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Mercuri C, Catone M, Bosco V, Guillari A, Rea T, Doldo P, Simeone S. Motivational Interviewing as a Strategy to Improve Adherence in IBD Treatment: An Integrative Review Amidst COVID-19 Disruptions. Healthcare (Basel) 2024; 12:1210. [PMID: 38921325 PMCID: PMC11204356 DOI: 10.3390/healthcare12121210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/25/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024] Open
Abstract
Aims and Objectives: This review aims to analyze the effectiveness of motivational interviewing (MI) in enhancing therapeutic adherence and compliance in adult patients with inflammatory bowel disease (IBD), especially considering the disruptions caused by the COVID-19 pandemic. Background: IBD, which includes conditions such as ulcerative colitis and Crohn's disease, affects over 10 million people globally. It significantly impacts both physical and psychological well-being, leading to challenges in therapeutic adherence. Only 25-47% of patients with IBD adequately follow prescribed treatments. Design and Methods: An integrative methodology that combines qualitative and quantitative research was utilized, following a 7-step framework. This framework encompasses identifying the research question, devising a search strategy, performing a critical appraisal, summarizing findings, extracting data, conducting an analysis, and drawing conclusions. Results: Poor adherence to therapy among patients with IBD can exacerbate disease progression and result in complications. MI has been identified as a promising approach to improving both adherence and treatment outcomes. Studies, including those predating the COVID-19 pandemic, have demonstrated MI's effectiveness in enhancing adherence among patients with IBD. Conclusions: MI shows promise in enhancing adherence among adult patients with IBD. Although initial results are promising, additional research is needed to thoroughly understand its effectiveness across various clinical contexts. Relevance to Clinical Practice: The findings underscore the potential of MI as an integral component of IBD treatment strategies, suggesting that its implementation could enhance patient-provider interactions and lead to better overall health outcomes.
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Affiliation(s)
- Caterina Mercuri
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (P.D.); (S.S.)
| | - Maria Catone
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (M.C.); (T.R.)
| | - Vincenzo Bosco
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Assunta Guillari
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (M.C.); (T.R.)
| | - Teresa Rea
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy; (M.C.); (T.R.)
| | - Patrizia Doldo
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (P.D.); (S.S.)
| | - Silvio Simeone
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (P.D.); (S.S.)
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Romano D, Chesterman S, Fuller-Tyszkiewicz M, Evans S, Dober M, Gearry R, Gibson PR, Knowles S, McCombie A, O E, Olive L, Raven L, Van Niekerk L, Mikocka-Walus A. Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress. Inflamm Bowel Dis 2024; 30:911-921. [PMID: 37477361 PMCID: PMC11144983 DOI: 10.1093/ibd/izad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The bidirectional relationship between inflammatory bowel disease (IBD) flare-ups and depression/anxiety symptoms has prompted investigations into psychotherapy to improve health-related quality of life (HRQoL) by targeting depression and anxiety. Acceptance commitment therapy (ACT) is effective in improving symptoms of depression and anxiety in people with chronic diseases, yet minimal research has examined ACT's effectiveness for IBD. This study examines the feasibility, acceptability, and preliminary efficacy of the ACTforIBD program, an online program codesigned with consumers to deliver ACT to those with IBD. METHODS Adults with IBD and symptoms of mild-moderate distress were randomized to ACTforIBD or an active control (psychoeducation) condition. Participants completed 8 weekly, 1-hour sessions, 4 of which were therapist facilitated. Feasibility was based on recruitment and retention and acceptability was derived from postprogram satisfaction measures. Preliminary efficacy was determined by group differences in rate of change in study outcomes from baseline to postprogram. RESULTS Of 62 participants (89% women, 11% men; mean age 33 years), 55 completed the program (ACTforIBD: n = 26 [83.9%]; active control: n = 29 [93.5%]). Adherence and acceptability were high in the ACTforIBD group, with 80% of participants completing all self-directed modules and 78% of participants expressing satisfaction with the program. Significant and marginally significant group × time interactions were found for anxiety symptoms (b = -1.89; 95% confidence interval, -3.38 to -0.42) and psychological HRQoL (b = -0.04; 95% confidence interval, -0.07 to 0.01), showing decreased anxiety and increased psychological HRQoL in the intervention group. CONCLUSIONS ACTforIBD is feasible, acceptable, and improved anxiety symptoms, and psychological HRQoL. This highlights the need for a full-scale randomized controlled trial to further examine the program's efficacy.
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Affiliation(s)
- Daniel Romano
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Susan Chesterman
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | | | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Madeleine Dober
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Richard Gearry
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Univeresity of Otago, Christchurch, New Zealand
| | - Peter R Gibson
- Department of Gastroenterology, Alfred Health, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Simon Knowles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Andrew McCombie
- Department of General Surgery, Te Whatu Ora Ōtautahi (Health New Zealand Christchurch), Christchurch, New Zealand
| | - Eric O
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Lisa Olive
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Leanne Raven
- Crohn’s and Colitis Australia, Camberwell, Victoria, Australia
| | - Leesa Van Niekerk
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
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Ferreira C, Pereira J, Skvarc D, Oliveira S, Galhardo A, Ferreira NB, Lucena-Santos P, Carvalho SA, Matos-Pina I, Rocha BS, Portela F, Trindade IA. Randomized controlled trial of an Acceptance and Commitment Therapy and compassion-based group intervention for persons with inflammatory bowel disease: the LIFEwithIBD intervention. Front Psychol 2024; 15:1367913. [PMID: 38784617 PMCID: PMC11112702 DOI: 10.3389/fpsyg.2024.1367913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives This study tested the acceptability and efficacy of an Acceptance and Commitment Therapy and compassion-based intervention (LIFEwithIBD) in people with IBD through a two-arm RCT. Methods Participants were recruited at the Gastroenterology Department of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, those who accepted to participate were randomly assigned to one of two conditions: experimental group (LIFEwithIBD; n = 25) or control group (waitlist; n = 29). Participants completed self-report measures at baseline (T0), post-intervention (T1), and 3-month (T2) and 12-month (T3) follow-ups. Intervention acceptability was assessed. Efficacy was examined using intent-to-treat ANCOVA at post-intervention after adjusting for baseline values of depressive, anxiety, and stress symptoms (primary outcomes). Linear mixed models for all longitudinal outcomes were also analysed. Inflammatory and disease biomarkers were determined at T0 and T3. Results Acceptability results revealed a high level of satisfaction and perceived usefulness regarding the intervention. Both groups experienced a significant decrease in stress symptoms and IBD symptom perception at T1. No significant differences were observed at follow-up for the primary outcomes. The experimental group reported significantly lower Crohn's disease Symptom severity at T2 than the control group. Post-hoc analyses designed to mitigate floor effects revealed substantial treatment effects for the experimental group regarding anxiety symptoms. No significant differences were observed in clinical biomarkers from T0 to T3. Conclusion The LIFEwithIBD intervention shows promising, although preliminary, benefits for managing disease activity and reducing anxiety symptoms in IBD patients with high severity of psychological distress.Clinical trial registration: https://www.clinicaltrials.gov/ct2/show/NCT03840707, identifier NCT03840707.
