Depression ‘stronger predictor’ of fatigue in IBD vs. self-reported disease activity
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Key takeaways:
- Depression was associated with all fatigue subtypes in IBD and was a stronger predictor of most subtypes than self-reported disease activity.
- The relationship was particularly strong with mental fatigue.
LAS VEGAS — Depression strongly correlated with most fatigue subtypes, especially mental fatigue, among patients with inflammatory bowel disease, according to a presentation at the Crohn’s & Colitis Congress.
“Our primary goal of this study was to better understand the complex nature of fatigue in IBD,” Brooke Duarte, MS, and Jessica K. Salwen-Deremer, PhD, from the department of psychiatry at Dartmouth Hitchcock Medical Center, told Healio. “From the literature, we know there are a number of psychosocial correlates of fatigue; however, these have infrequently been evaluated in terms of their unique contributions to fatigue. Investigation in different fatigue subtypes also allows for more in-depth understanding of these relationships.”
Image: Healio
In a cross-sectional study, Duarte and Salwen-Deremer assessed correlations between psychosocial factors and fatigue subtypes, including general, physical, mental, reduced motivation and activity avoidance, among 312 adults with IBD (mean age, 48 years; 66.3% women; 60.9% Crohn’s disease; 39.1% ulcerative colitis). More than half of participants (54.8%) had active disease, according to self-reported symptoms.
Patients completed a survey sent via an electronic medical record system, which measured Patient Reported Outcomes-3, Multidimensional Fatigue Inventory, Pain Catastrophizing Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Insomnia Severity Index and Brief Pain Inventory. Researchers performed forward linear regressions to include disease activity; covariates of age, gender and IBD diagnosis; and insomnia, pain severity, depression, anxiety and pain catastrophizing.
According to results, depression accounted for 29% of variance in mental fatigue, 22% in physical fatigue, 21% in general fatigue, 19% in reduced motivation and 18% in activity avoidance. Conversely, self-reported disease activity accounted for 23% of variance in general fatigue, 12% in reduced motivation, 10% in mental fatigue, 8% in activity avoidance and 7% in physical fatigue.
“We found that depression was a stronger predictor of most subtypes of fatigue than self-reported disease activity,” Duarte and Salwen-Deremer told Healio. “This was especially true for mental fatigue, where depression explained three times more of the experience of fatigue compared to disease activity itself.”
Among subtypes, insomnia and anxiety also were “significant psychosocial factors associated with general fatigue and activity avoidance, although to a lesser extent,” they added.
“Although fatigue is complex and multidimensional, psychosocial factors such as depression may play a larger role in a patient’s experience of fatigue in IBD than self-reported IBD symptoms or patient characteristics,” Duarte and Salwen-Deremer said.
They continued: “Assessment of depression should be included in the clinical management of IBD, especially when fatigue is present. Having conversations about the brain-gut interaction and the role of mental health providers on multidisciplinary teams early on in treatment is critical. These conversations can provide patients with information to better manage symptoms on their own or enhance buy-in for a referral for psychotherapy to directly address depression, anxiety or insomnia.”
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Duarte B, et al. Depression may be a stronger unique predictor of fatigue than self-reported IBD disease activity. Presented at: Crohn’s & Colitis Congress; Jan. 25-27, 2024; Las Vegas.
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