Anxiety, Depression, and Pain Can Predict Fatigue Burden in IBD

Depression, anxiety, and pain are predictors of fatigue among patients with inflammatory bowel disease (IBD), according to study findings in the American Journal of Gastroenterology. 

Fatigue in IBD may significantly affect QOL. Although fatigue is a common symptom, there is a lack of information regarding the progression of fatigue among patients with IBD. Researchers conducted a study to determine predictors of fatigue in patients with IBD. 

Data were collected from a prospective study conducted in Canada between November 2014 and July 2016. Participants in the study were adult patients aged 18 years and older with IBD, including Crohn disease (CD) or ulcerative colitis (UC). 

Patients completed the Fatigue Impact Scale for Daily Use (DFIS), which measured perceived fatigue. Scores on the scale ranged from 0 to 32, with a higher score indicating a greater level of fatigue. Fatigue was categorized as the following: none, mild, moderate, and severe (<5.0; ≥5 to <12.0; ≥12.0 to <19.0; and ≥19.0, respectively). A score change of 4 or more indicated a clinically important change. 

The researchers used the Hospital Anxiety and Depression Scale (HADS) to collect information regarding mental health disorders, such as major depressive disorder (HADS-D) and anxiety disorders (HADS-A).

Of the 247 participants with IBD enrolled in the original study, 214 completed the 4 required visits and were included in the final analysis. A majority of participants were White (85.4%), were women (63.2%), and had CD (62.3%). 

At baseline, 16.7% had clinically elevated anxiety (HADS-A, ≥11) and 6.5% had clinically elevated depression (HADS-D, ≥11).

A total of 39.3% had no fatigue, 32.8% had mild fatigue, and 27.93% had moderate to severe fatigue impact at baseline. The researchers found that DFIS and most predictors had little variation over time. 

Approximately half of the participants (52.6%) had meaningful improvements in DFIS scores across visits, and 48.6% reported worsened fatigue. In total, 71.7% of 

patients reported clinically meaningful changes in DFIS scores at some time in the study period. 

Patients with higher degrees of anxiety and depression had higher levels of fatigue. Other factors associated with increased fatigue included pain, comorbidities, poorer physical and cognitive function, and higher levels of disease activity. 

Specifically, the multivariable analysis revealed that participants who scored one point higher on HADS-D had a 0.63-point higher DFIS score, and those with one point higher on the pain assessment had a 0.78-point higher DFIS score on average. Upon individual assessment, a one-point increase in HADS-A scores was associated with 0.23-point higher DFIS scores on average.

“Future studies should examine factors associated with other aspects of fatigue including frequency, and duration, as well as specific effects on different aspects of functioning (e.g., cognitive versus physical)” study authors noted.

Study limitations include the lack of measures of active intestinal inflammation, generalizability, and well-defined measurements of physical and cognitive function. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Gastroenterology Advisor