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Affiliation(s)
- Cláudia Ferreira
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Joana Pereira
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - David Skvarc
- EMBRACE Lab, School of Behavioural, Social and Legal Sciences, University of Örebro, Örebro, Sweden
| | - Sara Oliveira
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Galhardo
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Nuno B. Ferreira
- School of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Paola Lucena-Santos
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Sérgio A. Carvalho
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- HEI-Lab: Digital Human-Environment Interaction Lab, School of Psychology and Life Sciences, Lusófona University, Lisbon, Portugal
| | - Inês Matos-Pina
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Bárbara S. Rocha
- Center for Neuroscience and Cell Biology, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Francisco Portela
- Coimbra University Hospital [CHUC], Gastroenterology Service, Coimbra, Portugal
| | - Inês A. Trindade
- CINEICC, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- School of Behavioural, Social and Legal Sciences, University of Örebro, Örebro, Sweden
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Sofia MA, Feuerstein JD, Narramore L, Chachu KA, Streett S. White Paper: American Gastroenterological Association Position Statement: The Future of IBD Care in the United States-Removing Barriers and Embracing Opportunities. Clin Gastroenterol Hepatol 2024; 22:944-955. [PMID: 38428707 DOI: 10.1016/j.cgh.2024.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/14/2023] [Accepted: 01/15/2024] [Indexed: 03/03/2024]
Abstract
Despite incredible growth in systems of care and rapidly expanding therapeutic options for people with inflammatory bowel disease, there are significant barriers that prevent patients from benefiting from these advances. These barriers include restrictions in the form of prior authorization, step therapy, and prescription drug coverage. Furthermore, inadequate use of multidisciplinary care and inflammatory bowel disease specialists limits patient access to high-quality care, particularly for medically vulnerable populations. However, there are opportunities to improve access to high-quality, patient-centered care. This position statement outlines the policy and advocacy goals that the American Gastroenterological Association will prioritize for collaborative efforts with patients, providers, and payors.
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Affiliation(s)
- M Anthony Sofia
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland Oregon.
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Leslie Narramore
- American Gastroenterological Association, Government Affairs Department, Bethesda, Maryland
| | - Karen A Chachu
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina
| | - Sarah Streett
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California
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5
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Huish E, Donnelly O, Marks E. "I Really Felt the Feeling": A Systematic Review and Qualitative Thematic Synthesis of Healthcare Workers' Experiences of Acceptance and Commitment Therapy Training. J Cogn Psychother 2024; 38:94-118. [PMID: 38631717 DOI: 10.1891/jcp-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Purpose: Existing research suggests that Acceptance and Commitment Therapy (ACT) training is beneficial for healthcare workers' professional practice and personal well-being. This review aimed to further understanding of healthcare workers' experiences of ACT training by synthesizing existing qualitative studies.Methods: A systematic literature review identified papers published up until April 2022 using the Embase, Ovid MEDLINE, and PsycINFO databases as well as relevant studies within the gray literature. Nine studies were included in the review, which were analyzed using Thematic Synthesis (Thomas & Harden, 2008).Results: Three analytical themes were identified through the thematic synthesis: I am both the patient and the professional; a powerful and empowering experience; and it is not always comfortable.Conclusion: This review has highlighted the importance of experiential learning. The training was a powerful experience for staff, but as such, it was not always comfortable. Recommendations for the future delivery of ACT training are made.
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Affiliation(s)
- Ellen Huish
- Department of Psychology, University of Bath, Bath, UK
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6
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Cooney R, Barrett K, Russell RK. Impact of mental health comorbidity in children and young adults with inflammatory bowel disease: a UK population-based cohort study. BMJ Open 2024; 14:e080408. [PMID: 38418244 PMCID: PMC11145984 DOI: 10.1136/bmjopen-2023-080408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/13/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVE To evaluate the impact of mental health comorbidity in children and young adults with inflammatory bowel disease (IBD). DESIGN Retrospective observational study. SETTING Representative population, routinely collected primary care data from the UK Optimum Patient Care Research Database (2015-2019). PARTICIPANTS Patients with IBD aged 5-25 years with mental health conditions were compared with patients with IBD of the same age without mental health conditions. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes comprised quality-of-life indicators (low mood, self-harm, parasuicide, bowel symptoms, absence from school or work, unemployment, substance use and sleep disturbance), IBD interventions (medication, abdominal surgery, stoma formation and nutritional supplements) and healthcare utilisation (primary care interactions and hospital admissions). RESULTS Of 1943 individuals aged 5-25 years with IBD, 295 (15%) had a mental health comorbidity. Mental health comorbidity was associated with increased bowel symptoms (adjusted incident rate ratio (aIRR) 1.82; 95% CI 1.33 to 2.52), sleep disturbance (adjusted HR (aHR) 1.63; 95% CI 1.02 to 2.62), substance use (aHR 3.63; 95% CI 1.69 to 7.78), primary care interactions (aIRR 1.33; 95% CI 1.12 to 1.58) and hospital admissions (aIRR 1.87; 95%CI 1.29 to 2.75). In individuals ≥18 years old, mental health comorbidity was associated with increased time off work (aHR 1.55; 95% CI 1.21 to 1.99). CONCLUSIONS Mental health comorbidity in children and young adults with IBD is associated with poorer quality of life, higher healthcare utilisation and more time off work. It is imperative that affected young patients with IBD are monitored and receive early mental health support as part of their multidisciplinary care. TRIAL REGISTRATION NUMBER The study protocol was specified and registered a priori (ClinicalTrials.gov study identifier: NCT05206734).
