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Storch B, Reigada LC. Utilizing a multisystemic model of resilience to synthesize research in youth with inflammatory bowel disease: a narrative review. Transl Gastroenterol Hepatol 2024; 9:45. [PMID: 39091650 PMCID: PMC11292072 DOI: 10.21037/tgh-24-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/23/2024] [Indexed: 08/04/2024] Open
Abstract
Background and Objective The study of resilience in youth with inflammatory bowel disease (IBD) is in early stages. The current review aims to illustrate how the use of a multisystemic framework may serve as a developmental and disease-appropriate framework for conceptualizing and designing resilience research for youth with IBD. Methods This is a narrative review; therefore, a comprehensive and systematic literature search was not conducted. Rather, the current paper aims to map selected existing literature to a multisystemic model as exemplars of how the model may be used in youth with IBD. Relevant literature was reviewed, synthesized, and mapped onto the proposed multi-systemic framework. Key Content and Findings The current review considers existing literature across three proposed dimensions of resilience: contexts of risk exposure, protective and promotive factors/processes, and desired outcomes. Review of each dimension includes consideration of selected existing literature to explain what is known about each dimension currently, as well as to propose additional potential future areas to broaden understanding. Specific key takeaways include: (I) understanding risk exposure in young people with IBD requires consideration of disease-specific, demographic, and sociocultural factors; (II) protective and promotive factors and processes for these young people span individual, familial, peer, school, and community levels; and (III) desired outcomes encompass both the absence of negative and the presence of positive indicators. Conclusions A multisystemic approach to the study of resilience in young people with IBD may not only clarify current gaps in the field, but also allow for additional future considerations to best understand how and for whom outcomes characterized as resilient may occur in this population.
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Affiliation(s)
- Barbara Storch
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Laura C. Reigada
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA
- Brooklyn College, City University of New York, New York, NY, USA
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Taylor AL, Kogan J, Meyers J, Lupe S, Click B, Cohen B, Szigethy E, Keefer L, Nikolajski C. Perceptions of and Experiences with the COVID-19 Pandemic Among Individuals with Inflammatory Bowel Disease. J Clin Psychol Med Settings 2024; 31:279-291. [PMID: 37932518 DOI: 10.1007/s10880-023-09979-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 11/08/2023]
Abstract
The COVID-19 pandemic resulted in increased feelings of emotional distress and disruptions in care across diverse patients subgroups, including those with chronic medical conditions such as inflammatory bowel diseases (IBD). We sought to understand the impact of the pandemic on the physical and emotional well-being of individuals with IBD and concurrent depression and/or anxiety symptoms. We conducted qualitative interviews after the beginning of the pandemic with 46 adults with IBD. Participants reported increased levels of emotional distress, feelings of social isolation, and uncertainty over whether IBD medications put them at increased risk. Young adults discussed feeling as if their lives had been disrupted. In addition, several individuals demonstrated resiliency and emphasized positives about the pandemic, including increased connectivity with family and friends, the convenience of being able to work from home despite their IBD symptoms, and lessened feelings of "missing out." Our findings highlight several opportunities to improve the health and well-being of individuals with IBD and beyond including increased support for combatting social isolation, enhanced counseling about medication risks and benefits, and the incorporation of resiliency skills building.
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Affiliation(s)
- Ashley L Taylor
- UPMC Center for High-Value Health Care, UPMC Insurance Services Division, U.S. Steel Tower, 600 Grant St., 40th Floor, Pittsburgh, PA, USA.
| | - Jane Kogan
- UPMC Center for High-Value Health Care, UPMC Insurance Services Division, U.S. Steel Tower, 600 Grant St., 40th Floor, Pittsburgh, PA, USA
| | - Jessica Meyers
- UPMC Center for High-Value Health Care, UPMC Insurance Services Division, U.S. Steel Tower, 600 Grant St., 40th Floor, Pittsburgh, PA, USA
| | - Stephen Lupe
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Click
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Gastroenterology and Hepatology, University of Colorado, Aurora, CO, USA
| | - Benjamin Cohen
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laurie Keefer
- Icahn School of Medicine, Mount Sinai, New York City, NY, USA
| | - Cara Nikolajski
- UPMC Center for High-Value Health Care, UPMC Insurance Services Division, U.S. Steel Tower, 600 Grant St., 40th Floor, Pittsburgh, PA, USA
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Neyer MA, Henry RS, Carrier ME, Kwakkenbos L, Virgili-Gervais G, Wojeck RK, Wurz A, Gietzen A, Gottesman K, Guillot G, Lawrie-Jones A, Mayes MD, Mouthon L, Nielson WR, Richard M, Sauvé M, Harel D, Malcarne VL, Bartlett SJ, Benedetti A, Thombs BD. The association of resilience and positive mental health in systemic sclerosis: A Scleroderma Patient-centered Intervention Network (SPIN) cohort cross-sectional study. J Psychosom Res 2024; 179:111648. [PMID: 38507968 DOI: 10.1016/j.jpsychores.2024.111648] [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: 10/18/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE A previous study using Scleroderma Patient-centered Intervention Network (SPIN) Cohort data identified five classes of people with systemic sclerosis (also known as scleroderma) based on patient-reported somatic (fatigue, pain, sleep) and mental health (anxiety, depression) symptoms and compared indicators of disease severity between classes. Across four classes ("low", "normal", "high", "very high"), there were progressively worse somatic and mental health outcomes and greater disease severity. The fifth ("high/low") class, however, was characterized by high disease severity, fatigue, pain, and sleep but low mental health symptoms. We evaluated resilience across classes and compared resilience between classes. METHODS Cross-sectional study. SPIN Cohort participants completed the 10-item Connor-Davidson-Resilience Scale (CD-RISC) and PROMIS v2.0 domains between August 2022 and January 2023. We used latent profile modeling to identify five classes as in the previous study and multiple linear regression to compare resilience levels across classes, controlling for sociodemographic and disease variables. RESULTS Mean CD-RISC score (N = 1054 participants) was 27.7 (standard deviation = 7.3). Resilience decreased progressively across "low" to "normal" to "high" to "very high" classes (mean 4.7 points per step). Based on multiple regression, the "high/low" class exhibited higher resilience scores than the "high" class (6.0 points, 95% confidence interval [CI] 4.9 to 7.1 points; standardized mean difference = 0.83, 95% CI 0.67 to 0.98). CONCLUSIONS People with worse disease severity and patient-reported outcomes reported substantially lower resilience, except a class of people with high disease severity, fatigue, pain, and sleep disturbance but positive mental health and high resilience.
