Impact of anxiety and depression on hospitalization outcomes and healthcare costs in ulcerative colitis and Crohn’s Disease: A National Inpatient Sample analysis

Abstract

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is associated with high rates of anxiety and depression, which can significantly influence disease outcomes through the gut-brain axis. This study utilized the National Inpatient Sample (NIS) database (2018–2021) to assess the impact of these psychiatric comorbidities on hospitalization outcomes, including length of stay (LOS), total hospitalization costs (TOTCHG), and mortality. Among 24,584 UC hospitalizations, depression significantly increased LOS (+3.49 days, p < 0.001) and TOTCHG (+$41,480, p< 0.001), whereas anxiety was associated with lower hospitalization costs (−$14,766, p = 0.025) but had no impact on LOS. In 46,117 CD hospitalizations, moderate-to-severe depression (1.08%) led to longer hospital stays (6.92 vs 4.86 days, p < 0.001), higher costs ($68,169 vs $51,981, p = 0.001), and a fivefold increase in mortality risk (OR = 5.05, p = 0.002). Anxiety (2.08%) was associated with a slight increase in LOS (5.83 vs 4.86 days, p < 0.001) but did not significantly impact costs or mortality. In addition, racial and socioeconomic disparities were evident, with Black and Hispanic patients experiencing longer hospitalizations and higher costs, underscoring the need for equitable access to care. These findings highlight the significant burden of psychiatric comorbidities in IBD, particularly the substantial impact of depression on hospitalization outcomes and mortality risk in CD. Integrating mental health support into routine IBD care may improve patient outcomes and reduce healthcare burdens. Further research is needed to develop targeted interventions that address these disparities and optimize treatment strategies.