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Affiliation(s)
- Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Richard K Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Children and Young People, Edinburgh, UK
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7
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Kobrosli J, Tapp K, Soucie K. Construction of identity in individuals with inflammatory bowel disease across the lifespan. Psychol Health 2024:1-21. [PMID: 38173135 DOI: 10.1080/08870446.2023.2299243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
Inflammatory bowel disease (IBD) is a chronic illness that affects 10 million individuals worldwide; however, Canada has the highest rates of IBD per capita in the world. Presently, 0.7% of Canadians are diagnosed with IBD, which is expected to rise to 1% by 2030. Disease onset is typically between the ages of 15-45 years old. This is a crucial period for identity development and growth; however, IBD symptoms often disrupt these processes and cause individuals to abandon or reconstruct parts of their identity. As a result, changes in individuals' life plans and health status may cause them to grieve their former pre-IBD identities. In this qualitative narrative study, we captured the lived experiences of IBD, with a focus on what individuals have lost, gained, or accomplished across various avenues (e.g. relationships, education, and future scripts). Thirteen participants constructed IBD narratives using a holistic-form narrative approach, a method that captures various plot formulations and discourses that emerge through storytelling. We found three main plotlines: The 'journey to acceptance', which detailed a route to acceptance wherein individuals integrated IBD into their identity, 'the ambivalent story', which exemplified individuals who were unsure of IBD and the resulting impacts of the diagnosis on their identity, and 'the grief story', which outlined grief and loss surrounding one's pre-IBD self. These results illuminate the role of narrative in shaping meaning-making and identity processes over the life course. We urge future researchers to explore narrative inquiry as a route to further understand the integration of IBD into one's life story/identity.
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Affiliation(s)
- Jasmine Kobrosli
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Kenzie Tapp
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Kendall Soucie
- Department of Psychology, University of Windsor, Windsor, ON, Canada
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8
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Hall CV, Radford-Smith G, Savage E, Robinson C, Cocchi L, Moran RJ. Brain signatures of chronic gut inflammation. Front Psychiatry 2023; 14:1250268. [PMID: 38025434 PMCID: PMC10661239 DOI: 10.3389/fpsyt.2023.1250268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Gut inflammation is thought to modify brain activity and behaviour via modulation of the gut-brain axis. However, how relapsing and remitting exposure to peripheral inflammation over the natural history of inflammatory bowel disease (IBD) contributes to altered brain dynamics is poorly understood. Here, we used electroencephalography (EEG) to characterise changes in spontaneous spatiotemporal brain states in Crohn's Disease (CD) (n = 40) and Ulcerative Colitis (UC) (n = 30), compared to healthy individuals (n = 28). We first provide evidence of a significantly perturbed and heterogeneous microbial profile in CD, consistent with previous work showing enduring and long-standing dysbiosis in clinical remission. Results from our brain state assessment show that CD and UC exhibit alterations in the temporal properties of states implicating default-mode network, parietal, and visual regions, reflecting a shift in the predominance from externally to internally-oriented attentional modes. We investigated these dynamics at a finer sub-network resolution, showing a CD-specific and highly selective enhancement of connectivity between the insula and medial prefrontal cortex (mPFC), regions implicated in cognitive-interoceptive appraisal mechanisms. Alongside overall higher anxiety scores in CD, we also provide preliminary support to suggest that the strength of chronic interoceptive hyper-signalling in the brain co-occurs with disease duration. Together, our results demonstrate that a long-standing diagnosis of CD is, in itself, a key factor in determining the risk of developing altered brain network signatures.
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Affiliation(s)
- Caitlin V. Hall
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Graham Radford-Smith
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Gut Health Research Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Emma Savage
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Conor Robinson
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Luca Cocchi
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Rosalyn J. Moran
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
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Minjoz S, Sinniger V, Hot P, Bonaz B, Pellissier S. The burden of early life stress in chronic inflammatory bowel diseases. J Health Psychol 2023; 28:1204-1216. [PMID: 37203800 DOI: 10.1177/13591053231173918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The aim of this study was to evaluate the prevalence of early life stress (ELS) in a population with inflammatory bowel diseases (IBD) and to estimate its burden on mental, physical, and digestive health. Ninety-three participants with IBD were asked to anonymously complete questionnaires (Childhood Trauma Questionnaire-Short Form, Early Life Event Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale, Ways of Coping Checklist, Gastro-Intestinal Quality of Life Index questionnaire, and ad hoc questions about symptoms). The prevalence of patients with IBD who were exposed to at least one childhood abuse was 53%. Mental health and quality of life were significantly poorer in patients with IBD who were exposed to early abuse than in those who were not. Patients exposed to ELS had also more digestive perturbations and fatigue. These results suggest that early abuse should be considered a component of IBD care.
