Depressive Symptom and Quality of Life Scores Improve Over Time in Patients With Inflammatory Bowel Disease at a Multidisciplinary IBD Center

Background: Patient-reported outcomes (PROs) including patient (pt) disease activity scores, quality of life, and depressive symptoms are increasingly being used for clinical care in pts with inflammatory bowel disease (IBD). However, little is known about PRO outcomes over time in a real-world setting. Methods: PROs were collected as part of clinical care from a tertiary care IBD center on an automated basis from the electronic medical record (EMR) from 2018-2020 (COVID pandemic affected further collection). Quality of life was measured by Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Disease activity was measured using Harvey Bradshaw Index (HBI) for Crohn’s disease (CD) and Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). Depressive symptoms were measured using the validated Patient Health Questionnaire-8 (PHQ-8). EMR PRO collection included either online pt portal entry up to 72 hours prior to clinic visit or on a tablet at the time of clinic visit. Only pts new to clinic were included to minimize confounding of prior multidisciplinary care. Statistical analysis included Pearson test and Wilcoxon test. Analysis for PRO over time included a linear mixed model fit by REML with t-tests using Satterthwaite’s method. Results: 1,376 patients were evaluated. Age was median 36 years (yrs) (75% IQR range 25, 52), 58% female, 66% with Crohn’s disease, 87% White, 7% Black, 6% other. 15% current smokers, 41% baseline corticosteroid use, 45% baseline biologic use, 23% baseline immunomodulator use, 32% baseline psychiatric medication use. In patients with UC, 71% had extensive disease. In patients with CD, 7% had perianal disease, 14% had penetrating and 29% had stricturing disease. Depressive symptoms and quality of life improved significantly over time for patients with CD and UC. Mean SIBDQ [95% CI] significantly increased in pts with CD by 2.9 per yr [2.3 to 3.6] and in pts with UC by 4.7 per yr [3.8 to 5.6]. Mean PHQ-8 [95% CI] significantly decreased in pts with CD by -1.0 per yr [-1.3 to -0.8] and in pts with UC by -1.7 per yr [-2.2 to -1.3]. This remained significant in PHQ-8 cognitive subscale decrease by -0.7 per yr [-0.9 to -0.5] and PHQ-8 somatic subscales by -0.4 per yr [-0.5 to -0.2] in pts with CD and for PHQ-8 cognitive subscales by -1.1 per yr [-1.3 to -0.8] and PHQ-8 somatic subscales by -0.7 per yr [-0.9 to -0.5]) in pts with UC. In evaluation of specific disease characteristics (age, sex, and for Crohn’s disease: perianal, penetrating, or stricturing disease) and medication use (corticosteroid use, biologic use, immunomodulator use, psychiatric medication use), significant improvement for all PROs persisted in CD and UC, and there was no evidence it differed between the subtypes. Conclusions: In a real-world multidisciplinary care setting, depressive symptoms (both cognitive and somatic subscales) and quality of life symptom scores improved over time. This was seen for all patients regardless of disease characteristics and medication use.