Modern Pediatrics. Ukraine. (2024). 1(137): 101-105. doi: 10.15574/SP.2024.137.101
Sorokman T. V., Cherney N. Ya., Makarova O. V., Koliesnik D. I.
Bukovinian State Medical University, Chernivtsi, Ukraine

For citation: Sorokman TV, Cherney NYa, Makarova OV, Koliesnik DI. (2024). The frequency of anxiety-depressive syndrome in children with inflammatory bowel diseases. Modern Pediatrics. Ukraine. 1(137): 101-105. doi: 10.15574/SP.2024.137.101.
Article received: Dec 04, 2023. Accepted for publication: Feb 12, 2024.

Inflammatory bowel diseases (IBD) have been spreading rapidly in industrialized countries since the beginning of the 21^st century.
Purpose – to determine the frequency of symptoms of anxiety and depression in children with IBD, in order to optimize treatment.
Materials and methods. 18 patients aged 10-17 years were surveyed: 10 people with ulcerative colitis (UC) and 8 people with Crohn’s disease (CD), symptoms of anxiety and depression were studied using PHQ-2, PHQ-9 questionnaires (Patient Health Questionnaire) and GAD-7 (Generalized Anxiety Disorder). The obtained results were analyzed using SPSS 26.0 programs. The odds ratio (OR) was considered significant if the 95% confidence interval (CI) did not include 1. The difference in samples was considered significant at p<0.05.
Results. Of the 18 patients who were surveyed using the PHQ-2 questionnaire, 13 (72.2%) were screened for further investigation using the PHQ-9 questionnaire. The prevalence of anxiety symptoms was 55.5% (95% CI: 38.3-66.5), depressive symptoms – 34.8% (95% CI: 21.4-45.8). Patients with CD had higher odds of anxiety symptoms (OR: 1.2, 95% CI: 1.1-3.6) and depressive symptoms (OR: 1.3, 95% CI: 1.1-1.7) than children with UC. There were differences in the severity of anxiety and depression in different pathological conditions (IBD: p<0.01; UC: p<0.05; CD: p=0.05). The frequency of symptoms of anxiety or depression was higher in patients with active IBD than in children with inactive disease (100% and 33.3% and 100% and 45.8%, respectively). Minimal (0-4 points) and mild (5-9) degrees of anxiety and depression prevailed.
Conclusions. The frequency of detection of symptoms of anxiety and depression in children with CD and UC in the active stage of the disease is 55.5% and 34.8%, respectively, with a predominance of minimal (0-4 points) and mild (5-9) degrees. Patients with CD are higher odds of anxiety and depression symptoms than children with UC.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: children, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, anxiety-depressive syndrome.

REFERENCES

1. Arp L, Jansson S, Wewer V, Burisch J. (2022). Psychiatric Disorders in Adult and Paediatric Patients with Inflammatory Bowel Diseases – A Systematic Review and Meta-Analysis. J Crohns Colitis. 16(12): 1933-1945. https://doi.org/10.1093/ecco-jcc/jjac095; PMid:35775920

2. Ashton JJ, Barakat FM, Barnes C et al. (2022). Incidence and Prevalence of Paediatric Inflammatory Bowel Disease Continues to Increase in the South of England. J Pediatr Gastroenterol Nutr. 75(2): e20-e24. https://doi.org/10.1097/MPG.0000000000003511; PMid:35666860

3. Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. (2021). Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 6(5): 359-370. https://doi.org/10.1016/S2468-1253(21)00014-5; PMid:33721557

4. Burgess CJ, Henderson P, Jones GR, Lees CW, Wilson DC; Lothian IBD. (2020). Registry Group. Paediatric Patients (Less Than Age of 17 Years) Account for Less Than 1.5% of All Prevalent Inflammatory Bowel Disease Cases. J Pediatr Gastroenterol Nutr. 71(4): 521-523. https://doi.org/10.1097/MPG.0000000000002842; PMid:32639452