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Affiliation(s)
- Séphora Minjoz
- Université Savoie Mont Blanc, Université Grenoble Alpes, LIP/PC2S, France
- Université Savoie Mont Blanc, Université Grenoble Alpes, LPNC, France
| | - Valérie Sinniger
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, France
| | - Pascal Hot
- Université Savoie Mont Blanc, Université Grenoble Alpes, LPNC, France
- Institut Universitaire de France, France
| | - Bruno Bonaz
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, France
| | - Sonia Pellissier
- Université Savoie Mont Blanc, Université Grenoble Alpes, LIP/PC2S, France
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10
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Lores T, Evans S, Chur-Hansen A, Andrews JM, Goess C, Smith L, Skvarc D, Mikocka-Walus AA. Virtual adjunctive gut-directed hypnotherapy for people with Crohn's disease: A randomized controlled pilot and feasibility trial. Complement Ther Clin Pract 2023; 53:101791. [PMID: 37531719 DOI: 10.1016/j.ctcp.2023.101791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Gut-directed hypnotherapy appears to be a promising adjunctive treatment for people with Crohn's disease. The primary objective of this pilot trial was to evaluate feasibility and acceptability of virtually delivered hypnotherapy to determine the parameters for a future definitive trial. METHODS This prospective, single-site, randomized controlled pilot and feasibility trial compared a 7-week course of virtually delivered adjunctive gut-directed hypnotherapy to standard medical treatment only for adults with Crohn's disease. Primary outcomes were study feasibility and intervention acceptability. Secondary outcomes were objective disease activity and patient-reported outcomes. Assessments took place at five time-points: baseline, post-intervention, and follow-up three-, six-, and 12-months post-intervention. KEY RESULTS Recruitment took place between July 2020 and August 2021 at a tertiary hospital. Recruitment was initially slow and subsequently expanded to community settings. Thirty-seven participants were enrolled in the trial: 95% were retained at post-intervention and 76% at 12-months. Completion of online assessments was high (97-100% across all time-points) whilst objective data collection was low (34-44%). Most intervention participants completed all hypnotherapy sessions (88%) and reported being extremely satisfied (73%), despite 60% experiencing technical issues. CONCLUSION & INFERENCES Virtually delivered hypnotherapy was acceptable to participants. Certain aspects of the trial including online assessment were feasible, while recruitment and objective data collection were challenges. Undertaking a future definitive trial will require broader recruitment scope and significant funding for widespread objective data collection. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ANZCTR#1260000348954.
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Affiliation(s)
- Taryn Lores
- Deakin University, Melbourne, Australia; Central Adelaide Local Health Network (CALHN), Adelaide, Australia.
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11
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Graff LA, Geist R, Kuenzig ME, Benchimol EI, Kaplan GG, Windsor JW, Bitton A, Coward S, Jones JL, Lee K, Murthy SK, Peña-Sánchez JN, Targownik LE, Jannati N, Jones May T, Akhtar Sheekha T, Davis T, Weinstein J, Dahlwi G, Im JHB, Amankwah Osei J, Rohatinsky N, Ghandeharian S, Goddard Q, Gorospe J, Gertsman S, Louis M, Wagner R, Brass C, Sanderson R, Bernstein CN. The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2023; 6:S64-S75. [PMID: 37674499 PMCID: PMC10478810 DOI: 10.1093/jcag/gwad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.
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Affiliation(s)
- Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tyrel Jones May
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tasbeen Akhtar Sheekha
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ghaida Dahlwi
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shira Gertsman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Richelle Wagner
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Sun S, Hu Y, Li H, Chen J, Lou Y, Weng C, Chen L, Lv B. Patients' perspectives on, experience with and concerns about crohn's disease: insights from Chinese social media. BMC Gastroenterol 2023; 23:105. [PMID: 37016327 PMCID: PMC10071262 DOI: 10.1186/s12876-023-02747-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
AIM The aim of this study was to explore the experience and perceptions of patients with Crohn's disease in China. METHODS Data mining was used to investigate posts in Crohn's disease online medical communities. The data were collected through the crawler code, and latent Dirichlet allocation (LDA) and grounded theory were used to mine the theme features after data cleaning. RESULTS In analyzing the topic characteristics of online posts, LDA divided 6757 posts into 15 topics on four aspects: seeking disease information, making decisions on medication use, psychological burden, and communicating about diet and nutrition. CONCLUSION Overall, social media is patient-centric and helps us better understand the experiences and perceptions of patients. This study can help medical staff predict the thoughts and concerns of Crohn's disease patients during the treatment process, facilitate doctor-patient communication, and assist in the formulation of medical policies.
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Affiliation(s)
- Shaopeng Sun
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunhong Hu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Heng Li
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiajia Chen
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yijie Lou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chunyan Weng
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lixia Chen
- Nursing College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
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13
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Characteristics and Effect of Anxiety and Depression Trajectories in Inflammatory Bowel Disease. Am J Gastroenterol 2023; 118:304-316. [PMID: 36227779 DOI: 10.14309/ajg.0000000000002063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Symptoms of common mental disorders, such as anxiety or depression, are associated with adverse clinical outcomes in inflammatory bowel disease (IBD). We report trajectories of these symptoms in IBD, patient characteristics associated with different trajectories, and effects on healthcare utilization and prognosis. METHODS We collected demographic, symptom, psychological, and quality-of-life data, with questionnaires at 3-month intervals, over 12 months of follow-up. We collected healthcare utilization and IBD outcomes through notes review. We compared characteristics of those with persistently normal or improving anxiety or depression scores with those with persistently abnormal or worsening scores and the number of flares, glucocorticosteroid prescriptions, escalations of therapy, hospitalizations, or intestinal resections due to IBD activity. RESULTS Among 771 and 777 patients, respectively, worsening or persistently abnormal anxiety or depression scores were associated with increased antidepressant (28.6% vs 12.3% anxiety, 35.8% vs 10.1% depression, P < 0.001) and opiate use (19.0% vs 7.8% anxiety, P = 0.001 and 34.0% vs 7.4% depression, P < 0.001), compared with those with persistently normal or improving scores. These individuals were also more likely to have been diagnosed with IBD in the last 12 months (16.3% vs 5.0% anxiety, P = 0.001, and 15.1% vs 5.5% depression, P = 0.006), to have clinically active disease at baseline (57.1% vs 26.6% anxiety and 71.7% vs 29.1% depression, P < 0.001) and lower quality-of-life scores ( P < 0.001). Individuals with worsening or persistently abnormal trajectories of anxiety or depression required significantly more outpatient appointments, radiological investigations, and endoscopic procedures for IBD-related symptoms. DISCUSSION In this 12-month follow-up study, patients with IBD with worsening or persistently high anxiety or depression scores were higher utilizers of health care but were not at an increased risk of future adverse disease outcomes.
