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Title: Inflammatory bowel disease, steroids and affective disorder
Author: Baig, Benjamin Jacob
ISNI:       0000 0001 2434 0323
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2019
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Inflammatory Bowel Disease (IBD) is associated with high rates of co morbid depression and anxiety. Corticosteroids, used commonly in IBD, are known to cause psychiatric side-effects. Recent studies show that depression is also associated with raised CRP and IL6. This thesis aims to evaluate which demographic, clinical, medication and immunological factors are predictors of anxiety and depression in IBD. The IBD, Steroids and Affective Disorder (ISA) study is a cross-sectional study of 578 IBD patients in Edinburgh, UK. Subjects underwent assessment including Hospital Anxiety Depression Scale (HADS) past psychiatric history, steroid medication history, Colitis activity Index (CAI) and Harvey Bradshaw Index (HBI), inflammatory markers including CRP, ESR and White Cell Count, the Medication Adherence Rating Scale (MARS) and Altman Self Rated Mania Scale (ARSM) as well as sociodemographic profile and a past history of IBD phenotype progression and past surgical history. 326 patients with Crohn's Disease and 256 with Ulcerative Colitis (72% of clinic attendees) were recruited. 251 (43%) patients scored 12 or above on the HADS questionnaire. 45% of patients had previously suffered from affective illness. Univariate predictors of affective disorder in IBD included female gender, unemployment, being on incapacity benefit, (all p < 0.0001), having bowel resections (p=0.032), having oral disease (p=0.03), being diagnosed before age 18 (p=0.001), CAI and HBI scores (p < 0.0001) and being on corticosteroid medication (p=0.026). Inflammatory markers were not predictive of affective disorder. Multivariate independent predictors were female gender, unemployment, incapacity benefit status, HBI, CAI and having been on corticosteroids. Subjects with Anxiety had low adherence scores. Affective illness remains common in IBD and undertreated. High risk groups can be targeted for screening and treatment and consideration should be given to patients on long term corticosteroids. Improved integrated care models may improve comorbid physical and mental health in these patients.
Supervisor: Lawrie, Stephen ; Satsangi, Jack Sponsor: Wellcome Trust
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: inflammatory bowel disease ; depression ; anxiety ; IBD ; Crohn's Disease ; Ulcerative Colitis ; liaison psychiatry ; affective disorders ; Corticisteroids