The Disease Severity Index for Inflammatory Bowel Disease Is Associated With Psychological Symptoms and Quality of Life, and Predicts a More Complicated Disease Course

Akhilesh Swaminathan; Dali Fan; Grace M. Borichevsky; Thomas C. Mules; Esther Hirschfeld; Chris M. Frampton; Andrew S. Day; Corey A. Siegel; Richard B. Gearry


Aliment Pharmacol Ther. 2022;56(4):664-674. 

In This Article

Abstract and Introduction


Background: The Disease Severity Index (DSI) is a novel tool to predict disease severity in inflammatory bowel disease (IBD). However, its ability to predict disease complications and the presence of psychosocial comorbidity is unclear. Aims: To assess prospectively associations between the DSI and psychological symptoms, quality-of-life (QoL) and disease outcomes in an IBD cohort.

Methods: Patients with IBD undergoing ileocolonoscopy were followed prospectively for 12 months. DSI, psychological symptoms (perceived stress (PSS-10), depression (PHQ-9), anxiety (GAD-7)) and QoL (IBDQ-32) scores were assessed at baseline. Logistic regression identified variables predicting a complicated IBD course at 12 months (composite outcome of need for escalation of biological/immunomodulator for disease relapse, recurrent corticosteroid use, IBD-related hospitalisation and surgery). Receiver operating characteristics (ROC) analysis identified optimal DSI thresholds predicting a complicated disease course and multivariable logistic regression assessed the risk of reaching this outcome.

Results: One hundred and seventy-two patients were recruited (100 Crohn's disease, 91 female). Median DSI was 21 (IQR 11–32) and 97 patients had endoscopically active disease at baseline. The DSI was significantly higher in patients with symptoms of moderate–severe stress (PSS-10 > 14, p < 0.01), depression (PHQ-9 ≥ 10, p < 0.01), anxiety (GAD-7 ≥ 10, p < 0.05) and impaired quality-of-life (IBDQ-32 < 168, p < 0.01). Only the baseline DSI (OR 1.05, p < 0.01) and endoscopically active disease (OR 6.12, p < 0.01) were associated with a complicated IBD course. A DSI > 23 was strongly predictive of a complicated IBD course (OR 8.31, p < 0.001).

Conclusions: The DSI is associated with psychological distress, impaired QoL and predicts a more complicated disease course in patients with IBD.


Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), are chronic, progressive intestinal disorders for which there is no cure.[1] Individuals with IBD follow a heterogeneous disease course. Whilst some with this disease have an indolent course of illness, others experience significant morbidity including the need for IBD-related hospitalisation and surgery.[2,3] Patients with IBD also experience higher rates of stress, anxiety and depression compared with those without IBD.[4–7] Thus, the overall burden of IBD is vast and has significant impacts on health-related quality of life (HRQoL).[8,9]

Predicting the overall severity of illness in IBD is a challenging concept for both clinicians and patients. A true measure of IBD severity needs to encompass indicators of current disease activity, markers of poor long-term outcomes such as previous medication failures and IBD-related surgery, and the impact of the disease on the patient.[10] The disease severity index (DSI) was developed using conjoint analysis methodology, based on expert opinions of IBD clinicians (Table S1).[11] The goal of this tool is to incorporate measures of IBD activity (biomarkers and endoscopic/radiological indices), clinical prognostic markers, a history of IBD-related complications and patient-reported outcomes to estimate overall disease severity. This instrument aims to stratify individuals from low to a high disease burden to better characterise overall disease severity as opposed to disease activity at a moment in time.

Given the importance of psychosocial health for patients with IBD it is important that prognostic scores can identify patients at risk for reduced/altered mental health. This prospective study investigated the associations of the DSI with symptoms of psychological illness and HRQoL. This study also aimed to assess the use of the DSI in predicting long-term IBD-related outcomes.