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Affiliation(s)
- Marieke A Neyer
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Richard S Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Linda Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, Canada.
| | - Amy Gietzen
- National Scleroderma Foundation, Tri-State Chapter, Binghamton, NY, USA
| | | | | | - Amanda Lawrie-Jones
- Scleroderma Australia, Melbourne, Victoria, Australia; Scleroderma Victoria, Melbourne, Victoria, Australia.
| | - Maureen D Mayes
- University of Texas McGovern School of Medicine, Houston, TX, USA.
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Paris, France; Assistance Publique Hôpitaux de Paris-Centre, Hôpital Cochin, Université Paris Cité, Paris, France.
| | - Warren R Nielson
- Department of Psychology, Western University, and Lawson Research Institute, London, Ontario, Canada
| | | | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton, Ontario, Canada; Scleroderma Canada, Hamilton, Ontario, Canada
| | | | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, USA; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
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You L, Wang S, Wang Y, Zhu L, Wang T, Yu X, Dong J, Guan Y. Factors promoting and hindering resilience in youth with inflammatory bowel disease: A descriptive qualitative study. Nurs Open 2024; 11:e2150. [PMID: 38629398 PMCID: PMC11022225 DOI: 10.1002/nop2.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
AIM To explore factors promoting and hindering resilience in youth with inflammatory bowel disease (IBD) based on Kumpfer's resilience framework. DESIGN A descriptive qualitative study design with an interpretative approach was used. METHODS Participants consisted of 10 youths with IBD from a tertiary hospital in Beijing (China) recruited using the purposive sampling method. Data were collected by semi-structured interviews from December 2020 to March 2021. The directed content analysis was performed for data analysis. RESULTS Both promoting factors and hindering factors could be divided into personal factors and environmental factors. Thirteen themes were identified. The promoting factors included acceptance of illness, strict self-management, previous treatment experience, life goals, family support, medical support and peer encouragement. Stigma, lack of communication, negative cognition, societal incomprehension, economic pressure and academic and employment pressure were hindering factors. CONCLUSION Health care professionals need to develop greater awareness of factors, stemming from both the individual and the outside world, that hinder or promote resilience in order to aid young patients with IBD. Building targeted nursing measures to excavate the internal positive quality of patients, provide external support and promote the development of resilience.
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Affiliation(s)
- Lili You
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Siyao Wang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Yangyang Wang
- Nursing DepartmentPeking Union Medical College HospitalBeijingChina
| | - Lingling Zhu
- Nursing DepartmentPeking Union Medical College HospitalBeijingChina
| | - Tiantian Wang
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Xiang Yu
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Jing Dong
- Department of GastroenterologyPeking Union Medical College HospitalBeijingChina
| | - Yuxia Guan
- Department of Internal MedicinePeking Union Medical College HospitalBeijingChina
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Jensen ET, Chaiboonma K, Ayala O, Proia A, Aceves SS. Sleep, Anxiety, Somatization, Quality of Life, and Resilience in Pediatric Patients With Eosinophilic Esophagitis. Clin Transl Gastroenterol 2024; 15:e00672. [PMID: 38205930 PMCID: PMC10962877 DOI: 10.14309/ctg.0000000000000672] [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: 08/23/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Emerging evidence suggests a high burden of psychosocial comorbidities in patients with eosinophilic esophagitis (EoE), although factors associated with this burden have not been explored. We aimed to increase understanding of the psychosocial burden of EoE and assess factors that are associated with disease burden. METHODS We conducted a cross-sectional study of patients with EoE (n = 87) recruited from a single-center, multidisciplinary pediatric eosinophilic gastrointestinal disorders clinic (2019-2021). Participants (aged 8-18 years) completed validated assessments during routine clinic visit to assess EoE symptoms (Pediatric Eosinophilic Esophagitis Symptom Score version 2.0), quality of life (Pediatric Quality of LIfe- Eosinophilic Esophagitis), anxiety state and trait (State-Trait Anxiety Score for Children), somatization (Child Somatic Symptoms Inventory 24), sleep disordered breathing (Pediatric Sleep Questionnaire) and, in a subset (n = 35), resilience (Connor Davidson Resilience Scale). Clinical and demographic data were collected. RESULTS Participants were at a mean (SD) age of 12.8 (3.1) years, and 26% (n = 23) were female. Shorter disease duration (6-12 months) was associated with higher symptom burden ( P = 0.03), somatization ( P < 0.01), and anxiety (State-Trait Anxiety Score for Children Trait P < 0.01) scores. Participants with neurodevelopmental comorbidities had higher anxiety trait, somatization, sleep disordered breathing, and lower quality of life ( P < 0.01 for all). Symptom burden was significantly associated with increased somatic symptoms (adjusted β [aβ] = 0.34; 95% confidence interval 0.23-0.45) and decreased quality of life (aβ = -0.42; 95% confidence interval -0.59 to -0.25) but not state anxiety, trait anxiety, or disordered sleep breathing. DISCUSSION Pediatric patients with a recent diagnosis of EoE can experience higher EoE symptoms, somatization, and anxiety when compared with those with a longer-standing diagnosis. Patients earlier in their diagnosis and with neurodevelopmental disorders may experience increased somatization and anxiety that may warrant additional support services.
