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P112 Effectiveness of "Hospital Anxiety and Depression Scale" for the screening of the psychiatric treatment need in outpatients with Inflammatory Bowel Diseases

O. Yanatas1, H.T. Kani2, M. Banzragch3, E. Bicakci3, K. Kuscu1, O. Atug3, N. Imeryuz3, H. Akin*3

1Marmara University, School of Medicine, Psychiatry, Istanbul, Turkey, 2Marmara University, School of Medicine, Internal Medicine, Istanbul, Turkey, 3Marmara University, Gastroenterology, Istanbul, Turkey

Background

Depression and anxiety disorders are reported to be decreasing the quality of life and quite frequent in Inflammatory Bowel Diseases (IBD) patients. It is important to diagnose and treat them in a timely manner. This is not easy for gastroenterologists. In that study, our aim was to determine the effectiveness of "Hospital Anxiety and Depression Scale (HADS)" for the detection of the psychiatric treatment need in IBD outpatient clinics.

Methods

HADS is a self-report test, which measures both the risk and severity of anxiety - depression in physical diseases. It has 14 questions. A predetermined cut point of 7 for depression, 10 for anxiety are considered as a risk for diagnoses. We sent the patients with scores higher than the cut-off, to an interview with the psychiatrist in a week time to assess if there was a requirement for any psychiatric drug intervention. The consultations completed with SCID (structured clinical interview for DSM IV) which is a specially structured and validated interview technique for making psychiatric diagnoses including anxiety and depression. The SCID interview takes 25-60 minutes and can only be administered by a psychiatrist who had specially certified for performing the instrument. All interviews were done by the same psychiatrist.

Results

We prospectively offered the HADS test to a total of 214 consecutive IBD outpatients, 177 of them accepted (82.7%). Mean age was 40.8 ± 12.7 years. 99 (56%) were female, 80(45%) Crohn's Disease (CD) and 97(55%) were Ulcerative Colitis(UC) patients. Mean Modified Mayo Score and Crohn's Disease Activity Index were 2.4, 130 respectively. History of past psychiatric treatment was 20.9 % (n=37) and suicide attempt was 4.0 % (n=7). Family history of psychiatric disease was 10.2 % . Patients themselves completed the HADS test in a mean time of 7 minutes. HADS scores of seventy patients (38 UC, 32 CD) (%39.5) were higher than cut- offs and sent to psychiatric examination. After SCID interview, 95.7 % (67 out of 70) of the patients had a psychiatric diagnosis with a treatment plan. Major depressive (41.4%) and generalized anxiety disorders (14.3%). were the most common diagnoses.

Conclusion

Depression and anxiety disorders is found to be quite frequent in our IBD outpatients (%39.5). HADS is a cheap, easily applied, not medical personal depended ie. self- report, paper tool which revealed a very high consistency (%95.7) with the Results of professional SCID interview to screen the presence of depression and anxiety disorders in outpatient IBD clinics. Positive test result may alarm the gastroenterologist for a consultation to the psychiatrist.