Psychological predictors of disease flares in pediatric inflammatory bowel disease: a prospective study

Previous research suggests that anxiety and depressive symptoms may influence the clinical course of Inflammatory Bowel Disease (IBD) in adults. Only few studies have evaluated the influence of mental health on the course of pediatric inflammatory bowel disease. This study aimed to examine the impact of anxiety and depressive symptoms, along with relevant covariates, on (1) the risk of disease flares during follow-up and (2) the time from baseline to the first flare. A cohort of 102 pediatric patients in clinical remission at baseline - comprising patients with Crohn disease and ulcerative colitis - was followed for four years. Negative binomial regression was used to assess predictors of the total number of flares, while survival analysis and Cox proportional hazards models evaluated predictors of the time to the first flare. To ensure robust estimates, multivariable models were adjusted using propensity scores to account for baseline pharmacological treatment variability and clinical complexity. Flares occurred in 59.3% of CD and 72.9% of UC patients. Survival analysis showed no significant difference in time-to-first-flare between groups (p = .13). In UC, negative binomial regression identified younger age at baseline (IRR 0.84, p = .046), shorter disease duration (IRR 0.98, p = .010), and absence of prior surgery (IRR 0.26, p = .002) as significant predictors of higher flare frequency. Conversely, no clinical or psychological predictors reached significance for CD. While initial UC models suggested a link between depressive symptoms and earlier relapse, this effect was attenuated (p = .335) after propensity score adjustment for pharmacological burden. In pediatric UC, disease duration and surgical history are the primary independent predictors of clinical stability. While psychological distress is prevalent, its independent impact on the disease course seems modulated by clinical and treatment variables.