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Affiliation(s)
- Elizabeth T. Jensen
- Departments of Epidemiology and Prevention and Internal Medicine, Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kira Chaiboonma
- Departments of Pediatrics and Medicine, University of California, San Diego, La Jolla, California, USA
| | - Oscar Ayala
- Departments of Pediatrics and Medicine, University of California, San Diego, La Jolla, California, USA
| | - Anthony Proia
- Departments of Pediatrics and Medicine, University of California, San Diego, La Jolla, California, USA
| | - Seema S. Aceves
- Departments of Pediatrics and Medicine, University of California, San Diego, La Jolla, California, USA
- Rady Children's Hospital, San Diego, California, USA
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Simpson E, Pourshahidi K, Davis J, Slevin M, Lawther R, O'Connor G, Porrett T, Marley J, Gill C. Living with and without an intestinal stoma: Factors that promote psychological well-being and self-care: A cross-sectional study. Nurs Open 2023; 10:7811-7825. [PMID: 37840444 PMCID: PMC10643826 DOI: 10.1002/nop2.2030] [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: 01/25/2022] [Revised: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
AIMS This study compared those living with and without an intestinal stoma in relation to physical and psychological health, stress and coping, quality of life and resilience. Also, identifying factors that could be used to promote better self-care in stoma patients in the future. DESIGN A cross-sectional and comparative study design was employed. METHODS Participants were recruited via email and social media (Facebook and Twitter) between August 2018 and March 2019, to complete an online survey. The data were analysed using analysis of variance to examine group difference and a series of hierarchical linear regression analyses determining predictors of psychological well-being. RESULTS Of 278 participants aged 18-68 years who completed the survey, 129 (46%) had a stoma and reported significantly poorer physical health. Approximately one-fifth experienced problems with stoma management. Psychological well-being was mediated by the duration of living with a stoma (under 3 years) and frequency of leaks (weekly and monthly).
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Affiliation(s)
- Ellen Simpson
- Psychology Research InstituteUlster UniversityColeraineUK
| | - Kirsty Pourshahidi
- Nutrition Innovation Centre for Food & Health (NICHE), Biomedical Sciences Research InstituteUlster UniversityColeraineUK
| | - James Davis
- Engineering Research InstituteUlster UniversityColeraineUK
| | - Mary Slevin
- Nutrition Innovation Centre for Food & Health (NICHE), Biomedical Sciences Research InstituteUlster UniversityColeraineUK
| | - Roger Lawther
- Altnagelvin HospitalWestern Health and Social Care TrustLondonderryUK
| | - Gloria O'Connor
- Altnagelvin HospitalWestern Health and Social Care TrustLondonderryUK
| | | | | | - Chris Gill
- School of Biomedical SciencesUlster University Faculty of Life and Health SciencesColeraineUK
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Xu J, Zhang L, Sun H, Gao Z, Wang M, Hu M, Ji Q, Guo L. Psychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases: multiple mediating effects through sleep quality and depression. BMC Geriatr 2023; 23:752. [PMID: 37978451 PMCID: PMC10655408 DOI: 10.1186/s12877-023-04473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The present study is intended to examine the multiple mediating roles of sleep quality and depression in the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases. METHODS From October 2, 2021, to February 27, 2022, a questionnaire survey was conducted using a multistage stratified sampling method among 339 middle-aged and older adults (45 years and over) hospitalized with chronic diseases. These participants were recruited from a hospital in Zhejiang Province, China. The questionnaire included the Aged Cumulative Disease Rating Scale, the Psychological Resilience Scale, the Pittsburgh Sleep Quality Index Scale, the Depression Scale, and the Quality-of-Life Scale. A descriptive analysis was performed to characterize the sample. Linear regression was utilized to evaluate the relationship between psychological resilience and quality of life. Amos 24.0 was used to analyze the multiple mediated effects of sleep quality and depression. RESULTS Psychological resilience exerted a remarkable direct effect on the quality of life in middle-aged and older adults hospitalized with chronic diseases (β = 0.239, 95% CI = 0.125-0.354), which represented 52.98% of the total effect. Through three significantly mediated pathways indirectly affect the quality of life: (1) through the sleep quality pathway (β = 0.115, 95% CI = 0.056-0.201), which represented 25.39% of the total effect; (2) through the depression pathway (β = 0. 060, 95% CI = 0.023-0.114), which represented 13.24% of the total effect; and (3) through both the sleep quality and depression pathway (β = 0. 038, 95% CI = 0.019-0.074), which represented 8.39% of the total effect. The total mediating effect was 47.02%. CONCLUSIONS Sleep quality and depression mediate the relationship between psychological resilience and quality of life in middle-aged and older adults hospitalized with chronic diseases. Therefore, healthcare professionals and stakeholders should be concerned about the sleep status and mental health of middle-aged and older adults hospitalized with chronic diseases, strengthen their attention to psychological resilience, and provide interventions and treatment measures for hospitalized patients who have sleep problems and depressive tendencies.
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Affiliation(s)
- Jiashuang Xu
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Higher Education Park, 22 Wenchang West Road, Wuhu City, An Hui Province, People's Republic of China
| | - Hong Sun
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Ziyun Gao
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Meiding Wang
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Mengya Hu
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Qiqi Ji
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Leilei Guo
- School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China.
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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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9
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Gnat L, Mihajlovic V, Jones K, Tripp DA. Differentiating Childhood Traumas in Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2023; 6:172-178. [PMID: 37811528 PMCID: PMC10558189 DOI: 10.1093/jcag/gwad026] [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] [Indexed: 10/10/2023] Open
Abstract
Background Inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract. Research on inflammatory bowel disease has shown a connection to childhood traumatic events. However, few studies have focused on specific types of traumatic experiences and the impact of confiding in others on disease-related outcomes. This comparative, cross-sectional study expected that: (1) patients would report higher prevalence rates of childhood traumas than healthy controls; (2) healthy controls would report fewer and less severe traumatic experiences than patients and less confiding in others compared to patients; (3) childhood trauma severity would be indirectly related to depressive symptoms through resilience and confiding in others would moderate this relationship. Methods Participants completed an online survey; an inflammatory bowel disease patient group (N = 195, Mage = 40.48, 76.4% female) was compared to a similarly recruited sample of healthy controls (N = 190, Mage = 31.16, 59.5% female). Results Patients reported a higher prevalence of experiencing sexual traumas (P = .031), major upheavals (i.e., disruptions) (P = .048), and violence (P = .050) than controls. Patients had significantly higher total trauma severity odds ratios (OR 0.89, 95% CI[0.81,0.97]) and significantly lower total confiding in other odds ratios than controls (OR 1.09, 95% CI[1.02,1.16]). Childhood trauma severity was indirectly related to depressive symptoms through resilience, b = .05, SE = 0.09, 95% CI[0.01,0.09]; however, confiding did not moderate this relationship. Conclusions Patients reported more sexual, disruptive, and violent traumas. Although confiding did not act as a moderator, trauma was related to depressive symptoms through resilience.