5. Carroll MW, Kuenzig ME, Mack DR et al. (2019). The Impact of Inflammatory Bowel Disease in Canada 2018: Children and Adolescents with IBD. J Can Assoc Gastroenterol. 2; Suppl 1: S49-S67. https://doi.org/10.1093/jcag/gwy056; PMid:31294385 PMCid:PMC6512244

6. Dalzell AM, Ba'Ath ME. (2019). Paediatric inflammatory bowel disease: review with a focus on practice in low- to middle-income countries. Paediatr Int Child Health. 39(1): 48-58. https://doi.org/10.1080/20469047.2019.1575056; PMid:30900526

7. Dharni K, Singh A, Sharma S et al. (2023). Trends of inflammatory bowel disease from the Global Burden of Disease Study (1990-2019). Indian J Gastroenterol. 3 (3). s12664-023-01430-z. https://doi.org/10.1007/s12664-023-01430-z; PMid:37783933

8. Dubinsky MC, Dotan I, Rubin DT et al. (2021). Burden of comorbid anxiety and depression in patients with inflammatory bowel disease: a systematic literature review. Expert Rev Gastroenterol Hepatol. 15(9): 985-997. https://doi.org/10.1080/17474124.2021.1911644; PMid:34130572

9. Facanali CBG, Sobrado Junior CW, Fraguas Junior R et al. (2023). The relationship of major depressive disorder with Crohn's disease activity. Clinics (Sao Paulo). 78: 100188. Published 2023 Mar 27. https://doi.org/10.1016/j.clinsp.2023.100188; PMid:36989545 PMCid:PMC10091387

10. Fairbrass KM, Lovatt J, Barberio B, Yuan Y, Gracie DJ, Ford AC. (2022). Bidirectional brain-gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis. Gut. 71(9): 1773-1780. https://doi.org/10.1136/gutjnl-2021-325985; PMid:34725197

11. Fuller MK. (2019). Pediatric Inflammatory Bowel Disease: Special Considerations. Surg Clin North Am. 99(6): 1177-1183. https://doi.org/10.1016/j.suc.2019.08.008; PMid:31676056

12. Gracie DJ, Hamlin JP, Ford AC. (2018). Longitudinal impact of IBS-type symptoms on disease activity, healthcare utilization, psychological health, and quality of life in inflammatory bowel disease. Am J Gastroenterol. 113(5): 702-712. https://doi.org/10.1038/s41395-018-0021-z; PMid:29453384

13. Graff LA, Geist R, Kuenzig ME et al. (2023). The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease. J Can Assoc Gastroenterol. 6(2): 64-75. https://doi.org/10.1093/jcag/gwad012; PMid:37674499 PMCid:PMC10478810

14. Guan QA. (2019). Comprehensive Review and Update on the Pathogenesis of Inflammatory Bowel Disease. J Immunol Res. 2019: 7247238. https://doi.org/10.1155/2019/7247238; PMid:31886308 PMCid:PMC6914932

15. Irving P, Barrett K, Nijher M, de Lusignan S. (2021). Prevalence of depression and anxiety in people with inflammatory bowel disease and associated healthcare use: population-based cohort study. Evid Based Ment Health. 4(3): 102-109. https://doi.org/10.1136/ebmental-2020-300223; PMid:33785498 PMCid:PMC8311072

16. Jansson S, Malham M, Wewer V, Rask CU. (2022). Psychiatric comorbidity in childhood onset immune-mediated diseases-A systematic review and meta-analysis. Acta Paediatr. 111(3): 490-499. https://doi.org/10.1111/apa.16246; PMid:34986519

17. Kaplan GG, Bernstein CN, Coward S et al. (2019). The Impact of Inflammatory Bowel Disease in Canada 2018: Epidemiology. J Can Assoc Gastroenterol. 2(1): 6-16. https://doi.org/10.1093/jcag/gwy054; PMid:31294381 PMCid:PMC6512243