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14
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Fang N, Deng H, Fu T, Zhang Z, Long X, Wang X, Tian L. Association between caregiver ability and quality of life for people with inflammatory bowel disease: The mediation effect of positive feelings of caregivers. Front Psychol 2022; 13:988150. [PMID: 36267073 PMCID: PMC9577491 DOI: 10.3389/fpsyg.2022.988150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammatory bowel disease (IBD) is an incurable digestive disease. Since patients have to live with it, improving patients' quality of life is important. Caregiver's positive feelings and closeness may have a positive effect on patients' quality of life. We hypothesized that caregiver's positive feeling affected patient's quality of life through caregiver's caring ability, and closeness might be the upstream of this chain. In this study, we conducted a single-center cross-sectional survey by questionnaire in China to tested the hypothesis. A total of 181 patient-caregiver pairs were included. The short version of the IBD questionnaire (SIBDQ), the twelve-item short-form health survey (SF-12), the positive aspects of caregiving (PAC) and Capacity Scale of caregivers were used to collect data. All the data were collected in one interview. Spearman correlation and Bootstrap method were used to analyze the data. Mediation analysis results indicated that caregiver's caring ability mediated the association between caregiver's positive feelings and patients' quality of life (p < 0.01), which explained 34.1% of the total variation of patients' quality of life. Mediation analysis results also revealed that patient-evaluated or caregiver-evaluated closeness had a positive effect on patients' quality of life through caregiver's positive feeling and caregiver's caring ability (p < 0.05), which explained 2.1 and 2.3% of the variation of patients' quality of life. Caregiver's positive feelings were related to caregivers' quality of life (p < 0.01), but there was no significant association between caregivers' ability and caregivers' quality of life. In summary, our model revealed that caregiver's positive feeling affected patients' quality of life through caregiver's caring ability.
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Affiliation(s)
- Ning Fang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Haijun Deng
- Department of Statistics, Guizhou University of Finance and Economics, Guiyang, Guizhou, China
| | - Tian Fu
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zinan Zhang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiuyan Long
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoyan Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li Tian
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
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15
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Tiles-Sar N, Neuser J, de Sordi D, Rücker G, Baltes A, Preiss J, Moser G, Timmer A. Psychological interventions for inflammatory bowel disease: a systematic review and component network meta-analysis protocol. BMJ Open 2022; 12:e056982. [PMID: 35732389 PMCID: PMC9226957 DOI: 10.1136/bmjopen-2021-056982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients with inflammatory bowel diseases (IBD) often report psychological problems, unemployment, disability, sick leave and compromised quality of life. The effect of psychological interventions on health-related outcomes in IBD is controversial as previous reviews faced the obstacle of high heterogeneity among provided multimodular interventions. The heterogeneity can be addressed with network meta-analysis (NMA) and (multi)component NMA (CNMA). We aim to investigate whether psychological interventions can improve quality of life, clinical and social outcomes in IBD using NMA and CNMA. This is the study protocol. METHODS AND ANALYSIS We will consider randomised, quasi-randomised and non-randomised controlled trials, including cluster randomised and cross-over trials with 2 months of minimum follow-up. The conditions to be studied comprise Crohn's disease and ulcerative colitis in children, adolescents and adults. We will include any psychological intervention aiming to change the health status of the study participant.We will search Medline, Embase, Web of Science, CENTRAL, LILACS, Psyndex, PsycINFO, Google Scholar and trial registries from inception (the search will be updated before the review completion). Two authors will independently screen all references based on titles and abstracts. For data extraction, standard forms are developed and tested before extraction. All information will be assessed independently by at least two reviewers, and disagreements solved by consensus discussion or a third rater if necessary.The data synthesis will include a pairwise meta-analysis supported by meta-regression. We will conduct NMA (all treatments will constitute single nodes of the network) and CNMA (we will define all treatments as sums of core components, eg, cognitive +behaviour, or cognitive +behaviour + relaxation, and additionally consider interactions) using the R Package netmeta. ETHICS AND DISSEMINATION No ethical approval is required. Reports will include the final report to the funder, conference presentation, peer-reviewed publication and a patient report. PROSPERO REGISTRATION NUMBER CRD42021250446.
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Affiliation(s)
- Natalia Tiles-Sar
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Johanna Neuser
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Dominik de Sordi
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Medical Informatics, Medical Faculty and Medical Center - University of Freiburg, Freiburg, Germany
| | - Anne Baltes
- German Association for Crohn's Disease and Ulcerative Colitis (DCCV e.V.), Berlin, Germany
| | - Jan Preiss
- Clinic for Internal Medicine - Gastroenterology, Diabetology and Hepatology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Antje Timmer
- Department of Epidemiology and Biometry, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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16
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Wu Q, Zhu P, Liu X, Ji Q, Qian M. Nirvana: A Qualitative Study of Posttraumatic Growth in Adolescents and Young Adults with Inflammatory Bowel Disease. CHILDREN (BASEL, SWITZERLAND) 2022; 9:879. [PMID: 35740816 PMCID: PMC9222066 DOI: 10.3390/children9060879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: Psychosomatic discomfort is prevalent among adolescents and young adults (AYAs) with inflammatory bowel disease (IBD). Post-traumatic growth (PTG) has been a protective factor in earlier research. However, little is known regarding PTG among AYAs with IBD. This study investigates the generation of PTG in adolescents and young adults with inflammatory bowel disease (IBD) and finds positive coping skills employed in clinical nursing practice. (2) Methods: In 2021, 32 individuals were interviewed utilizing a semi-structured interview guide. This study used qualitative content analysis. (3) Results: The interviews revealed five themes: spiritual change, internalized supportiveness, cognitive re-shaping, externalized behaviors, and future-oriented thinking. (4) Conclusions: The research revealed the presence of PTG in AYAs with IBD. To give tailored care to patients, medical professionals must monitor the state of their PTG development in a planned and focused manner.
