The Impact of IBD on Mental Health

by Dr Simon Knowles

Dr Knowles' clinical and research interest relate to the biological and psychological interactions of gastrointestinal conditions and the Brain-Gut-Axis and he has developed several free online comprehensive gastrointestinal-specific mental-health support services, including

Research indicates that around 1 in 4 Australians will experience a mental health condition in their lifetime.1 This number increases dramatically when individuals also live with a chronic illness, especially if it involves pain.

One such chronic illness that can often involve pain is Inflammatory Bowel Disease (IBD), also known as IBD.2 Using the same mental health questionnaire often given by general practitioners, the “Own your IBD” survey3 found that of Australian respondents living with IBD, 57% experienced symptoms consistent with having a mental disorder3 with the highest rate of severe mental disorder reported in respondents living with IBD for less than 10 years.3

Around 75,000 Australians experience Inflammatory Bowel Disease4 a group of medical conditions whereby the gastrointestinal tract becomes inflamed. Individuals living with IBD can experience daily gastroenterological complaints, including pain, abdominal discomfort and tenderness, often requiring medication and the ongoing involvement of multiple health specialists.

Although the “Own your IBD” survey involved people completing an online survey, the reported high rates of mental distress are consistent with other hospital-based studies. For example, Dr Evertsz and colleagues in the Netherlands found that 43% of those surveyed with IBD had symptoms of anxiety and or depression, indicative of a psychiatric disorder.5

These high levels of mental distress in people with IBD mirror that of other chronic disease such as diabetes and in some instances, cancer. In fact one European study indicated that patients with IBD had higher levels of anxiety and depression than those with colon cancer.6  I’ve seen this to be the case in my work as a practising clinical psychologist, with IBD patients often at greater risk of psychological distress than some other chronic diseases.

Why do people with IBD have psychological distress?

This is probably due to multiple factors including:

• the ongoing fluctuating nature of IBD

• the commonly associated pain

• the impact of bowel problems on work, family and social life, and

• fears of bowel urgency and having bowel accidents.

Many of my patients report the distress that comes with outwardly appearing fine when they are really in terrible internal pain. Further, in our society, talking about one’s bowels is not a common thing to do so patients find it difficult to express how they are feeling to their friends, family and co-workers. Consequently, those around them are often unable to relate or understand what they are going through both physically and mentally.

…in our society, talking about one’s bowels is not a common thing to do so patients find it difficult to express how they are feeling…

The findings from the 2013 “Own your IBD” survey indicated that individuals living with IBD, like with any other chronic health condition, need access to, and more importantly need to be willing to engage with, mental health services.

How to get support

If you are living with IBD, talk to your GP or Gastroenterologist about the benefits of obtaining mental health support. Remember, many individuals with IBD experience distress; you don’t need to suffer in silence. 

For more information and tips about mental health and IBD, read the other articles on