P0646 Significant mental health and fatigue burden found in tertiary paediatric IBD service in Australia
Authors: Au Yeung S T , You D , Mahmood D , Tano M , Chidgey T , Magoffin A , O’Loughlin E , Thacker K , Dutt S 
Published: January 2025

Background

Mental health issues such as anxiety and depression in patients with inflammatory bowel disease (IBD) are well-documented in the literature1,2. Aim: We reviewed the cohort within our new IBD psychology service, to establish the prevalence of anxiety and depression in the Australian paediatric setting.

Methods

213 outpatients aged 5-18 attending the outpatient IBD service at the Children’s Hospital at Westmead, Australia were recruited from April to October 2024. They completed a validated self-report tool, PROMIS Paediatric Profile v2.0 – Profile 25, which measures anxiety, depression, mobility, fatigue, peer relationships, pain interference, and pain intensity. Clinical disease data, including PUCAI/PCDAI scores and biochemical markers (faecal calprotectin, ESR, and CRP) were collected for the same visits. Demographic data included age, sex, disease type (Crohn’s Disease or Ulcerative Colitis), and age at diagnosis.

Results

Moderate to severe levels of anxiety, depression, and fatigue were reported by 28.7%, 20.2%, and 26.7% of participants, respectively. There was a significant difference in psychological distress (combined anxiety and depression) across different groups when stratified on age of diagnosis (i.e. ages 0-5, 6-12, and 13-18; F(2, 208)=5.37, p=.005). Psychological distress positively correlated with clinical disease severity (PCDAI: r=.244, p=.007; PUCAI: r=.317, p=.004), and pain interference (r=.600, p&lt;.001) and intensity (r=.461, p&lt;.001); negatively correlated with mobility (r=-.514, p&lt;.001) and peer relationships (r=-.437, p&lt;.001). A hierarchical regression was conducted to assess predictors of psychological distress among participants. Fatigue emerged as the strongest predictor in the final model, significantly explaining additional variance in distress levels (F(1, 164)=79.34, p&lt;.001). Additionally, mobility and sex also emerged as significant predictors of psychological distress (ps=.049 and .017, respectively), while age, biochemical markers, and disease severity were non-significant. This model explained 57.3% of the variance in psychological distress.

Conclusion

Paediatric patients with IBD experience significant burden from anxiety, depression, and fatigue. The strong association between fatigue and psychological distress mirrors findings in the adult IBD population3, suggesting that fatigue and psychological factors significantly influence each other, independent of the disease state. These results underscore the importance of targeted screening and management of psychological symptoms to improve IBD care and improve quality of life in paediatric patients.

References

1.Butwicka A, Olén O, Larsson H, et al. Association of childhood-onset inflammatory bowel disease with risk of psychiatric disorders and suicide attempt. JAMA Pediatr. 2019 Oct;173(10):969-978. doi: 10.1001/jamapediatrics.2019.2662.

2.Cooney R, Tang D, Barrett K, Russell RK. Children and young adults with inflammatory bowel disease have an increased incidence and risk of developing mental health conditions: a UK population-based cohort study. Inflamm Bowel Dis. 2024 Aug;30(8):1264-1273. doi: 10.1093/ibd/izad169.

3.Uhlir V, Stallmach A, Grunert PC. Fatigue in patients with inflammatory bowel disease-strongly influenced by depression and not identifiable through laboratory testing: a cross-sectional survey study. BMC Gastroenterol. 2023 Aug 22;23(1):288. doi: 10.1186/s12876-023-02906-0. PMID: 37608313; PMCID: PMC10463723.