The Incidence and Prevalence of Anxiety, Depression, and PTSD Among a National Cohort of United States Veterans With Inflammatory Bowel Disease

Thakur ER, Waljee AK, Gaidos J, Feagins LA, Govani SM, Sansgiry S, Kramer JR, Dindo L, El-Serag HB, Hou JK. The Incidence and Prevalence of Anxiety, Depression, and PTSD Among a National Cohort of United States Veterans With Inflammatory Bowel Disease. Poster session presented at: Digestive Disease Week Annual Conference; 2016 May 22; San Diego, CA.

Related HSR&D Project(s)

• CDA 11-217 – Risk Stratification and Targeted Therapy for HELP Diseases in Veterans

BACKGROUND: Mental health problems, such as anxiety, depression, and post-traumatic stress disorder (PTSD) commonly occur with inflammatory bowel diseases (IBD). The burden of mental health problems is likely exacerbated among military veterans with IBD, as compared to the general population; however, the prevalence of mental health problems among IBD patients have only been reported among civilians and are not known among veteran patients with IBD. AIM: The aim of this study was to identify temporal trends in incidence and prevalence of anxiety, depression, and PTSD among veterans with IBD using national Veterans Health Administration (VHA) data sets. METHODS: A national cohort of 63,210 veterans with IBD first diagnosed in the VHA during 1998-2012 was examined for concomitant anxiety, depression, and PTSD in VHA outpatient and inpatient datasets. Diagnoses of IBD, depression, anxiety, and PTSD were determined using previously defined ICD-9 code algorithms. Incidence and prevalence rates were calculated as crude and direct-standardized annual rates for age and gender using the 1998 VHA IBD population as the standard population. Patients with diagnoses of anxiety, depression, or PTSD prior to their first VHA IBD encounter were excluded from incidence calculations. RESULTS: A total of 28,282 patients with IBD (45%) had a VHA encounter for mental health problems during the study period, including, 37%, 23%, and 15% for depression, anxiety, or PTSD, respectively. Prior to their first IBD encounter, 15% of patients had an encounter for depression, whereas 9% had an encounter for anxiety, and 7% had an encounter for PTSD. Subsequent to their first IBD encounter, 13,929 patients had their first encounter for depression (22%), 8,978 patients for anxiety (14%), and 5,183 patients with PTSD (8%).The annual incidence of depression in the study cohort ranged from 3-6 cases/100 IBD patients per year, whereas incidence of anxiety ranged from 2-4 cases/100 IBD patients per year, and incidence of PTSD ranged from 1-2 cases/100 IBD patients per year. Over the study period, the annual prevalence of depression had the greatest increase in the study cohort, from 11 cases/100 IBD patients to 20 cases/100 IBD patients, followed by PTSD, which increased 4/100 IBD patients to 11/100 IBD patients, and anxiety, which increased from 6 cases/100 IBD patients to 10 cases/100 IBD patients. CONCLUSIONS: The prevalence of anxiety, depression, and PTSD among veterans with IBD has increased from 1998 to 2012. Concomitant mental health problems may impair health-related quality of life, precipitate IBD flares, increase healthcare costs and utilization, and complicate medical management for this population. Future research should focus on identifying factors associated with mental health problems among veterans with IBD and their impact on both IBD and mental health outcomes.