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Affiliation(s)
- Lauren Gnat
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | | | - Krista Jones
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Dean A Tripp
- Departments of Psychology, Anesthesiology and Urology Queen’s University, Kingston, Ontario, Canada
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10
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Fuss A, Lease S. Moderating the Relationship Between Ulcerative Colitis and Crohn's Disease and Symptoms of PTSD: The Role of Remission. J Clin Gastroenterol 2023; 57:816-823. [PMID: 35997689 DOI: 10.1097/mcg.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/11/2022] [Indexed: 12/10/2022]
Abstract
GOALS This study examined whether inflammatory bowel disease (IBD) patients endorse clinically significant symptoms of post-traumatic stress disorder (PTSD), and tested whether remission status and remission expectations effectively moderate the relationship between endorsements of PTSD symptoms and aspects of IBD. BACKGROUND STUDY The enduring somatic threat model speaks to the presentation of symptoms of trauma that result from ongoing somatic concerns rather than discrete external events. Literature shows patients living with acute conditions experience symptoms of PTSD; however, few studies extend this to the IBD population. In addition, literature suggests remission may serve as a protective factor for the impact of IBD; as such, aspects of remission may serve as moderators in the relationship between aspects of IBD and PTSD symptoms. RESULTS Among a sample of adults with IBD, results showed that 32.8% of participants met the established cutoff for PTSD symptoms warranting further diagnostic evaluation. The findings further showed several aspects of remission moderated the relationship between multiple distinct IBD related concerns and PTSD symptoms. CONCLUSIONS Given the results of this study, it would be beneficial for providers to maintain awareness of the potential impact of PTSD symptoms, including the ways in which these symptoms may influence patient engagement/presentation. Ultimately, these results inform efforts to continue appropriate referral to mental health professionals for follow up.
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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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Krok D, Telka E, Szcześniak M, Falewicz A. Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3649. [PMID: 36834343 PMCID: PMC9963736 DOI: 10.3390/ijerph20043649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 06/17/2023]
Abstract
Research indicates that both cognitive appraisal and personal resources can noticeably influence health behaviors, as individuals modify their health convictions and practices on the basis of threat appraisal, personality, and meaning. The aim of the current study was to investigate whether coping strategies and meaning-making can serially mediate the relationship of threat appraisal and resilience with health behaviors in recovered COVID-19 patients. Self-report measures of threat appraisal, resilience, coping, meaning-making, and health behaviors were completed by 266 participants (aged 17 to 78, 51.5% female) who had recovered from COVID-19. The serial mediation analysis showed that the relationship of threat appraisal and resilience with health behaviors was mediated by problem-focused coping, meaning-focused coping, and meaning-making, but not by emotion-focused coping. These results suggest that associations among threat perception, resilience, and health behavior depend to some extent on the interplay of coping and meaning-making, which reveals their unique role in the process of recovery from COVID-19, with potential implications for health interventions.
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Affiliation(s)
- Dariusz Krok
- Institute of Psychology, University of Opole, 45-052 Opole, Poland
| | - Ewa Telka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | | | - Adam Falewicz
- Institute of Psychology, University of Szczecin, 71-017 Szczecin, Poland
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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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Philippou A, Birhanu B, Biello A, Keefer L, Gorbenko K. A Mixed-methods Assessment of the Impact of Insurance Issues on the Emotional and Physical Health of Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1851-1858. [PMID: 35191977 DOI: 10.1093/ibd/izac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND In patients with inflammatory bowel disease (IBD), failure to adhere to treatment regimens due to insurance issues can lead to disease complications. Our aim was to examine patients' perceptions of the impact of insurance issues on their health. METHODS Twenty-nine patients with IBD at a large US academic center and an insurance issue participated in a mixed-methods study. Retrospective chart review and an online questionnaire were completed to collect demographic information, IBD characteristics, and validated resilience scores. Semistructured interviews were completed for insurance experiences, which were coded independently by 2 coders for themes. RESULTS Twenty-nine patients completed the interview, and 24 completed the online survey. Sixteen had Crohn's disease, 13 had ulcerative colitis, and 66% were female. The most common insurance issue was lapsed insurance. Many experienced physical consequences, with 58% having flares, 14% undergoing surgery, and 14% developing antibodies. All emotional responses were negative, with the majority feeling stressed (38%). Providers were uninformed of insurance issues in 28% of cases. When asked about perceived resilience, 41% felt incapable of managing the situation, and 45% gave up trying to solve the problem. When asked how to improve going forward, 38% requested an easily accessible advocate to guide them. CONCLUSIONS A large proportion of our cohort chose not to inform their provider, felt incapable of managing on their own, and gave up on resolving their insurance issue. This highlights the need to consider restructuring the insurance system, to identify those at risk for insurance issues, and to make advocates available to avoid devastating consequences.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Beselot Birhanu
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony Biello
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ksenia Gorbenko
- Institute for Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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15
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Levy AN. Diagnosis and Classification of Inflammatory Bowel Disease Strictures. Gastrointest Endosc Clin N Am 2022; 32:615-629. [PMID: 36202506 DOI: 10.1016/j.giec.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intestinal strictures are a common complication in inflammatory bowel disease (IBD). Symptoms due to intestinal strictures range from mild bloating and/or abdominal discomfort to complete bowel obstruction. Careful selection of available medical, endoscopic, or surgical therapies is critical for optimizing patient outcomes and is dependent on the effective characterization of the stricture. This article will focus on the diagnosis and classification of IBD strictures.
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Affiliation(s)
- Alexander N Levy
- Division of Gastroenterology & Hepatology, Tufts Medical Center, 800 Washington Street, Box 233, Boston, MA 02111, USA.
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16
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Zhao YE, He XF, Zhu XQ. Progress in research of level of psychological resilience and its influencing factors in patients with inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2022; 30:823-828. [DOI: 10.11569/wcjd.v30.i18.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are often accompanied by varying degrees of anxiety or depression. These negative emotions may increase the frequency and severity of IBD attacks and form a vicious cycle. Psychological resilience is a kind of ability that reflects an individual's ability to maintain a good state in the face of suffering and crisis. A higher level of psychological resilience is helpful for IBD patients to improve their psychological state, and actively adapt to and treat the disease. This article reviews the level of psychological resilience and its influencing factors in IBD patients.
