This study examined differences in anxiety, depression, and illness-related anxiety between youth with Crohn's disease (CD) and ulcerative colitis (UC). It analyzed data from 133 adolescents with IBD (109 with CD, 24 with UC). Multivariate analyses found that youth with UC reported significantly higher levels of illness-related anxiety and general anxiety than those with CD, while depression did not differ. The results support the hypothesis that UC is associated with greater emotional distress, particularly anxiety, in youth with inflammatory bowel disease.

1. Does Anxiety and Depression Vary Among Youth with IBD based on Subtype?
Raisa Hasan and Laura C. Reigada, PhD
Department of Psychology, Brooklyn College of the City University of New York, NY 11210
The IBD-Specific-Anxiety Scale (IBD-SAS; Reigada et al., 2013) is a 20-item
self-report questionnaire designed to measure illness-related anxiety described
within the last two weeks. Items are on a 6-point scale (0 “Never” to 5
“Always”). Higher scores are indicative of more illness-related anxiety.
Disease Activity (DA) was measured by the Pediatric Ulcerative Colitis Activity
Index (PUCAI;2007) for those diagnosed with UC and the shortened Crohn’s
Disease Activity Index (SCDAI;1976) was used for those with CD, both
validated measures of disease activity. DA was coded into three categories of
no activity, mild, and moderate.
Procedure
Data was extracted from Crohn’s & Colitis Foundation of America (CCFA) Kids
& Teens, a large internet based cohort of individuals living with IBD. We added
the IBD-SAS scale to the study to measure illness-related anxiety. The study is
ongoing since August, 2014 to present. Follow-ups are conducted at 6 and 12
months.
Statistical Analysis
A multivariate analysis of variance (MANOVA) was conducted to determine
whether anxiety and depression symptoms differed based on IBD subtype. DA,
gender and age were controlled for.
DV: Anxiety, IBD-specific anxiety and depression [PROMIS, IBD-SAS].
IV: IBD-subtype, UC/CD.
Disease activity and age were entered as covariates. Gender was entered
as a fixed factor.
Results
Descriptive Statistics
Tests of Between Subjects Effects (MANOVA)
Note only 115 was included in analyses due to missing data.
The results of the MANOVA revealed IBD-specific-anxiety was significantly
higher in UC patients (M= 17.5, SD= 14.8) compared to CD (M= 15.2, SD=
17.2), (p= .006).
Additionally, anxiety measured by PROMIS was significantly higher in UC
patients (M= 46.1, SD= 8.3) compared to CD patients (M= 45.8, SD= 9.5),
(p=.023).
Depression did not significantly vary by IBD type.
Conclusions
Results support our first prediction, that a greater degree of anxiety and IBD-
specific anxiety contributes to higher emotional distress in youths with UC.
It was also confirmed, that greater IBD-specific anxiety was influenced by
greater general anxiety symptoms.
Findings didn’t support our second prediction, depression did not significantly
vary in UC and CD.
An uneven number of CD and UC patients, with a mostly inactive sample
restricts the interpretation and generalizability of the differences in these
phenotypes.
Future studies should examine UC separately, when assessing anxiety and
IBD-specific anxiety in children with IBD.
Introduction
One in ten people prior to age 18 are diagnosed with Inflammatory Bowel
Disease (IBD), which consists of Crohn’s disease (CD) and ulcerative
colitis (UC).
There are underlying biological and quality of life distinctions between UC and
CD.
Previous findings suggest, CD patients report fewer anxiety symptoms but
higher depressive symptoms compared to UC. A dearth of existing studies on
psychological symptoms combined CD and UC patients in adult samples,
however it hasn’t been adequately studied in pediatrics .
Methodological shortcomings in the existing literature presents conflicting
results, therefore demands further inquiry in psychological differences, which
may differentially impact youths with IBD.
Aim
The current study aims to examine whether there are significant group
differences in emotional distress (i.e., depression, anxiety & IBD-specific
anxiety) by type of IBD diagnosis (UC or CD) in youths.
H1: It is predicted that youths diagnosed with UC will display higher
levels of anxiety and IBD-specific anxiety compare to youths with CD,
controlling for disease activity, gender and age.
H2: Youths with CD will exhibit much higher levels of depression than
youths with UC, controlling for disease activity, gender and age.
Methods
Participants
A total of 133 adolescents with CD (n=109) and UC (n=24), male=59.8%,
ages 12 to 17 (M=14.24, SD= 1.68), was included in the study.
90.2% of the sample was White/Caucasian.
• Current Age: CD- N=109, M=14.1, SD=1.7; UC- N=24, M=14.6, SD=1.7.
Measures
The Patient Reported Outcomes Measurement Information System Pediatrics
(PROMIS; 2004) is a standardized patient-reported outcomes measure that
focuses on health domains. It consists of separate domains for anxiety and
depressive symptoms, which contains items with a 7-day recall period, on a 5-
point Likert scale (1 “Never to 5 “Almost Always”). Higher scores are indicative
of higher distress. Scores converted to T-scores, in which the mean is 50 and
the standard deviation is 10.
Acknowledgement: Supported by the National Science Foundation
Award #1156870
IBD Subtype
CD UC
Sex Measure Outcome N M SD N M SD
Male IBDSAS 59 14.6 16.1 10 18.7 18.1
PROMIS Anxiety 59 44.5 8.9 10 48.6 8.7
PROMIS Depression 59 41.8 8.0 10 47.4 8.9
Female IBDSAS 34 16.2 19.1 12 16.6 12.1
PROMIS Anxiety 34 48.1 10.1 12 44.1 7.7
PROMIS Depression 34 42.9 7.3 12 41.8 6.9
Total IBDSAS 93 15.2 17.2 22 17.5 14.8
PROMIS Anxiety 93 45.8 9.5 22 46.1 8.3
PROMIS Depression 93 42.2 7.8 22 44.4 8.2
The sample size is 133 but due to missing data, the statistics of 115 observations are
reported.
Partial
Source Dependent Variable F Sig. Eta Squared
IBD Type IBDSAS 7.853 0.006 ** 0.067
PROMIS Anxiety 5.330 0.023 * 0.047
PROMIS Depression 0.368 0.545 0.003
*p < 0.05, ** p < 0.01
IBD Subtype
CD UC Total
Disease Activity N % N % N %
No Activity 92 86.8% 8 36.4% 100 78.1%
Mild 7 6.6% 10 45.5% 17 13.3%
Moderate 7 6.6% 4 18.2% 11 8.6%
Total 106 100.0% 22 100.0% 128 100.0%
The sample size is 133 but due to missing data, the distribution of 128
observations are reported.