Depression in Coeliac Disease and the Impact on ADHERENCE: a Systematic Review of the Literature

Abstract

Background: Psychological symptoms are common in coeliac disease (CD). This review examined the incidence of depression in CD, focusing on factors responsible for the link between the two conditions and the impact of depressive symptoms on gluten free diet (GFD) adherence. Methods: A literature search was conducted across several electronic databases using the following search terms: coeliac/celiac disease OR gluten free diet adherence AND depression OR psychological. Findings: 41 studies were included. 16/22 studies found evidence for increased depressive symptoms in CD compared to healthy controls/norms; 11/14 established a link with poorer adherence. Mechanisms to explain the link included gluten exposure in newly diagnosed/poorly treated patients via deficient serotonin metabolites; psychosocial reaction to the restrictions of the GFD; and comorbidity with other gastrointestinal or autoimmune conditions. Discussion: Regardless of the direction of the relationship, CD patients with comorbid depression had poorer adherence and may require psychological treatment to experience symptom relief and reduce the negative impact of depression on adherence and quality of life.