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Affiliation(s)
- Yu-E Zhao
- Nursing Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xi-Fei He
- Nursing Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiu-Qin Zhu
- Nursing Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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17
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Peerani F, Watt M, Ismond KP, Whitlock R, Ambrosio L, Hotte N, Mitchell N, Bailey RJ, Kroeker K, Dieleman LA, Siffledeen J, Lim A, Wong K, Halloran BP, Baumgart DC, Taylor L, Raman M, Madsen KL, Tandon P. A randomized controlled trial of a multicomponent online stress reduction intervention in inflammatory bowel disease. Therap Adv Gastroenterol 2022; 15:17562848221127238. [PMID: 36187365 PMCID: PMC9520184 DOI: 10.1177/17562848221127238] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Psychological stress negatively impacts inflammatory bowel disease (IBD) outcomes. Patients have prioritized access to online interventions; yet, the data on these have been limited by mixed in-person/online interventions, low adherence, and non-randomized controlled trial (RCT) design. OBJECTIVES We assessed the efficacy of and adherence to a 12-week online multicomponent stress reduction intervention in IBD. DESIGN This is a RCT. METHODS Adult participants on stable IBD medical therapy with elevated stress levels from four centers were randomized to intervention or control groups. Intervention participants received a 12-week online program including a weekly yoga, breathwork and meditation video (target 2-3 times/week), a weekly cognitive behavioral therapy/positive psychology informed video activity, and weekly 10-min check-ins by a study team member. Control participants received weekly motivational messages by email. All patients received standard of care IBD therapy. The primary outcome was Cohen's Perceived Stress Scale (PSS). Secondary outcomes evaluated mental health, resilience, health-related quality of life (HRQoL), symptom indices, acceptability, adherence, and inflammatory biomarkers. Analysis of covariance was used to determine between-group differences. RESULTS Of 150 screened patients, 101 were randomized to the intervention (n = 49) and control (n = 52) groups (mean age: 42.5 ± 14.1 years; M:F 1:3, 48% with ulcerative colitis and 52% with Crohn's disease). The between-group PSS improved by 22.4% (95% confidence interval, 10.5-34.3, p < 0.001). Significant improvements were seen in mental health, resilience, and HRQoL measures, with a median satisfaction score of 89/100 at the end of the 12 weeks. In the 44/49 patients who completed the intervention, 91% achieved program adherence targets. CONCLUSION This 12-week online intervention improved perceived stress, mental health, and HRQoL, but did not impact IBD symptom indices or inflammatory biomarkers. The program was readily adopted and adhered to by participants with high retention rates. After iterative refinement based on participant feedback, future studies will evaluate the impact of a longer/more intense intervention on disease course. REGISTRATION ClinicalTrials.gov Identifier NCT03831750. PLAIN LANGUAGE SUMMARY An online stress reduction intervention in inflammatory bowel disease patients improves stress, mental health, and quality of life People with inflammatory bowel disease (IBD) have high levels of stress, anxiety, and depression. Although IBD patients have expressed the need for online mental wellness interventions, the existing data to support these interventions in IBD are limited. In this trial, 101 IBD patients had the chance to participate in a 12-week online stress reduction intervention. In those patients randomly selected to participate in the online intervention, each week they received the following: a 20- to 30-min yoga, breathwork, and meditation video that they were asked to do 2-3 times a week, a 10- to 20-min mental wellness activity they were asked to do once during the week, and a 10-min telephone check-in with a study team member. Participants who were not selected to use the online intervention received a weekly motivational message by email. In all, 90 of the 101 participants (89%) completed the study with the mean age of participants being 43 years and the majority being females (75%). Ninety-one percent of participants who completed the intervention met the program target of doing the yoga, breathwork, and meditation video at least 2 times per week. Significant improvements were seen in perceived stress (by 22.4%), depression (by 29.5%), anxiety (by 23.7%), resilience (by 10.6%), and quality of life (by 8.9%). No changes were seen in IBD severity or in blood markers of inflammation. In conclusion, this study demonstrates evidence that a 12-week online stress reduction intervention had low dropout rates, high adherence and beneficial effects on stress, mental health, and quality of life measures. Continued feedback will be sought from study participants and our IBD patient partners to refine the intervention and assess the impact in future studies of patients with active IBD, as well as the impact of a longer/more intense intervention.
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Affiliation(s)
- Farhad Peerani
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Makayla Watt
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kathleen P Ismond
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Reid Whitlock
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Lindsy Ambrosio
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naomi Hotte
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nicholas Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Robert J Bailey
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Levinus A Dieleman
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jesse Siffledeen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Allen Lim
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Wong
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Brendan P Halloran
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lorian Taylor
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
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18
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Fairbrass KM, Lovatt J, Barberio B, Yuan Y, Gracie DJ, Ford AC. Bidirectional brain-gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis. Gut 2022; 71:1773-1780. [PMID: 34725197 DOI: 10.1136/gutjnl-2021-325985] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The role of the brain-gut axis is of increasing interest in IBD, as the link between common mental disorders and GI inflammation may be bidirectional. We performed a systematic review examining these issues. DESIGN We searched EMBASE Classic and EMBASE, Medline, and APA PsychInfo (to 11 July 2021) for longitudinal follow-up studies examining effect of symptoms of anxiety or depression on subsequent adverse outcomes in IBD, or effect of active IBD on subsequent development of symptoms of anxiety or depression. We pooled relative risks (RRs) and HRs with 95% CIs for adverse outcomes (flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) according to presence of symptoms of anxiety or depression at baseline, or RRs and HRs with 95% CIs for new onset of symptoms of anxiety or depression according to presence of active IBD at baseline. RESULTS We included 12 separate studies, recruiting 9192 patients. All 12 studies examined brain-to-gut effects. Anxiety at baseline was associated with significantly higher risks of escalation of therapy (RR=1.68; 95% CI 1.18 to 2.40), hospitalisation (RR=1.72; 95% CI 1.01 to 2.95), emergency department attendance (RR=1.30; 95% CI 1.21 to 1.39), or a composite of any adverse outcome. Depression at baseline was associated with higher risks of flare (RR=1.60; 95% CI 1.21 to 2.12), escalation of therapy (RR=1.41; 95% CI 1.08 to 1.84), hospitalisation (RR=1.35; 95% CI 1.17 to 1.57), emergency department attendance (RR=1.38; 95% CI 1.22 to 1.56), surgery (RR=1.63; 95% CI 1.19 to 2.22) or a composite of any of these. Three studies examined gut-to-brain effects. Active disease at baseline was associated with future development of anxiety or depression (RR=2.24; 95% CI 1.25 to 4.01 and RR=1.49; 95% CI 1.11 to 1.98, respectively). CONCLUSION Bidirectional effects of the brain-gut axis are present in IBD and may influence both the natural history of the disease and psychological health.
