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Psychological Distress in Newly Diagnosed Ulcerative Colitis Patients

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease known to affect not only physical but also mental health. Anxiety and depression are common in UC patients, yet the short-term psychological impact of treatment is less understood. This prospective observational study aimed to assess changes in psychiatric symptoms over four weeks of treatment in newly diagnosed UC patients. The study was conducted at a tertiary healthcare center over two months, involving 25 adults (aged 29–63, mean age 47) with confirmed UC. Participants completed the Hospital Anxiety and Depression Scale (HADS) at diagnosis and again after four weeks of treatment. Statistical analyses, including paired t-tests and regression, evaluated symptom changes and potential predictors of persistent psychological distress. At diagnosis, mean depression and anxiety scores were 15.92 and 16.48, respectively—indicating moderate to severe distress. After treatment, both scores significantly declined to 2.48 (depression) and 2.36 (anxiety), reflecting substantial improvement. Women reported slightly higher baseline anxiety and more variability in post-treatment outcomes. However, regression analysis found no significant predictors for persistent symptoms. These results suggest that early UC treatment can markedly reduce psychological distress. Yet, residual anxiety in some patients—particularly women—underscores the need for routine mental health screenings and integrated psychological care as part of UC management.

Keywords: Ulcerative Colitis, Anxiety, Depression, Mental Health, Prospective Studies

Introduction

Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract characterized by periods of remission and relapse1. While its physical manifestations—abdominal pain, diarrhea, and fatigue—are well-documented, the psychological impact of UC remains underexplored2. Increasing evidence suggests a bidirectional relationship between mental health and UC severity, where stress exacerbates inflammation and disease burden contributes to psychiatric distress3,4.

Anxiety and depression are among the most common psychiatric comorbidities in UC patients5. Studies have shown that patients with inflammatory bowel disease (IBD), including UC, experience higher rates of psychological distress compared to the general population6,7. However, there is limited research on the short-term trajectory of anxiety and depression in newly diagnosed UC patients undergoing early medical intervention8.

This study investigates the prevalence and progression of anxiety and depression in UC patients at diagnosis and four weeks post-treatment, addressing a critical gap in the literature. The findings aim to inform integrated gastroenterology-psychiatry care models, emphasizing the importance of mental health screenings in UC management9.

Methods

Study Design

This was a prospective observational study conducted over a two-month period at a tertiary medical center10. Ethical approval was obtained from the Institutional Ethics Committee, and all participants provided written informed consent.

Participants

A total of 25 adults (18–65 years old) newly diagnosed with UC were enrolled. Diagnosis was confirmed using clinical, endoscopic, and histological criteria11.

Data Collection

Patients were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS)4 at:

  1. Baseline (at diagnosis)
  2. Follow-up (4 weeks post-treatment)

The questionnaire was administered in English and Malayalam (validated translations available)12.

Statistical Analysis

  1. Paired t-tests (or Wilcoxon signed-rank tests) were used to assess changes in psychiatric symptoms13.
  2. Regression analysis was conducted to identify predictors of persistent anxiety or depression14.
  3. Gender differences were analyzed using boxplots and comparative tests15.

Results

Baseline Characteristics

The study cohort consisted of 25 patients (Males = 12, Females = 13) with a mean age of 47 years (Range: 29–63 years)6.

Prevalence of Anxiety and Depression at Diagnosis

  • Mean HADS Depression Score: 15.92 ± 3.50 (Moderate-Severe)
  • Mean HADS Anxiety Score: 16.48 ± 2.90 (Severe)7

Changes post-treatment

TestDepression (p-value)Anxiety (p-value)
Paired t-test0.000000000000002484130.00000000000000034208
Wilcoxon Signed-Rank0.000000059604644775390.00000005960464477539

Table 1: Results of the Changes Post-Treatment of Paired-t test and Wilcoxon Signed-Rank for Depression and Anxiety measuring the p-value

Both depression and anxiety scores significantly declined following treatment (p < 0.0001)8:

  • Post-treatment Depression Score: 2.48 ± 2.02
  • Post-treatment Anxiety Score: 2.36 ± 2.18

Figure 1: Showing the significant change in HADS-D and HADS-A scores before and after treatment for Ulcerative Colitis

AgeYrsHADSDepBeforeHADSAnxBeforeHADSDepAfterHADSAnxAfter
count2525252525
mean4715.9216.482.482.36
std8.751193.4990472.9028722.0231992.177154
min2981300
25%40141410
50%48141633
75%53191833
max61212177

Table 2: Shows the different parameters of measures in HADS-D and HADS-A before and after treatment for Ulcerative Colitis

Gender-Based Differences

  • Women reported slightly higher anxiety levels at baseline.
  • Post-treatment, both men and women showed improvements, but female patients exhibited more variability in symptom reduction9.

Figure 2: Showing Difference in Genders for Confidence Intervals in Males and Females before and after Treatment using HADS-D and HADS-A scores

Regression Analysis

  • No significant predictors of persistent psychiatric symptoms were found10.
  • Age, pre-treatment anxiety, and depression scores did not significantly correlate with post-treatment scores11.

Conclusion

This study provides new insights into the short-term psychiatric burden of UC and demonstrates that effective treatment significantly reduces anxiety and depression symptoms12. However, gender-based differences and individual variability suggest that a personalized, multidisciplinary approach is needed in UC management13.

Recommendations

  1. Routine mental health screenings should be incorporated into UC treatment protocols14.
  2. Psychiatric support should be integrated early in UC care, particularly for female patients15.
  3. Further research should examine long-term mental health outcomes in UC patients10.

 

References

  • Byrne, G., Rosenfeld, G., & Leung, Y. (2017). Prevalence of anxiety and depression in patients with inflammatory bowel disease. Canadian Journal of Gastroenterology and Hepatology, 2017(3276383). https://doi.org/10.1155/2017/3276383