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Affiliation(s)
- Qiwei Wu
- School of Nursing, Yangzhou University, Yangzhou 225009, China; (Q.W.); (X.L.); (Q.J.); (M.Q.)
| | - Pingting Zhu
- School of Nursing, Yangzhou University, Yangzhou 225009, China; (Q.W.); (X.L.); (Q.J.); (M.Q.)
- Jiangsu Key Laboratory of Zoonosis, Yangzhou 225009, China
| | - Xinyi Liu
- School of Nursing, Yangzhou University, Yangzhou 225009, China; (Q.W.); (X.L.); (Q.J.); (M.Q.)
| | - Qiaoying Ji
- School of Nursing, Yangzhou University, Yangzhou 225009, China; (Q.W.); (X.L.); (Q.J.); (M.Q.)
| | - Meiyan Qian
- School of Nursing, Yangzhou University, Yangzhou 225009, China; (Q.W.); (X.L.); (Q.J.); (M.Q.)
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17
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Skvarc D, Evans S, Cheah S, Cranney M, German B, Orr R, Emerson C, Olive L, Beswick L, Massuger W, Raven L, Mikocka-Walus A. Can an online expressive writing program support people with inflammatory bowel disease? A feasibility randomised controlled trial. Complement Ther Clin Pract 2022; 48:101616. [PMID: 35716442 DOI: 10.1016/j.ctcp.2022.101616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/17/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND We explored feasibility, acceptability and preliminary efficacy of an online writing intervention (WriteforIBD) against an active control condition for distress in people with inflammatory bowel disease (IBD) at the time of the COVID-19 pandemic. METHODS A feasibility RCT was conducted in 19 adults (89.5% female, aged 20-69 years) with IBD and mild-moderate distress. Participants allocated to the WriteForIBD group completed a 4-day 30-min writing program adapted for IBD. The active control group wrote about trivial topics provided by researchers. Feasibility was established based on the recruitment and retention while acceptability based on completion rates and a numeric rating scale. All participants completed measures of mental health and disease activity before and after the intervention (one week) and at follow-up three months after the study commencement. RESULTS The retention rate in the study was high (100% WriteForIBD; 82% control). All participants attended every session. 84.2% of participants were satisfied with the intervention. All participants reported a significant improvement in IBD-Control immediately after the intervention; F (2, 33.7) = 7.641, p = .002. A significant interaction of group*time for resilience was noted, R2 = 0.19, p < .001, with the active control group reporting a significant decline in resilience from the first follow-up to three months while no significant change in resilience for the WriteForIBD group was recorded. CONCLUSIONS Online expressive writing is potentially feasible and highly acceptable to people with IBD who report distress. Future large-scale trials should explore the intervention that is adapted from this feasibility study. REGISTRATION ID: ACTRN12620000448943p.
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Affiliation(s)
- David Skvarc
- School of Psychology, Deakin University, Melbourne, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Melbourne, Australia
| | - Suiyin Cheah
- School of Psychology, Deakin University, Melbourne, Australia
| | | | - Bonnie German
- School of Psychology, Deakin University, Melbourne, Australia
| | - Rebecca Orr
- School of Psychology, Deakin University, Melbourne, Australia; iMPACT, School of Medicine, Deakin University, Geelong, Australia
| | | | - Lisa Olive
- School of Psychology, Deakin University, Melbourne, Australia; iMPACT, School of Medicine, Deakin University, Geelong, Australia
| | - Lauren Beswick
- Department of Gastroenterology, Barwon Health, Geelong, Australia
| | | | - Leanne Raven
- Crohn's & Colitis Australia, Melbourne, Australia
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18
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Hurtte E, Rogers BD, Richards C, Gyawali CP. The clinical value of psycho-gastroenterological interventions for functional esophageal symptoms. Neurogastroenterol Motil 2022; 34:e14315. [PMID: 34994058 DOI: 10.1111/nmo.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Disorders of gut-brain interaction (DGBI) are associated with high symptom burden and poor quality of life. We evaluated the clinical value of multimodal therapy with psycho-gastroenterological interventions in patients with refractory functional symptoms. METHODS Of 80 DGBI patients managed over a 12-month period, 26 patients undergoing multimodal therapy (median age 60.0 years, 73.1%F) were compared to 54 patients (median age 56.0 years, 68.5%F) managed using conventional approaches. Psycho-gastroenterological multimodal therapy was individualized and included relaxation training (diaphragmatic breathing, passive muscle relaxation) and gut-direct hypnotherapy/guided imagery. All patients completed documentation of symptom frequency and severity using a 100 mm visual analog scale (VAS) and assessment of health-related quality of life (BEST score) before and following therapy. Data were analyzed to determine comparative change in symptom burden between the two cohorts. KEY RESULTS Baseline demographics and symptom burden were similar between the two treatment subgroups. While patients improved with both multimodal and conventional therapies, BEST score demonstrated greater improvement with multimodal therapy (p = 0.03). Physician perception of symptom burden at baseline and on follow-up did not correspond to self-reported questionnaire data. On multivariable analysis, multimodal therapy (OR 7.9, 95% CI 1.8-34.6, p = 0.006) and functional esophageal disorders (OR 17.6, 95% CI 2.6-121.1, p = 0.004) predicted >50% improvement in BEST score, while the presence of psychiatric disease was a negative predictor (OR 0.22, CI 0.05-0.94, p = 0.04). CONCLUSIONS & INFERENCES Psychological intervention using multimodal therapy provides clinical value to the management of functional esophageal symptoms among patients refractory to conventional therapy.