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Affiliation(s)
- Keeley M Fairbrass
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Jessica Lovatt
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
| | - Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David J Gracie
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK .,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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19
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Giannouli V. Patients with inflammatory bowel disease and positive–negative psychological attributes: What else should we include? Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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20
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Hayes B, Apputhurai P, Mikocka-Walus A, Barreiro-de Acosta M, Bernstein CN, Burgell R, Burisch J, Bennebroek Evertsz F, Ferreira N, Graff LA, Trindade IA, Gearry R, Lo B, Mokrowiecka A, Moser G, Petrik M, Stengel A, Knowles SR. Extending the Common Sense Model to Explore the Impact of the Fear of COVID-19 on Quality of Life in an International Inflammatory Bowel Disease Cohort. J Clin Psychol Med Settings 2022; 29:678-688. [PMID: 34559331 PMCID: PMC8461148 DOI: 10.1007/s10880-021-09823-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/17/2022]
Abstract
The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (χ2 (9) = 17.06, p = .05, χ2/N = 1.90, RMSEA = 0.05, SRMR = 0.04, CFI = .99, TLI = .97, GFI = 0.99), indicating the influence of gastrointestinal symptoms on QoL was mediated by illness perceptions, fear of COVID-19, adaptive and maladaptive coping, and psychological distress. Interventions targeting the fear of COVID-19 in the context of an individual's perceptions will likely enhance QoL during the pandemic.
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Affiliation(s)
- Bree Hayes
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, Hawthorn, VIC, 3122, Australia
| | - Pragalathan Apputhurai
- Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | | | - Charles N Bernstein
- University of Manitoba and IBD Clinical and Research Centre, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Rebecca Burgell
- Department of Gastroenterology, Alfred Health and Monash University, Prahran, VIC, Australia
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Nuno Ferreira
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Lesley A Graff
- University of Manitoba and IBD Clinical and Research Centre, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Inês A Trindade
- University of Coimbra, Coimbra, Portugal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Bobby Lo
- Gastrounit, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark
| | - Anna Mokrowiecka
- Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | | | - Megan Petrik
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon R Knowles
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, Hawthorn, VIC, 3122, Australia.
- Department of Gastroenterology, Alfred Health and Monash University, Prahran, VIC, Australia.
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC, Australia.
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
- Department of Mental Health, St Vincent's Hospital, Fitzroy, VIC, Australia.
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
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21
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Fairbrass KM, Gracie DJ, Ford AC. Relative Contribution of Disease Activity and Psychological Health to Prognosis of Inflammatory Bowel Disease During 6.5 Years of Longitudinal Follow-Up. Gastroenterology 2022; 163:190-203.e5. [PMID: 35339461 DOI: 10.1053/j.gastro.2022.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Symptoms of common mental disorders, such as anxiety or depression, are common in inflammatory bowel disease (IBD) and may affect prognosis. However, unlike clinical or biochemical markers of disease activity, psychological health is not a recommended therapeutic target. We assessed relative contribution of poor psychological health and clinical or biochemical activity to prognosis. METHODS Demographic features, IBD subtype, treatments, and anxiety and depression scores were recorded at baseline for 760 adults, with clinical activity determined using validated scoring systems. Fecal calprotectin was analyzed in 379 (49.9%) patients (≥250 μg/g used to define biochemical activity). Glucocorticosteroid prescription or flare, escalation, hospitalization, intestinal resection, or death were assessed during 6.5 years of follow-up. Occurrence was compared using multivariate Cox regression across 4 patient groups according to presence of disease remission or activity, with or without symptoms of a common mental disorder, at baseline. RESULTS In total, 718 (94.5%) participants provided data. Compared with clinical remission without symptoms of a common mental disorder at baseline, need for glucocorticosteroid prescription or flare (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.58-3.54), escalation (HR, 1.65; 95% CI, 1.14--2.40), and death (HR, 4.99; 95% CI, 1.80-13.88) were significantly higher in those with clinical activity and symptoms of a common mental disorder. Rates in those with clinical remission and symptoms of a common mental disorder at baseline or those with clinical activity without symptoms of a common mental disorder were not significantly higher. Similarly, with biochemical activity and symptoms of a common mental disorder, rates of glucocorticosteroid prescription or flare (HR, 2.48; 95% CI, 1.38-4.46), escalation (HR, 2.97; 95% CI, 1.74-5.06), hospitalization (HR, 3.10; 95% CI, 1.43-6.68), and death (HR, 6.26; 95% CI, 2.23-17.56) were significantly higher. CONCLUSIONS Psychological factors are important determinants of poor prognostic outcomes in IBD and should be considered as a therapeutic target.
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Affiliation(s)
- Keeley M Fairbrass
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - David J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.
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22
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Lawton RC. "The Tough Get Going": Understanding the Role of Resilience and a Multidimensional Conceptualization of Mental Health Among Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:977-979. [PMID: 34534289 DOI: 10.1093/ibd/izab233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Rachel C Lawton
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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23
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Taft TH, Craven MR, Adler EP, Simons M, Nguyen L. Stigma experiences of patients living with gastroparesis. Neurogastroenterol Motil 2022; 34:e14223. [PMID: 34337831 DOI: 10.1111/nmo.14223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stigmatization toward chronic digestive diseases is well documented. Patients perceive others hold negative stereotypes toward their disease and may internalize these beliefs as true. Because of this, stigmatization is associated with poor outcomes across disease-related and psychosocial domains. No study to date evaluates stigmatization toward patients living with gastroparesis (GP), a poorly understood disease affecting gastric motility. We aimed to gain deep understanding of stigma in patients living with gastroparesis. METHODS Patients with GP were recruited from two university-based gastroenterology practices as well as patient advocacy support groups. Participants underwent a semi-structured qualitative interview about their experiences with stigma related to their GP diagnosis, which were audio-recorded and transcribed to text for analysis using a grounded theory approach. Major themes with representative quotations were documented. RESULTS Twenty-three patients participated. The majority were White, female, with idiopathic GP under the care of a gastroenterologist. All patients reported stigma related to GP. Seven major themes were found: stigma from healthcare providers, stigma within interpersonal relationships, GP as an invisible disease, blame, unsolicited suggestions on how to manage disease, disclosure, and stigma resistance. CONCLUSIONS This is the first study to describe stigma experiences in patients with GP. The results suggest patients experience considerable stigmatization toward their condition from multiple sources. Patients also demonstrated resistance to negative beliefs, which can serve as a protective factor for the negative effects of disease stigma. Clinicians should be aware of stigma in GP patients, including their own potential internal biases and behaviors.
