Psychological Morbidity in IBD: The Dominant Role of Disease Activity over Subtype and Demographic Factors

Background: Patients with inflammatory bowel disease (IBD) experience disproportionately high rates of anxiety and depressive symptoms, representing a 2-3-fold increased risk versus the general population. While psychological morbidity is well-documented, the relative contributions of disease activity (active vs. inactive), IBD subtype (ulcerative colitis [UC] vs. Crohn's disease [CD]), and sociodemographic factors remain clinically contested. This study aimed to quantify these relationships to guide targeted interventions. Methods: We conducted a cross-sectional, single-center study comparing 94 consecutive IBD patients (61 UC, 33 CD; mean age 34.2 ± 11.1 years) with 79 age- and sex-matched healthy controls. The psychological status was assessed using the validated Turkish version of the Hospital Anxiety and Depression Scale (HADS), with 14 items (7 per subscale, 0-21 range) and established cutoffs (≥10 for anxiety, ≥7 for depression). Disease activity was objectively classified: UC patients via the Truelove-Witts Index (inactive, mild, moderate, or severe) and CD patients via the Crohn's Disease Activity Index (CDAI < 150 inactive, ≥150 active). Statistical analyses employed SPSS 20.0 (IBM Corp., Armonk, NY, USA), including Student's t-tests, Mann-Whitney U tests, and chi-square tests, with p < 0.05 as the significance threshold. Results: Disease activity was the strongest predictor: active IBD patients exhibited 64% higher anxiety symptom scores (11.2 ± 3.1 vs. 6.8 ± 2.4, p < 0.001) and 107% higher depressive symptom scores (8.9 ± 2.7 vs. 4.3 ± 1.9, p < 0.001) than inactive patients. Gender and education modulated the risk: females showed 23% elevated anxiety (OR 1.23, 95% CI 1.06-1.43; p = 0.008), while college education correlated with 31% lower depression odds (OR 0.69, 95% CI 0.51-0.93; p = 0.026). Strikingly, 32.1% of IBD patients met depressive symptom thresholds versus 17.7% of controls (p = 0.028). No UC/CD subtype differences emerged (p > 0.05). Conclusions: Our findings confirm that active IBD inflammation-not the disease subtype (UC/CD)-is the strongest predictor of anxiety and depressive symptoms, with one in three patients meeting clinical depression thresholds. Women and those with less education face heightened risks, underscoring the need for routine mental health screening during flares and targeted psychosocial support. These results advocate for integrated psychiatric care in IBD management to address this invisible burden.