Specific Depressive Symptoms are Associated with Subtypes of Fatigue in Inflammatory Bowel Disease

Fatigue is common in inflammatory bowel disease (IBD) yet firm understanding of its management remains unclear. While psychosocial factors influence fatigue, less is known about how these factors differ among fatigue subtypes. This study examined the contributions of self-reported disease activity and psychosocial factors to five fatigue subtypes. Patients with Crohn's disease or ulcerative colitis were recruited from an academic medical center. Participants completed online surveys including the Multidimensional Fatigue Inventory (MFI-20) and measures of depression, anxiety, pain interference, pain catastrophizing, and insomnia. In 312 participants, depression was most associated with subtypes of fatigue. Percent variance attributable to fatigue subtypes: general (17%), physical (12%), mental (25%), and reduced motivation (17%). Anxiety was most strongly associated with activity avoidance (17% variance). Factors associated to a lesser degree were pain interference and insomnia. The contribution of psychosocial factors to fatigue was as, if not more substantial than patient-reported disease activity. Symptom-level analysis found cognitive and behavioral symptoms of depression to be most associated with fatigue. While subtypes of fatigue differ in their association to psychosocial factors, depression was a consistent and strongly associated factor. Results highlight the importance of screening for depression and point to specific treatments that may be beneficial for fatigue management.