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McBain S, Cordova MJ. Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology. J Trauma Stress 2024. [PMID: 38970812 DOI: 10.1002/jts.23075] [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: 04/01/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 07/08/2024]
Abstract
Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.
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Affiliation(s)
- Sacha McBain
- Departments of Psychiatry and Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Matthew J Cordova
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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2
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Jagielski CH, Fuss A, Taft TH. Providing trauma-informed care for all in gastroenterology. Lancet Gastroenterol Hepatol 2024; 9:587-588. [PMID: 38870960 DOI: 10.1016/s2468-1253(24)00154-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Christina H Jagielski
- Department of Internal Medicine, Division of Gastroenterology/Hepatology, Michigan Medicine, Ann Arbor, MI 48109-5362, USA.
| | - Alexandra Fuss
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Crohn's and Colitis Center, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany H Taft
- The Rome Foundation Research Institute, Chapel Hill, NC, USA
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Kent KG. The relationship between post-traumatic stress disorder and gastrointestinal disease in United States Military Veterans. SAGE Open Med 2024; 12:20503121241260000. [PMID: 38911441 PMCID: PMC11193927 DOI: 10.1177/20503121241260000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Background This study examined the relationship between gastrointestinal disease and post-traumatic stress disorder in U.S. military Veterans. Based on literature and clinical practice data sources from the U.S. Veterans Administration, gastrointestinal disease and post-traumatic stress disorder were hypothesized to be positively correlated in Veterans. Objectives This study aimed to determine the frequency with which gastrointestinal disease and post-traumatic stress disorder are diagnosed comorbidities, a diagnosis of gastrointestinal disease accompanies a diagnosis of post-traumatic stress disorder, and a diagnosis of post-traumatic stress disorder accompanies a diagnosis of a gastrointestinal disease. Methods The methodology was a retrospective, correlational design using data collected from the U.S. Department of Veterans Affairs patient database. Results The results were that post-traumatic stress disorder is bi-directionally correlated with the gastrointestinal diseases of gastroesophageal reflux disease, peptic ulcer disease, functional dyspepsia, Crohn's disease, diverticular disease, irritable bowel syndrome, and the symptoms of constipation and nausea/vomiting within Veterans who served during wartime periods. The study also found that post-traumatic stress disorder is not correlated with ulcerative colitis in Veterans. Conclusions The conclusions are that clinicians who see a presentation of post-traumatic stress disorder should be screening for gastrointestinal disease, while primary care and gastroenterology providers treating gastrointestinal disease should be screening for a history of trauma, as improved diagnosis rates may lead to improved treatment.
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Aliu A, Bosch DHCA, Keszthelyi D, Rezazadeh Ardabili A, Colombel JF, Sawyer R, Törnblom H, Hart A, Jonkers DMAE, Pierik MJ, Mujagic Z. Review article: A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission. Aliment Pharmacol Ther 2024; 59:1470-1488. [PMID: 38590140 DOI: 10.1111/apt.17988] [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: 10/16/2023] [Revised: 11/29/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Persistent gastrointestinal symptoms are prevalent in adult patients with inflammatory bowel disease (IBD), even when endoscopic remission is reached. These symptoms can have profound negative effects on the quality of life of affected patients and can be difficult to treat. They may be caused by IBD-related complications or comorbid disorders, but they can also be explained by irritable bowel syndrome (IBS)-like symptoms. AIMS To provide a practical step-by-step guide to diagnose and treat persistent gastrointestinal symptoms in patients with IBD in remission via a personalised approach. METHODS We scrutinised relevant literature on causes, diagnostics and treatment of persistent gastrointestinal symptoms (abdominal pain or discomfort, bloating, abdominal distension, diarrhoea, constipation and faecal incontinence) in patients with IBD in remission. RESULTS A graphical practical guide for several steps in diagnosing, identifying potential triggers and adequate treatment of persistent gastrointestinal symptoms in IBD in remission is provided based on supporting literature. The first part of this review focuses on the diagnostic and treatment approaches for potential IBD-related complications and comorbidities. The second part describes the approach to IBS-like symptoms in IBD in remission. CONCLUSIONS Persistent gastrointestinal symptoms in IBD in remission can be traced back to potential pathophysiological mechanisms in individual patients and can be treated adequately. For both IBD-related complications and comorbidities and IBS-like symptoms in IBD in remission, pharmacological, dietary, lifestyle or psychological treatments can be effective. A systematic and personalised approach is required to reduce the burden for patients, healthcare systems, and society.
