Implementation of a Depression and Quality of Life Screening Protocol for Patients Aged 11-30 Years with Inflammatory Bowel Disease

Written by Scott Hirst & Joseph Cipriano

doi: https://doi.org/10.13178/jnparr.2025.1501.1506

Abstract

Introduction: Inflammatory bowel disease (IBD), which consists of two inflammatory pathways, Crohn’s Disease and Ulcerative Colitis (UC), affects approximately three million Americans each year. A person with IBD has a two-to four-fold greater risk of psychosocial and mental health problems including depression, anxiety, and decreased quality of life.

Objective: This quality improvement project aimed to implement a depression and quality of life screening protocol for patients aged 11-30 with IBD within a federally qualified healthcare center (FQHC) in New Jersey to improve the identification, management, and referral of patients to mental health services.

Methods: The Patient Health Questionnaire-2 (PHQ-2) followed by the Patient Health Questionnaire-9 (PHQ-9) given to those patients who had a positive PHQ-2 score of three or higher, and The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) were implemented to routinely screen for depression and quality of life during an outpatient office visit.

Results: Referrals to mental health services increased for those patients who screened and had higher reports of depression and decreased quality of life on the PHQ-9 and the SIBDQ questionnaire after the implementation of this quality improvement initiative. In addition, a statistically significant correlation (r = .966, p = 0.00) was found between depression and quality of life in patients living with IBD, as measured by the PHQ-9 and SIBDQ.

Conclusion: Patients with lower scores on the SIBDQ demonstrated an increased likelihood of moderate depressive symptoms according to their responses on the PHQ-9. The incorporation of self-screening tools for patients living with IBD should become a standard of practice in identifying, managing, and referring patients to mental health services.

Keywords: Inflammatory bowel disease, Crohn’s, Ulcerative Colitis, depression, quality of life, practice improvement, tablet technology