%。若考虑心理健康症状，患病率更高，因为近三分之一的IBD患者有焦虑症状加重的情况，四分之一有抑郁症状。这些症状在疾病活动期的发生率更高，在女性中比男性更常见，在克罗恩病中比溃疡性结肠炎更常见。基于对结果进行长期跟踪的纵向研究，有充分证据表明合并抑郁症和焦虑症对IBD的后续病程有不利影响。然而，精神疾病和IBD具有双向影响，彼此都会影响对方的风险。心理健康问题增加一直与IBD患者更高的医疗利用率和费用相关。有迹象表明，青少年时期恢复力低可能是患IBD的一个风险因素，提高恢复力可能会改善IBD患者的心理健康和肠道疾病预后。用于治疗IBD患者出现的焦虑和抑郁的心理疗法已被证明能显著改善IBD患者的生活质量，并减轻焦虑和抑郁。关于精神药物对IBD患者心理健康或疾病预后的影响，证据较少。然而，人们一致认为，必须将心理健康作为儿童和成人IBD综合护理的一部分加以解决。
