Pooled prevalence of psychological distress and mental health conditions in older adults with inflammatory bowel disease: a protocol for a systematic review and meta-analysis

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Abstract
Background: Older adults (≥60 years) are one of the fastest-growing age groups, with a rising prevalence of chronic conditions such as inflammatory bowel disease (IBD). Mental health conditions are common among people living with IBD; however, the burden of depression, anxiety, and stress/psychological distress, specifically among older adults with IBD, remains poorly characterized. Most available evidence comes from younger or mixed-age cohorts, underscoring the need to synthesize evidence explicitly focused on older adults to address this gap. Methods/design: We will conduct a systematic review and, where applicable, a meta-analysis following PRISMA-P guidance. The protocol is registered in PROSPERO (ID: (CRD420251157744)). We will include quantitative observational studies (cross-sectional, cohort, and case-control) published in English-language journals from January 2014 to the present. Eligible studies must report extractable data for older adults (≥60 years, or ≥65 years where used) with IBD (Crohn’s disease, ulcerative colitis, or IBD-unclassified) and at least one eligible mental health outcome (depression, anxiety, and/or stress/psychological distress). Searches will be conducted in MEDLINE, EMBASE, PsycINFO, and CINAHL, and supplemented with reference-list screening, forward citation searching, and targeted grey literature searches using a pre-specified approach. Two reviewers will independently screen records, extract data, and assess risk of bias using design-appropriate tools. Pooled prevalence will be estimated using random-effects meta-analyses, with an appropriate transformation for proportions. Heterogeneity will be explored using I² and pre-specified subgroup/sensitivity analyses. Where pooling is not appropriate due to substantial heterogeneity, findings will be summarized using structured narrative synthesis. Where eligible longitudinal or comparative observational studies are available, association estimates (e.g., OR/RR/HR) will be synthesized and reported separately from prevalence outcomes. Discussion: This review may provide a consolidated synthesis of international evidence on the prevalence and pooled prevalence of depression, anxiety, and stress/psychological distress among older adults with IBD. Where data allow, it may also summarize association evidence as a separate stream. Findings may inform integrated care pathways for older adults with IBD, helping to identify key sources of heterogeneity and evidence gaps that can inform future research and care planning.

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