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Affiliation(s)
- Arta Aliu
- Department Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Daan H C A Bosch
- Department Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Daniel Keszthelyi
- Department Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ashkan Rezazadeh Ardabili
- Department Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jean-Frederic Colombel
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Sawyer
- IBD Patient Advocacy, Founder of the Bottom Line IBD and IBD Women, UK
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital & Imperial College, London, UK
| | - Daisy M A E Jonkers
- Department Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Marieke J Pierik
- Department Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Zlatan Mujagic
- Department Gastroenterology and Hepatology, Maastricht University Medical Center+, Maastricht, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Petrik M, Kuhn T, Kinsinger S. Clinical Education: Psychosocial Assessment and Treatment Planning for Patients with Inflammatory Bowel Disease. J Clin Psychol Med Settings 2024; 31:237-244. [PMID: 38734760 DOI: 10.1007/s10880-024-10006-8] [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] [Accepted: 01/22/2024] [Indexed: 05/13/2024]
Abstract
Psychosocial factors play an important role in the disease course and illness experience of patients with inflammatory bowel disease (IBD). Consultation with a health psychologist is an important component of care for many IBD patients and provides an opportunity to identify areas of psychosocial concern, recognize coping deficits and strengths, and facilitate treatment recommendations. Psychosocial assessment in IBD requires a nuanced approach that goes beyond general mental health screening and considers the disease-specific concerns that impact patients. In this paper, we outline strategies for an IBD-focused psychological evaluation, including specific guidance for assessing disease-specific concerns of anxiety, depression, post-traumatic stress, sleep, pain, body image disturbance, food-related quality of life, and psychological resilience.
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Affiliation(s)
- Megan Petrik
- Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Tyler Kuhn
- Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Sarah Kinsinger
- Department of Medicine, Division of Gastroenterology, Loyola University Medical Center, Maywood, IL, USA
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Xu C, Shao J. High-throughput omics technologies in inflammatory bowel disease. Clin Chim Acta 2024; 555:117828. [PMID: 38355001 DOI: 10.1016/j.cca.2024.117828] [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: 07/23/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/16/2024]
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing intestinal disease. Elucidation of the pathogenic mechanisms of IBD requires high-throughput technologies (HTTs) to effectively obtain and analyze large amounts of data. Recently, HTTs have been widely used in IBD, including genomics, transcriptomics, proteomics, microbiomics, metabolomics and single-cell sequencing. When combined with endoscopy, the application of these technologies can provide an in-depth understanding on the alterations of intestinal microbe diversity and abundance, the abnormalities of signaling pathway-mediated immune responses and functionality, and the evaluation of therapeutic effects, improving the accuracy of early diagnosis and treatment of IBD. This review comprehensively summarizes the development and advancement of HTTs, and also highlights the challenges and future directions of these technologies in IBD research. Although HTTs have made striking breakthrough in IBD, more standardized methods and large-scale dataset processing are still needed to achieve the goal of personalized medicine.
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Affiliation(s)
- Chen Xu
- Laboratory of Anti-infection and Immunity, College of Integrated Chinese and Western Medicine (College of Life Science), Anhui University of Chinese Medicine, Zhijing Building, 350 Longzihu Road, Xinzhan District, Hefei 230012, Anhui, PR China
| | - Jing Shao
- Laboratory of Anti-infection and Immunity, College of Integrated Chinese and Western Medicine (College of Life Science), Anhui University of Chinese Medicine, Zhijing Building, 350 Longzihu Road, Xinzhan District, Hefei 230012, Anhui, PR China; Institute of Integrated Traditional Chinese and Western Medicine, Anhui Academy of Chinese Medicine, Zhijing Building, 350 Longzihu Road, Xinzhan District, Hefei 230012, Anhui, PR China.
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Fourie S, Norton C, Jackson D, Czuber-Dochan W. Grieving multiple losses: Experiences of intimacy and sexuality of people living with inflammatory bowel disease. A phenomenological study. J Adv Nurs 2024; 80:1030-1042. [PMID: 37788088 DOI: 10.1111/jan.15879] [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: 10/09/2022] [Revised: 07/20/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023]
Abstract
AIM To explore patient experiences of intimacy and sexuality in those living with inflammatory bowel disease. DESIGN An interpretative phenomenological study guided by van Manen's framework. Thematic analysis was conducted through interpretation and reflection on four existential domains: body, relationships, time and space. METHODS Data were collected during 2019-2021 from 43 participants via face-to-face or telephone interviews, as well as anonymous collection of narratives submitted via Google Forms. RESULTS Four themes were identified: Sexuality as lived incompleteness was the overarching theme representing the essence of the experiences of intimacy and sexuality. This theme covered the four main themes: Otherness of the body, Interrupted connectedness, Missing out on life fullness and Fragmented openness and each corresponded to an existential domain. Intimacy and sexuality are negatively affected by inflammatory bowel disease, with impact on quality of life. Patients experienced grieving multiple losses, from body image and control, to choice of partners and future opportunities. The four domains were difficult to separate and a close inter-relationship between each domain was acknowledged. CONCLUSIONS A model was developed to draw new theoretical insights to understanding the relationship between sexual well-being and psycho-emotional distress similar to grief. IMPACT First qualitative study to explore intimacy and sexuality experiences of those living with inflammatory bowel disease. Illness impact on sexuality has negative psycho-emotional implications as a result of losing the old self and capacity to have the desired relationships/sex life. A theoretical model was developed in an attempt to illustrate the close relationship of intimacy, sexuality and psycho-emotional well-being. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study design.
