Ethical and Practical Considerations for Mental Health Screening in Adult Patients With Inflammatory Bowel Disease.

Abstract

Adults with inflammatory bowel disease (IBD) experience disproportionately high rates of comorbid mental health conditions, including depression and anxiety, which are associated with increased disease activity, reduced treatment adherence, higher healthcare utilization, and reduced quality of life. In this narrative review, we discuss ethical and practical considerations for mental health screening in adult patients with IBD and propose actionable strategies for implementation in gastroenterology practices. This narrative review applies the Four-Box Model of Clinical Medical Ethics to evaluate challenges and opportunities associated with anxiety and depression screening in IBD care. Practical considerations were developed based on existing literature on mental health screening in medical settings and expert opinion. Mental health screening in gastroenterology clinics is ethically justified and practically feasible when implemented with appropriate safeguards. Key challenges include limited visit time, clinician discomfort, symptom overlap between IBD and mental health comorbidities, and management of suicidal ideation. Opportunities include leveraging validated brief screening tools, normalizing mental health discussions, and establishing clear workflows for positive screens. The implementation of routine mental health screening for adults with IBD aligns with core ethical principles and supports comprehensive biopsychosocial care. With thoughtful implementation, gastroenterology practices can improve identification of depression and anxiety and facilitate timely access to appropriate mental health services.