Quick Shot #7 Answer
Answer: Refer Patient to a Mental Health Provider
Due to the potential for impact on daily activities, the stigma associated with a chronic illness and the need for self management of a disease that can impact multiple facets of life, patients with inflammatory bowel disease are at risk for dual diagnosis with mood disorders. In fact, a retrospective study showed an increased risk of depression compared with health controls (21.2% vs 13.4%). Concomitant mental health diagnoses can impact a patient’s ability to cope with their disease and to manage complex medication regimens. This patient is demonstrating changes in mood, sleep, appetite, and concentration, which are all symptoms consistent with an adjustment disorder, major depressive disorder or other mood disorders.
It is possible that he has been missing injections as a result of an undiagnosed mood which has led to his low drug levels. It is important to address not only the psychological impacts of IBD itself on mood but also the impact of mental health disorders on IBD. If a provider is not comfortable managing such concerns the patient should be referred to an appropriate mental health provider.
- Keefer L, Kane SV. Considering the Bidirectional Pathways Between Depression and IBD: Recommendations for Comprehensive IBD Care. Gastroenterol Hepatol (N Y). 2017;13(3):164-169.
- Mikocka-Walus A, Knowles SR, Keefer L, Graff L. Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases. Inflamm Bowel Dis. 2016 Mar;22(3):752-62.
- Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H. Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review. J Psychosom Res. 2016 Aug;87:70-80. doi: 10.1016/j.jpsychores.2016.06.001. Epub 2016 Jun 6. PMID: 27411754.