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ORLANDO -- Young people with inflammatory bowel disease (IBD) used medications to treat anxiety and depression at a much higher rate than the general pediatric population, a researcher said here.

In a small study, 28.5% of pediatric patients with IBD had taken or were taking antidepressants and other psychotropic drugs to treat anxiety, depression, or another psychiatric disorder, which is 10 times the rate of the general pediatric population, reported Natalie Conboy, an undergraduate student at Auburn University in Alabama.

But more than three-quarters of patients had no record of receiving mental health services, she said at a presentation at the Advances in Inflammatory Bowel Diseases (AIBD) meeting.

Conboy noted that about a quarter of patients with IBD are diagnosed prior to age 20, and that the disease can be more aggressive in young people, often requiring hospitalization, surgery, nutritional supplements, and use of steroids.

Not only that, but IBD can lead to growth retardation, weight changes, and stress, "leading to a lot of psychological distress," Conboy said.

She noted that research has found that pediatric patients suffer from higher rates of anxiety, depression, and suicidality versus other children. But Conboy added that studies in adults found that while 43% of patients have high anxiety or depressive symptoms, less than half either take medication or receive mental health counseling.

"Overall, these disorders are undertreated," Conboy said. "This ... leads to medication non-compliance, increased cost, and worse outcomes."

Researchers performed a retrospective chart review for all pediatric IBD patients at an academic medical center from 2015-2018 using ICD-10 billing codes. Examined data included medication history, excluding medications used to treat attention deficit hyperactivity disorder (ADHD) and chronic migraine, as well as any record of mental health services.

Overall, there were 400 patients, with a mean age of about 11 at diagnosis and 57% were boys. More than three-quarters of patients had Crohn's disease, with 17% having ulcerative colitis. About 15% of patients had an IBD-related surgery, and around 40% were hospitalized for IBD. Nearly 90% had steroid use and 13% had fistulas and/or abscesses.

Anxiety was the most common diagnosis in this population (23%), followed by depression (14%). They also found that of the patients taking medication, 22% were taking selective serotonin reuptake inhibitors (SSRIs).

Of the 152 patients who were either using mental health services or taking medication, three-quarters of them started after their diagnosis of IBD. Interestingly, Conboy noted that of the 114 patients who had taken or were taking medication, 43% had not been seen by a mental health provider.

AIBD session moderator Andrew Grossman, MD, of Children's Hospital of Philadelphia, noted that perhaps patients were seeing a psychiatrist or mental health provider outside of the system without an effective way to communicate with a subspecialist.

"Show of hands," he said, turning to the clinicians in the audience. "Who here is prescribing psychotropic medications for depression/anxiety ... out of the pediatric GI office?" His response was only a handful of clinicians raising their hands.

Conboy said that clinicians should be aware that mental health problems are more common in this population than they think, and something they need to bring up, as well as screen patients and refer patients for on a regular basis.

"Pediatric gastroenterologists should be more comfortable talking about mental health with their patients and making it a conversation during appointments," she noted.

Conboy suggested that future directions in research could include longitudinal studies to examine whether "preemptive health interventions can reduce patients' risk of developing IBD-related psychopathology."

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