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Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Meredith R Craven
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emerald P Adler
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Gastroenterology, Stanford University, Palo Alto, CA, USA
| | - Madison Simons
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Nguyen
- Division of Gastroenterology, Stanford University, Palo Alto, CA, USA
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24
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Plevris N, Lees CW. Disease Monitoring in Inflammatory Bowel Disease: Evolving Principles and Possibilities. Gastroenterology 2022; 162:1456-1475.e1. [PMID: 35101422 DOI: 10.1053/j.gastro.2022.01.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/07/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease is a progressive and debilitating condition. Early and effective treatment using a treat-to-target approach is key to improving patient outcomes. Therefore, proactive monitoring is essential to ensure that treatment strategies are working and targets are being met. In this review we discuss the current monitoring tools available to us and how they can be used. We also discuss the importance of monitoring during key phases of the disease and propose an optimum treat-to-target monitoring strategy for Crohn's disease and ulcerative colitis. Regarding the advent of new technology, we discuss how this may improve our monitoring capabilities and how we envisage future monitoring strategies of inflammatory bowel diseases.
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Affiliation(s)
- Nikolas Plevris
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, Scotland, United Kingdom; Centre for Genomics and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Edinburgh, Scotland, United Kingdom
| | - Charlie W Lees
- The Edinburgh IBD Unit, Western General Hospital, Edinburgh, Scotland, United Kingdom; Centre for Genomics and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital Campus, Edinburgh, Scotland, United Kingdom.
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25
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Cococcia S, Lenti MV, Mengoli C, Klersy C, Borrelli de Andreis F, Secco M, Ghorayeb J, Delliponti M, Corazza GR, Di Sabatino A. Validation of the Italian translation of the perceived stigma scale and resilience assessment in inflammatory bowel disease patients. World J Gastroenterol 2021; 27:6647-6658. [PMID: 34754158 PMCID: PMC8554395 DOI: 10.3748/wjg.v27.i39.6647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/21/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stigmatization is the separation of an individual from a group due to aspects that make them different. Resilience may in turn influence the perception of stigma. Patients with inflammatory bowel disease (IBD) are susceptible to stigma, although data are very limited.
AIM To validate an Italian translation of the IBD perceived stigma scale (PSS) in relation to patients’ resilience.
METHODS Consecutive IBD outpatients were prospectively enrolled (December 2018-September 2019) in an Italian, tertiary referral, IBD center. Clinical and demographic data were collected. Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale, respectively. The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality. Higher scores represent greater perceived stigma and resilience. Multivariable analysis for factors associated with greater stigma was computed.
RESULTS Overall, 126 IBD patients (mean age 46.1 ± 16.9) were enrolled. The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied, with optimal data completeness. There was no ceiling effect, whilst floor effect was present (7.1%). The discriminant validity and the internal consistency reliability were good (Cronbach alpha = 0.87). The overall internal consistency was 95%, and the test-retest reliability was excellent 0.996. The median PSS score was 0.45 (0.20-0.85). Resilience negatively correlated with perceived stigma (Spearman’s correlation = -0.18, 95% confidence intervals: -0.42-0.08, P = 0.03).
CONCLUSION We herein validated the Italian translation of the PSS scale, also demonstrating that resilience negatively impacts perceived stigma.
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Affiliation(s)
- Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Caterina Mengoli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Catherine Klersy
- Service of Biometry & Statistics, Foundation IRCCS Policlinico San Matteo, Pavia 27100, Lombardia, Italy
| | - Federica Borrelli de Andreis
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Matteo Secco
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Jihane Ghorayeb
- Psychology, Zayed University, Dubai 00000, United Arab Emirates
| | - Mariangela Delliponti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
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26
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Philippou A, Sehgal P, Ungaro RC, Wang K, Bagiella E, Dubinsky MC, Keefer L. High Levels of Psychological Resilience Are Associated With Decreased Anxiety in Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 28:888-894. [PMID: 34448855 PMCID: PMC9165553 DOI: 10.1093/ibd/izab200] [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: 04/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety and depression are comorbid disorders with IBD and are associated with poor outcomes. Resilience is an innate but modifiable trait that may improve the symptoms of psychological disorders. Increasing resilience may decrease the severity of these comorbid disorders, which may improve IBD outcomes. The aim of this study was to describe the association between resilience, anxiety, and depression in IBD patients. METHODS We performed a cross-sectional study of IBD patients. Patients completed a questionnaire consisting of the Connor-Davidson Resilience Scale (CD-RISC), a measure of resilience, the Generalized Anxiety Disorder 7 (GAD-7), and the Patient Health Questionnaire-9. Primary outcome was severity of anxiety and depression in patients with high resilience. Multivariable linear regression analysis evaluated the association between severity of anxiety and depression and level of resilience. RESULTS A sample of 288 patients was analyzed. Bivariable linear regression analysis showed a negative association between resilience and anxiety (Pearson rho = -0.47; P < .0001) and between resilience and depression (Pearson rho = -0.53; P < .0001). Multivariable linear regression indicated that high resilience is independently associated with lower anxiety and that for every 1-unit increase in CD-RISC, the GAD-7 score decreased by 0.04 units (P = .0003). Unlike anxiety, the association between resilience and depression did not remain statistically significant on multivariable analysis. CONCLUSIONS High resilience is independently associated with lower anxiety in IBD patients, and we report a quantifiable decrease in anxiety score severity for every point of increase in resilience score. These findings suggest that IBD patients with higher resilience may have better coping mechanisms that buffer against the development of anxiety.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Priya Sehgal
- Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York, New York, USA
| | - Ryan C Ungaro
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kelly Wang
- The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emilia Bagiella
- The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marla C Dubinsky
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA,Address correspondence to: Laurie Keefer, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, 17 E. 102nd Street, Box 1134, New York, NY, USA. ()
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27
