P106 Depressive symptoms and anxiety and their screening in IBD patients: performance of the distress thermometer in Italian IBD patients

C. Canaletti1, F. Colombo2, A. Dessì2, E. Geccherle3, A. Tongiorgi4, P. Cai5, F. Giudici6, G. Mocci7, F.M. Onidi7, A. Orlando8, M.G. Mortillaro8, F. Bossa9, G. Martino9, M. Placentino9, L. Guidi10, D. Pugliese10, L. Tiberio10, F. Costa4, G. Deledda3, A. Geccherle3, A. Paolini1, C.F. Tonello1, G.M. Pecoraro1, F. Monica1

1Asuits Cattinara Hospital, Gastroenterology, Trieste, Italy, 2Istituto Milanese di Psicoterapia Cognitivo Comportamentale - IMIPSI, Psychology, Milano, Italy, 3Ospedale IRCCS ‘Sacro Cuore - Don Calabria’ Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Classificato e Presidio Ospedaliero Accreditato - Regione Veneto, Gastroenterology, Verona, Italy, 4Azienda Ospedaliero Universitaria di Pisa – AOUP, Gastroenterology, Pisa, Italy, 5Ospedale San Martino, Genova, Psychology, Genova, Italy, 6Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, VascularSciences and Public Health, University of Padova, Biostatistics, Padova, Italy, 7Ospedale S. Michele Brotzu, Gastroenterology, Cagliari, Italy, 8Ospedali Riuniti Villa Sofia-Cervello, Internal Medicine, Palermo, Italy, 9Ospedale Regionale Casa Sollievo della Sofferenza IRCCS di San Giovanni Rotondo, Gastroenterology, San Giovanni Rotondo, Italy, 10IBD Unit Presidio Columbus-Fondazione Policlinico Universitario A. Gemelli IRCCS e Università Cattolica del Sacro Cuore, Gastroenterology, Roma, Italy


Roughly 50% of patients with IBD have symptoms of psychological distress (Mikocka-Walus et al. 2019) but only 15.2% receive attention for their mental health although the effect on disease severity can be profound. It is necessary to have an easy-to-administer psychological distress screening tool. The distress thermometer (DT) is a single-item distress screening scale with 11-likert response widely used in oncological patients. The aim of study was to determine whether the single-item DT compared favourably with IBD clinical indices and time consuming measures currently used to screen for distress.


Two hundered and twenty IBD patients (51.43% male) who were recruited in eight Italian hospitals completed the DT and identified the presence or absence of 34 problems using standardised problem list (PL). They completed the 14-item Hospital Anxiety and Depression Scale (HADS) and the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ). Disease clinical indices have been collected for each patient (Mayo score, Harvey–Bradshaw Index–HBI, years of illness, and exacerbation in the last year). Using receiver operating characteristic (ROC) analyses validated the use of the DT in Italian IBD population.


47.6% reported anxiety and depression symptoms (HADS ≥15) and needs emotional care. Anxiety is much more associated (43.8%) than depressive problems (26.2%). Data are confirmed by responses to DT and PL: 44.5% of patients reported moderate–severe emotional distress (TD ≥ 5), 43.1% of patients report nervousness and worry, 27.1% reported depression. We observed a strong positive correlation between IBDQ and HADS (r = 0.74, p < 0.001) and DT (r = 0.58, p < 0.001), while there was a slightly smaller association with Mayo score (r = 0.46, p < 0.001) and HBI (r = 0.39, p < 0.001). There was not a statistical significant correlation between disease indices and the emotional distress as measured by HADS or DT. ROC analyses showed that a DT cutoff score of 5 or higher had optimal sensitivity (83%) and specificity (68%) relative to the HADS score as ‘gold’ standard. DT scores yielded area under the curve estimates relative to the HADS cutoff score indicative of good overall accuracy (AUC = 0.81–95% CI: 0.77–0.85).


Our study confirms that anxiety and depression symptoms are associated with IBD. This is the first study that demonstrated that DT is an easy-to-administer screening tool of psychosocial distress in IBD population. We propose that gastroenterologists use DT to identify patients with psychological distress: an early psychological support and a multidisclinar equipe can determinate a patient’s better disease course (Mawdsley et al. 2005). Our analyses indicated that using a DT’s cutoff of 5 to indicate high levels of distress.