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Affiliation(s)
- Edward Hurtte
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Benjamin D Rogers
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.,Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Cheryl Richards
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
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19
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Kok KB, Byrne P, Ibarra AR, Martin P, Rampton DS. Understanding and managing psychological disorders in patients with inflammatory bowel disease: a practical guide. Frontline Gastroenterol 2022; 14:78-86. [PMID: 36561780 PMCID: PMC9763641 DOI: 10.1136/flgastro-2022-102094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
Abstract
Mood disturbances such as anxiety and depression are common in patients with inflammatory bowel disease (IBD), and impact negatively on their quality of life and disease course. An integrated multidisciplinary IBD team, which includes access to psychology and psychiatry opinion, makes possible the prompt recognition and management of psychological disturbance in patients with IBD. Based on our experience and existing literature, including systematic reviews of the effectiveness of available treatment modalities, a stepwise approach to the maintenance and restoration of psychological well-being is recommended, evolving upwards from lifestyle advice, through behavioural therapies to pharmacotherapy.
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Affiliation(s)
- Klaartje Bel Kok
- Gastroenterology, Barts and The London NHS Trust, London, UK,Centre for Immunobiology, Barts and The London School of Medicine and Dentistry Blizard Institute, London, UK
| | - Peter Byrne
- Gastroenterology, Barts and The London NHS Trust, London, UK
| | - Ana R Ibarra
- Gastroenterology, Barts and The London NHS Trust, London, UK
| | - Peter Martin
- Gastroenterology, Barts and The London NHS Trust, London, UK
| | - David S Rampton
- Gastroenterology, Barts and The London NHS Trust, London, UK
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20
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Rada C, Gheonea D, Ţieranu CG, Popa DE. Diagnosis and Psychotherapeutic Needs by Early Maladaptive Schemas in Patients With Inflammatory Bowel Disease. Front Psychol 2022; 12:807107. [PMID: 35222160 PMCID: PMC8864133 DOI: 10.3389/fpsyg.2021.807107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Inflammatory bowel disease (IBD) is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient's personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged 16-76 years. An increase in the domain overvigilance and inhibition score had a significant effect (Wald = 6.583, p = 0.010), with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme (nearly three-quarters) and dependence/incompetence, vulnerability to harm and illness and subjugation schemas (over 80%). The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme's intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition.
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Affiliation(s)
- Cornelia Rada
- Biomedical Department, “Francisc I. Rainer” Anthropology Institute of the Romanian Academy, Bucharest, Romania
| | - Dan Gheonea
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Cristian George Ţieranu
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Gastroenterology Department, “Elias” Emergency University Hospital, Bucharest, Romania
| | - Denisa Elena Popa
- Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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21
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Möller SP, Apputhurai P, Tye-Din JA, Knowles SR. Quality of life in coeliac disease: relationship between psychosocial processes and quality of life in a sample of 1697 adults living with coeliac disease. J Psychosom Res 2021; 151:110652. [PMID: 34739942 DOI: 10.1016/j.jpsychores.2021.110652] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coeliac disease is a chronic gastrointestinal condition associated with an increased risk of psychiatric comorbidity, and diminished quality of life. Ongoing gastrointestinal symptomatology is frequently reported post-diagnosis, despite undertaking a gluten-free diet. PURPOSE To examine the role of psychosocial factors in mediating the relationship between gastrointestinal symptoms and quality of life, using a cross-sectional structural equation modelling mediation analysis guided by the Common-Sense Model. METHODS 1697 adults with coeliac disease (83.1% female, mean age = 55.79, SD = 14.98 years) completed an online questionnaire. Measures included gluten-free diet adherence, gastrointestinal symptoms, illness perceptions, coping, gastrointestinal-specific anxiety, pain catastrophising, psychological flexibility, psychological distress, and quality of life. RESULTS A structural equation model was developed explaining 50.6% of the variation in quality of life and demonstrating good fit (χ2 (2) = 8.54, p = .014, χ2/N = 4.27, RMSEA = 0.04, SRMR = 0.01, CFI = 0.999, TLI = 0.98, GFI = 0.999). Gastrointestinal symptoms directly affected quality of life, and indirectly, via negative illness perceptions, maladaptive coping, pain catastrophising, and psychological distress. CONCLUSION Psychosocial processes may affect adjustment in coeliac disease by mediating the relationship between gastrointestinal symptoms and quality of life. Individuals living with coeliac disease may benefit from interventions targeting maladaptive psychosocial factors.
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Affiliation(s)
- Stephan P Möller
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Pragalathan Apputhurai
- Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - Jason A Tye-Din
- Immunology Division, Walter and Eliza Hall Institute, Melbourne, Australia; Department of Gastroenterology, the Royal Melbourne Hospital, Melbourne, Australia
| | - Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia; Department of Gastroenterology, Alfred Health, Melbourne, Australia.
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Honig G, Larkin PB, Heller C, Hurtado-Lorenzo A. Research-Based Product Innovation to Address Critical Unmet Needs of Patients with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2021; 27:S1-S16. [PMID: 34791292 PMCID: PMC8922161 DOI: 10.1093/ibd/izab230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 12/09/2022]
Abstract
Despite progress in recent decades, patients with inflammatory bowel diseases face many critical unmet needs, demonstrating the limitations of available treatment options. Addressing these unmet needs will require interventions targeting multiple aspects of inflammatory bowel disease pathology, including disease drivers that are not targeted by available therapies. The vast majority of late-stage investigational therapies also focus primarily on a narrow range of fundamental mechanisms. Thus, there is a pressing need to advance to clinical stage differentiated investigational therapies directly targeting a broader range of key mechanistic drivers of inflammatory bowel diseases. In addition, innovations are critically needed to enable treatments to be tailored to the specific underlying abnormal biological pathways of patients; interventions with improved safety profiles; biomarkers to develop prognostic, predictive, and monitoring tests; novel devices for nonpharmacological approaches such as minimally invasive monitoring; and digital health technologies. To address these needs, the Crohn's & Colitis Foundation launched IBD Ventures, a venture philanthropy-funding mechanism, and IBD Innovate®, an innovative, product-focused scientific conference. This special IBD Innovate® supplement is a collection of articles reflecting the diverse and exciting research and development that is currently ongoing in the inflammatory bowel disease field to deliver innovative and differentiated products addressing critical unmet needs of patients. Here, we highlight the pipeline of new product opportunities currently advancing at the preclinical and early clinical development stages. We categorize and describe novel and differentiated potential product opportunities based on their potential to address the following critical unmet patient needs: (1) biomarkers for prognosis of disease course and prediction/monitoring of treatment response; (2) restoration of eubiosis; (3) restoration of barrier function and mucosal healing; (4) more effective and safer anti-inflammatories; (5) neuromodulatory and behavioral therapies; (6) management of disease complications; and (7) targeted drug delivery.