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Agrawal M, Spencer EA, Colombel JF, Ungaro RC. Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User's Guide for Adult and Pediatric Gastroenterologists. Gastroenterology 2021; 161:47-65. [PMID: 33940007 PMCID: PMC8640961 DOI: 10.1053/j.gastro.2021.04.063] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, are chronic, progressive, immune-mediated diseases of adults and children that have no cure. IBD can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. In children, IBD can also result in growth impairment and pubertal delays. IBD is highly heterogenous, with severity ranging from mild to severe and symptoms ranging from mild to debilitating. Delay in IBD diagnosis, especially in Crohn's disease, is common and associated with adverse outcomes. Early diagnosis and prompt institution of treatment are the cornerstones for improving outcomes and maximizing health. Early diagnosis requires a low threshold of suspicion and red flags to guide early specialist referral at the primary provider level. Although the armamentarium of IBD medications is growing, many patients will not respond to treatment, and the selection of first-line therapy is critical. Risk stratification of disease severity, based on clinical, demographic, and serologic markers, can help guide selection of first-line therapy. Clinical decision support tools, genomics, and other biomarkers of response to therapy and risk of adverse events are the future of personalized medicine. After starting appropriate therapy, it is important to confirm remission using objective end points (treat to target) with continued control of inflammation with adjustment of therapy using surrogate biomarkers (tight control). Lastly, IBD therapy extends far beyond medications, and other aspects of the overall health and wellbeing of the patient are critical. These include preventive health, nutrition, and psychobehavioral support addressing patients' concerns around complementary therapy and medication adherence, prevention of disability, and ensuring open communication.
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Affiliation(s)
- Manasi Agrawal
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Elizabeth A. Spencer
- The Division of Pediatric Gastroenterology and Nutrition, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan C. Ungaro
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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28
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Keefer L. What can we do to tackle anxiety and depression in patients with inflammatory bowel disease? Lancet Gastroenterol Hepatol 2021; 6:337-338. [PMID: 33721556 DOI: 10.1016/s2468-1253(21)00066-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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29
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Luo D, Zhou M, Sun L, Lin Z, Bian Q, Liu M, Ren S. Resilience as a Mediator of the Association Between Perceived Stigma and Quality of Life Among People With Inflammatory Bowel Disease. Front Psychiatry 2021; 12:709295. [PMID: 34421685 PMCID: PMC8377363 DOI: 10.3389/fpsyt.2021.709295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Improving Quality of Life (QOL) is an essential objective in the management of inflammatory bowel disease. An accumulating body of research has been conducted to explore the association between perceived stigma and QOL among patients with chronic illness. Still, underlying mechanisms behind this pathway have not been thoroughly examined. Objective: To investigate (a) the effect of perceived stigma on QOL among patients with inflammatory bowel disease; and (b) the mediating role of resilience in the association between perceived stigma and QOL. Methods: This cross-sectional study included a convenient sample of patients diagnosed with inflammatory bowel disease from four tertiary hospitals in Jiangsu Province, China. Patients completed the Perceived Stigma Scale in Inflammatory Bowel Disease (PSS-IBD), the Resilience Scale for Patients with Inflammatory Bowel Disease (RS-IBD), and the Inflammatory Bowel Disease Questionnaire (IBDQ). A bootstrapping analysis was implemented using the SPSS macro PROCESS. Results: A total of 311 patients with Cohn's disease and ulcerative colitis participated in this study, and 57.6% were men. The mean disease duration was 3.51 ± 1.04 years. Approximately 40% of the sample exceeded the criterion score for moderate stigma. Patients who perceived moderate or severe stigma reported lower QOL compared with those with mild stigma. After controlling for sociodemographic and clinical variables, we observed that perceived stigma was negatively associated with resilience. Moreover, resilience was found to mediate the relationship between perceived stigma and all aspects of QOL. Conclusions: These findings suggested that QOL of patients with inflammatory bowel disease was associated with perceived stigma and resilience and identified the mediating effects of resilience in the relationship between perceived stigma and QOL. Furthermore, this suggests that integrating intervention techniques to target resilience into the QOL improvement program of individuals with perceived stigma is possible.
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Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Meijing Zhou
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lifu Sun
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Zheng Lin
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,School of Nursing, Nanjing Medical University, Nanjing, China
| | - Qiugui Bian
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meihong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shurong Ren
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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30
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Expressive writing to combat distress associated with the COVID-19 pandemic in people with inflammatory bowel disease (WriteForIBD): A trial protocol. J Psychosom Res 2020; 139:110286. [PMID: 33171431 PMCID: PMC7609228 DOI: 10.1016/j.jpsychores.2020.110286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A large proportion of patients with inflammatory bowel disease (IBD) receive immunosuppressive medication, may be at higher risk of complications if they contract SARS-CoV-2 virus, and therefore report high levels of COVID-19-related distress. This trial will evaluate a brief, evidence-based, online, group-based expressive writing intervention to reduce COVID-19-related distress in people living with IBD at the time of pandemic. METHODS A parallel double-blind randomised controlled trial will be conducted. Overall, up to 154 adult participants with IBD and mild-moderate distress will be recruited via patient organisations. Participants will be allocated to the expressive writing intervention or an active control group. All participants will complete questionnaires including measures of distress, quality of life, resilience, self-efficacy, social support and disease activity before and after the intervention (1 week) and at 3 months post-intervention. The expressive writing group will participate in the evidenced-based 4-day writing program adapted from Pennebaker and Beall, 1986. The active control group will write about untherapeutic topics provided by researchers. Statistical analysis will be carried out on an intention-to-treat basis and will involve linear mixed effects models. CONCLUSIONS If successful, this simple intervention may bring personal and societal benefits, particularly because it is low cost, can be easily implemented online, ensuring social distancing, and be made widely available, during future disasters and to help with trauma-related distress in IBD. TRIAL REGISTRATION The trial has been prospectively registered in the Australian New Zealand Trial Registry - ACTRN12620000448943p.
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