Psychological Distress During a Global Pandemic: Prevalence and Risk Factors in a National Cohort of Inflammatory Bowel Disease (IBD) Patients

Introduction: The COVID-19 pandemic is associated with increased rates of anxiety and depression; particularly among those with chronic illness. We describe the prevalence of anxiety, depression, and fatigue in a national cohort of IBD patients and identify factors associated with these disorders. We hypothesize that greater perceived vulnerability to illness is associated with higher psychological distress. Methods: We conducted a cross-sectional survey using NIH PROMIS (®) Anxiety, Depression and Fatigue Scales among COVID-19 vaccinated adult IBD subjects enrolled in the Coronavirus Risk Associations and Longitudinal Evaluation-IBD (CORALE-IBD) study. PROMIS scores were reported as T-scores (ranging from 1 to 100 points; 50 representing the general population mean). Perceived vulnerability was quantified using a composite metric of responses to 5 questions about perceived risk of illness. We performed univariate analyses to assess differences in group means and multivariable linear regression to evaluate associations between anxiety, depression and fatigue and perceived vulnerability. Results: The cohort included 1496 subjects (Table 1). Median scores for anxiety (53.7; IQR 40.3 – 59.5), depression (49.0; 41-55.7) and fatigue (51.2; 51.0 -58.8) were similar to the general population. Females reported higher anxiety (54.13 vs 50.26; p< 0.001), depression (49.55 vs 47.88; p=0.001), and fatigue (52.89 vs 47.42; p< 0.001). Latinx reported higher anxiety (56.42 vs 52.79; p=0.009) and depression (52.96 vs 48.85; p=0.004). Anxiety (54.1 vs 52.31; p=0.002), depression (50.29 vs 48.3; p< 0.001) and fatigue (52.44 vs 50.51; p< 0.004) were higher for subjects not in a relationship. Subjects on disability and low-income individuals experienced higher rates of anxiety, depression and fatigue (all p< 0.001). After adjusting for these factors, higher perceived vulnerability to illness was associated with higher anxiety, depression and fatigue scores (Image 1). Conclusion: Although levels of anxiety, depression and fatigue in this national cohort of IBD patients appeared similar to the general population, the data paints a nuanced picture. Many subjects from traditionally disadvantaged backgrounds including women, Latinx, disabled and low-income earners experienced much higher psychological burden. Further, high perceived vulnerability to COVID-19 infection was associated with higher levels of psychological distress.Table 1.: BMI and IL-10 are independent risk factors for AI on MRE in CD.Figure 1.: a) Average preferences, overall IBD population (N=400) b) Relative Attribute Importance (RAI) scores for the overall IBD (N=400), CD (n=215), and UC (n=185) populations c) Maximum acceptable risk of mild or moderate side effects, overall IBD population (N=400) Note: Log-likelihood at convergence = -1770.7; adjusted McFadden pseudo-R2 = 43.62; BIC = 4431.3; alternative specific constant = 0.036 (SE = 0.051; p = NS). BIC, Bayesian Information Criterion; IBD, inflammatory bowel disease; MLE, mixed likelihood estimate; NS, non-significant; SD, standard deviation; SE, standard error. **p<0.01; ***p<0.001. CD, Crohn’s disease; IBD, inflammatory bowel disease; UC, ulcerative colitis. IBD, inflammatory bowel disease; MAR, maximum acceptable risk; SE, standard error.