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Bogale K, Yadav S, Stuart A, Kunselman AR, Dalessio S, Bernasko N, Tinsley A, Clarke K, Williams E, Coates MD. Dedicated Psychiatry Clinic for Inflammatory Bowel Disease Patients Has a Positive Impact on Depression Scores. Inflamm Intest Dis 2021; 7:81-86. [PMID: 35979189 PMCID: PMC9294925 DOI: 10.1159/000520797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background Psychiatric disorders, including anxiety and depression, are significantly more common in patients with inflammatory bowel disease (IBD). We established an integrated psychiatry clinic for IBD patients at our tertiary center IBD clinic to provide patients with critical, but frequently unavailable, coordinated mental health services. We undertook this study to evaluate the impact of this service on psychiatric outcomes, quality of life, and symptom experience. Methods We performed a longitudinal prospective study comparing patients who had been cared for at our integrated IBD-psychiatry clinic to those who had not. We abstracted demographic and clinical information as well as contemporaneous responses to validated surveys. Results Thirty-six patients cared for in the IBD psychiatry clinic were compared to a control cohort of 35 IBD patients. There was a significant reduction in the Hospital Anxiety and Depression Scale (HADS) depression score over time in the study cohort (p = 0.001), though not in the HADS anxiety score. When compared to the control group, the study cohort showed a significant reduction in the HADS depression score. No significant differences were observed in the Harvey-Bradshaw Index, Simple Clinical Colitis Activity Index, or Short IBD Questionnaire. Conclusions This is the first study to evaluate the impact of an integrated psychiatry clinic for IBD patients. Unlike their control counterparts, individuals treated in this clinic had a significant reduction in the mean HADS depression score. Larger scale studies are necessary to verify these findings. However, this study suggests that use of an integrated psychiatry IBD clinic model can result in improvement in mental health outcomes, even in the absence of significant changes in IBD activity.
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Affiliation(s)
- Kaleb Bogale
- Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sanjay Yadav
- Department of Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - August Stuart
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Allen R. Kunselman
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shannon Dalessio
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Nana Bernasko
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Andrew Tinsley
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Kofi Clarke
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Emmanuelle Williams
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Matthew D. Coates
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
- Department of Pharmacology, Penn State University College of Medicine, Hershey, Pennsylvania, USA
- *Matthew D. Coates,
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Kuźnicki P, Neubauer K. Emerging Comorbidities in Inflammatory Bowel Disease: Eating Disorders, Alcohol and Narcotics Misuse. J Clin Med 2021; 10:4623. [PMID: 34640641 PMCID: PMC8509435 DOI: 10.3390/jcm10194623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and potentially devastating condition of the digestive tract which is exemplified by increasing prevalence worldwide, byzantine pathogenesis with a poorly defined role of the environmental factors, and complex clinical demonstration. As a systemic disease, IBD may progress with a wide spectrum of extraintestinal manifestations (EMs) and comorbidities affecting different organs and systems, from anaemia, undernutrition, and cancer to those which are often neglected like anxiety and depression. Evolving IBD epidemiology and changing environment are reflected by an expanding list of IBD-related comorbidities. In contrast to the well-established role of smoking the connection between alcohol and IBD is still debatable on many levels, from pathogenesis to complications. Furthermore, little is known about narcotics use in IBD patients, even if there are obvious factors that may predispose them to narcotics as well as alcohol misuse. Last but not least, the question arises what is the prevalence of eating disorders in IBD. In our paper, we aimed to discuss the current knowledge on alcohol and drugs misuse and eating disorders as emerging extraintestinal comorbidities in IBD.
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Affiliation(s)
- Paweł Kuźnicki
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Division of Dietetics, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Person H, Keefer L. Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110209. [PMID: 33326819 PMCID: PMC8382262 DOI: 10.1016/j.pnpbp.2020.110209] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
The high comorbidity of psychological disorders in both functional and organic gastrointestinal diseases suggests the intimate and complex link between the brain and the gut. Termed the brain-gut axis, this bidirectional communication between the central nervous system and enteric nervous system relies on immune, endocrine, neural, and metabolic pathways. There is increasing evidence that the gut microbiome is a key part of this system, and dysregulation of the brain-gut-microbiome axis (BGMA) has been implicated in disorders of brain-gut interaction, including irritable bowel syndrome, and in neuropsychiatric disorders, including depression, Alzheimer's disease, and autism spectrum disorder. Further, alterations in the gut microbiome have been implicated in the pathogenesis of organic gastrointestinal diseases, including inflammatory bowel disease. The BGMA is an attractive therapeutic target, as using prebiotics, probiotics, or postbiotics to modify the gut microbiome or mimic gut microbial signals could provide novel treatment options to address these debilitating diseases. However, despite significant advancements in our understanding of the BGMA, clinical data is lacking. In this article, we will review current understanding of the comorbidity of gastrointestinal diseases and psychological disorders. We will also review the current evidence supporting the key role of the BGMA in this pathology. Finally, we will discuss the clinical implications of the BGMA in the evaluation and management of psychological and gastrointestinal disorders.
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Affiliation(s)
- Hannibal Person
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Laurie Keefer
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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