18. Kaplan GG. (2015). The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 12(12): 720-727. https://doi.org/10.1038/nrgastro.2015.150; PMid:26323879

19. Keefer L. (2021). What can we do to tackle anxiety and depression in patients with inflammatory bowel disease? Lancet Gastroenterol Hepatol. 6(5): 337-338. https://doi.org/10.1016/S2468-1253(21)00066-2; PMid:33721556

20. Kuenzig ME, Benchimol EI, Lee L et al. (2019). The Impact of Inflammatory Bowel Disease in Canada 2018: Direct Costs and Health Services Utilization. J Can Assoc Gastroenterol. 29 (1): 17-33. https://doi.org/10.1093/jcag/gwy055; PMid:31294382 PMCid:PMC6512251

21. Laurie K. (2021). Screening for Depression in Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 17(12): 588-591.

22. Levine A, Koletzko S, Turner D et al. (2014). ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 14; 58(6): 795-806. https://doi.org/10.1097/MPG.0000000000000239; PMid:24231644

23. Lewis K, Marrie RA, Bernstein CN et al. (2019). The Prevalence and Risk Factors of Undiagnosed Depression and Anxiety Disorders Among Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis. 25(10): 1674-1680. https://doi.org/10.1093/ibd/izz045; PMid:30888037

24. Mak WY, Zhao M, Ng SC, Burisch J. (2020). Epidemiology of inflammatory bowel disease: east meets west. J Gastroenterol Hepatol. 35(3): 380-389. https://doi.org/10.1111/jgh.14872; PMid:31596960

25. Ng SC, Shi HY, Hamidi N et al. (2018). Global incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 390(10114): 2769-2778. https://doi.org/10.1016/S0140-6736(17)32448-0; PMid:29050646

26. Park J, Cheon JH. (2021). Incidence and Prevalence of Inflammatory Bowel Disease across Asia. Yonsei Med J. 62(2): 99-108. https://doi.org/10.3349/ymj.2021.62.2.99; PMid:33527789 PMCid:PMC7859683

27. Pivac I, Jelicic Kadic A, Despot R et al. (2023). Characteristics of the Inflammatory Bowel Disease in Children: A Croatian Single-Centre Retrospective Study. Children (Basel). 10(10): 1677. https://doi.org/10.3390/children10101677; PMid:37892340 PMCid:PMC10605261

28. Spitzer RL Kroenke K, Williams JBW, Lowe BA. (2006). A brief measure for assessing generalized anxiety disorder. Arch Intern Med. 166(10): 1092-1097. https://doi.org/10.1001/archinte.166.10.1092; PMid:16717171

29. Spitzer RL, Kroenke K, Williams JBW. (1999). Validation and utility of a self-report version of PRIMEMD – The PHQ primary care study. JAMA. 282: 1737-1744. https://doi.org/10.1001/jama.282.18.1737; PMid:10568646

30. Stapersma L, van den Brink G, Szigethy EM, Escher JC, Utens EMWJ. (2018). Systematic review with meta-analysis: anxiety and depression in children and adolescents with inflammatory bowel disease. Aliment Pharmacol Ther. 48(5): 496-506. https://doi.org/10.1111/apt.14865; PMid:29984495

31. Sýkora J, Pomahačová R, Kreslová M, Cvalínová D, Štych P, Schwarz J. (2018). Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol. 24(25): 2741-2763. https://doi.org/10.3748/wjg.v24.i25.2741; PMid:29991879 PMCid:PMC6034144

32. Zeng S, Yu Y, Lu S et al. (2023). Neuro-11: a new questionnaire for the assessment of somatic symptom disorder in general hospitals. Gen Psychiatr. 36(4): e101082. https://doi.org/10.1136/gpsych-2023-101082; PMid:37663052 PMCid:PMC10471855