Routine depression and anxiety screening in IBD clinics was tied to significantly more referrals and sustained follow-up with psychogastroenterology services
Integrating routine depression and anxiety screening into
The research, led and presented by Jennifer A. Schmaus, PhD, of the University of Chicago, adds to a growing evidence base supporting team-based, integrated mental health care as a standard component of IBD management.
"When we include things like mental health screening for depression and anxiety, I think it demonstrates to patients that mental health is really important, and this is something that I should be bringing up in my clinic visit," Schmaus said.
The retrospective study reviewed 155 adult patients with IBD who were referred to a psychogastroenterology service at a single tertiary IBD center. Referrals came from 22 IBD specialists, including 10 gastroenterologists, 10 advanced practice providers, 1 dietitian, and 1 colorectal surgeon. One specialist had piloted integrated mental health screening using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) during routine outpatient visits; all other referring providers practiced in clinics without such screening.
Despite representing only 1 of 22 referring providers, that single screening-integrated specialist accounted for the largest share of referrals, 34 patients, or 21.9% of the total cohort. Patients from the integrated clinic were significantly more likely to schedule and complete an initial psychogastroenterology evaluation (P = .021) and to return for one or more follow-up visits (P = .022), with a median of 5 return visits (range 1–35).1
These findings suggest that embedding mental health screening in routine GI care may address structural barriers to psychogastroenterology engagement that persist when referrals occur in the absence of systematic screening.1
Among the 34 patients referred from the integrated clinic, the cohort was predominantly female (64.7%), had a diagnosis of Crohn's disease (55.9%), and was predominantly White (70.6%), with a median age of 33.5 years (IQR 28–44). Median PHQ-9 score was 5.5 and median GAD-7 score was 6 at the time of referral. Across the broader study population, a greater proportion of patients who were female, had a prior history of anxiety, or did not have symptomatic IBD at the time of referral completed their psychogastroenterology evaluation and followed up with at least 1 additional visit, though none of these predictors reached statistical significance.
Notably, prior engagement with mental health services did not significantly differentiate those who followed through with psychogastroenterology care from those who did not, suggesting that history of mental health treatment alone is not a reliable predictor of service uptake. Schmaus noted that patients across a range of mental health histories and presentations were represented among those who engaged with the service.1
Clinical Context: Mental Health Comorbidity in IBD and the Case for Integrated Care
Depression and anxiety occur at elevated rates in patients with IBD compared with the general population, and current clinical guidelines recommend routine mental health screening in this population to identify comorbidities and connect patients with appropriate resources.2, 3 Despite these recommendations, systematic integration of mental health screening into GI clinic workflows remains inconsistent across practice settings.
Psychogastroenterology, a subspecialty focused on brain-gut behavioral therapies, has emerged as a clinically meaningful component of IBD care, with evidence suggesting benefits in quality of life and reduction of mental health symptom burden. However, referral to and follow-up with these services has historically been limited. Schmaus noted that the busy pace of GI clinic visits can make mental health discussions easy to deprioritize, and that embedded screening may function as a natural entry point for those conversations.
"It really is a team effort. It's us, it's the gastroenterologists, it's our dietitians and our pharmacists. So mental health, I think, is a really important part of this holistic IBD care," said Schmaus. Integrated care models that include gastroenterologists, dietitians, pharmacists, and mental health professionals reflect a broader shift toward holistic, team-based IBD management.
Implementation Considerations for Scaling Mental Health Screening
The authors acknowledged that scaling integrated mental health screening across IBD clinics involves meaningful logistical and workforce considerations. Administering validated tools such as the PHQ-9 and GAD-7 in routine clinical workflows requires staff training and dedicated time.
Critically, clinics implementing screening must have protocols in place to respond to urgent findings, including endorsement of suicidality, and should ensure that trained mental health practitioners are accessible. Schmaus emphasized that the infrastructure required to safely administer and act on screening results is a key planning consideration for programs pursuing expansion.
The research team reported plans to extend the integrated screening program to additional IBD clinics within the institution, with the goal of building on these preliminary findings at scale. Limitations of the current study include its retrospective, single-center design, the relatively small patient sample from the integrated clinic, and the non-significant nature of observed subgroup differences in engagement. Broader, multi-site prospective research will be needed to establish generalizability.1
