Association between Ulcerative Colitis, mental health, and Quality of Life in a Pakistani cohort: A cross-sectional analysis.

Abstract

Ulcerative colitis (UC) is chronic inflammatory bowel disease that significantly impairs both physical and psychological well-being. This study explores the prevalence of depression and its impact on quality-of-life (QoL) among UC patients in Pakistan, aiming to inform integrated care approaches in a setting where mental health often remains under-addressed. A cross-sectional study was conducted at outpatient IBD clinics of Gastroenterology department of Holy Family Hospital, Rawalpindi, from February 2024 to May 2025. Data were collected using structured forms covering demographics, clinical history, and disease severity (assessed via Mayo Score and Montreal classification). Psychological status was evaluated using HADS and BDI-II, while QoL was assessed using the IBDQ-32. Among 101 UC patients, anxiety was present in 21.8% and depression in 17.8% patients. The mean IBDQ score was 150 ± 32.9, with 12.9% reporting poor QoL, 60.4% good QoL, and 1% excellent QoL. Disease severity showed significant positive correlations with anxiety (ρ = 0.42,p = 0.001) and depression (ρ = 0.38,p = 0.002), and strong negative correlation with QoL (ρ = -0.51,p < 0.001). Kruskal-Wallis tests confirmed significant differences in psychological distress and QoL across severity groups (p < 0.05). Multivariable regression identified Mayo score, HADS-A, HADS-D, and disease extent as significant negative predictors of IBDQ score (p < 0.05). This study underscores strong correlation between higher Mayo scores, together with elevated levels of anxiety and depression, and poorer QoL as measured by IBDQ among patients with UC in Pakistan. Therefore, there is an important consideration to explore the psychological burden and QoL impairments faced by UC patients in Pakistan to inform holistic management strategies.