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ON002. Hospital Anxiety and Depression Scale (HADS) and self perception: Preliminary results from a multidisciplinary approach in a small cohort of IBD patients

D. Ferrarese1, F. Scaldaferri IV1, L. Laterza1, M. Pizzoferrato1, L. Sparano1, M. Quarta1, E. Gaetani1, L. Lopetuso1, S. Pecere1, V. Gerardi1, A. Poscia2, A. Gasbarrini1

1Catholic University of Rome, Internal Medicine Department, Gastroenterology Division, Rome, Italy; 2Catholic University of Rome, Institute of Hygiene, Rome, Italy

Stress and IBD are extremely interdependent. Relapses can be associated to stressful events and anxiety-depression could occur during active disease. HADS is one of the most reliable test in assessing anxiety and depression, but its use in IBD has not been explored deeply.

Aim: To investigate the prevalence of anxiety-depression assessed by HADS in a cohort of IBD patients followed as outpatients.

Materials and Methods: Patients underwent to control visit were asked to complete the HADS questionnaire, together with a visual wellbeing assessment scale (VWAS), completed by the patient (P-VWAS) and also by the gastroenterologist during the visit (G-VWAS). Patients were also checked for levels of C reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and fecal calprotectine (FC). HADS was considered to be negative for scores lower than 8, indeterminate between 9 and 10 and positive for score higher than 10. The VWAS was considered normal for scores higher than 7 and abnormal for scores lower than 6.

Results: Twenty-seven IBD patients were enrolled (18 female and 10 male, 46 years as mean age).

The prevalence of anxiety and depression (A-DP) in our IBD cohort was 55% (58% in female and 40% in male) while 30% of patients had a borderline score. The A-DP was not apparently associated to the subjective perception of wellbeing as it was 50% in patients with normal P-VWAS and 55% in patients with impaired P-VWAS. On the contrary, from the physician perspective, A-DP was higher (71%) in patients with an impaired G-VWAS but lower (50%) in patients with a normal G-VWAS. Stronger differences were found when comparing A-DP in the subgroup of patients with low levels of FC (100 mg/kg), being A-DP 50% and 75% respectively.

When the P-VWAS was compared to the G-VWAS, a concordance was found in 52% of the cases (13 patients, 35% in women and 70% in male), with a down-estimation in 91% of the cases. In these patients the A-DP was similar to that of the patients with concordance of wellbeing perception scores (58% vs 66%), suggesting that other psychological mechanisms beside anxiety or depression could participate in this phenomenon.

Conclusion: Taken together our observations underline that anxiety/depression is an important aspect dealing with IBD management. However those aspects are not crucial in determining the self-perception of the disease. HADS could help in discriminating patients that would benefit from a multidisciplinary approach, particularly among sicker patients, displaying higher levels of FC or lower levels of G-VWAS.

The high level of discordance among P- and G-VWAS suggests that other complex psychological mechanisms could participate in how IBD patients perceive their physical/psychological wellbeing.