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Affiliation(s)
- Simona Fourie
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Debra Jackson
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Aswani-Omprakash T, Balasubramaniam M, McGarva J, Pandit A, Mutlu EA, Hanauer SB, Taft TH. Post-traumatic stress disorder symptoms are frequent among inflammatory bowel disease patients of South Asian descent-A case-control study. Indian J Gastroenterol 2024; 43:244-253. [PMID: 37823984 DOI: 10.1007/s12664-023-01424-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/27/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Post-traumatic stress (PTS) is the psycho-physiological response to a traumatic or life-threatening event and is implicated in inflammatory bowel disease (IBD). IBD-PTS is present in up to 30% of white, non-Hispanic patients. The rates of IBD in Asian populations are expanding, making the exploration of IBD-PTS in this population imperative. METHODS Adult patients of South/Southeast (S/SE) Asian decent with IBD for more than 6 months were recruited online via social media and patient-support groups. Participants completed the post-traumatic stress disorder (PTSD) Checklist-5 (PCL-5), the United States National Institutes of Health's Patient-Reported Outcomes Measurement Information System (NIH-PROMIS) -43 profile and demographics. S/SE Asian participants were age and sex matched (1:2) with randomly selected white, non-Hispanic controls. Statistical analyses evaluated differences in IBD-PTS symptoms between groups, the relationship between disease severity and health-related quality of life (HRQoL) and predictors of IBD-PTS severity. RESULTS Forty-seven per cent of the 51 S/SE Asian participants met the diagnostic cut-off for PTSD on the PCL-5 compared to 13.6% of 110 IBD controls. The mean global score on the PCL-5 was three times higher in S/SE Asians. Patients of S/SE Asian decent were over five times more likely to have PTSD due to their IBD experiences than controls, nearly doubling when controlling for disease activity. More severe IBD-PTS was present in S/SE Asian patients with active disease and those with extraintestinal manifestations. Higher global levels of IBD-PTS were associated with poorer HRQoL in S/SE Asians where increased hyperarousal from IBD-PTS predicted more sleep disturbance. CONCLUSIONS S/SE Asian patients are five times more likely to experience IBD-PTS than their white, non-Hispanic counterparts. Several cultural factors lead to IBD-PTS in S/SE Asian patients that must be considered by IBD providers. Preventing, screening for and treating IBD-PTS in this population appears warranted.
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Affiliation(s)
- Tina Aswani-Omprakash
- Mount Sinai Icahn School of Medicine, School of Public Health, New York, NY, USA
- South Asian IBD Alliance, New York, NY, USA
| | - Madhura Balasubramaniam
- South Asian IBD Alliance, New York, NY, USA
- Department of Humanities and Social Sciences, Indian Institute of Technology, Madras, Chennai, 600 036, India
| | - Josie McGarva
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Anjali Pandit
- South Asian IBD Alliance, New York, NY, USA
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Ece A Mutlu
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Illinois College of Medicine, Chicago, IL, USA
- Rush University, The Graduate College, Chicago, IL, USA
| | - Stephen B Hanauer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA
| | - Tiffany H Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair Street, Suite 1400, Chicago, IL, 60611, USA.
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Straume Z, Krūmiņa N, Elbere I, Rozenberga M, Rudzīte D, Proskurina A, Ozoliņa J, Kloviņš J, Skuja V, Krūmiņa A. Exploring the Impact of COVID-19 on Ulcerative Colitis Patients: A Lifestyle Perspective. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:182. [PMID: 38276061 PMCID: PMC10819492 DOI: 10.3390/medicina60010182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 is the new coronavirus that caused the coronavirus disease 2019 (COVID-19) outbreak. Studies have increasingly reported the involvement of organs outside the respiratory system, including the gastrointestinal tract. Data on the association between COVID-19 and ulcerative colitis (UC) are lacking. Materials and Methods: In this one-centre cross-sectional study, 49 patients with UC from the Riga East Clinical University Hospital outpatient clinic were included from June 2021 to December 2021. The patients were divided into two groups according to their history of a confirmed positive or negative COVID-19 status. Data on their lifestyle, diet, and medications and the food supplements used by the patients were collected during interviews and analysed using the R 4.2.1 software. Results: Out of 49 patients, 33 (63.3%) were male and 13 (36.7%) were female, with a mean age of 32.33 ± 8.6 years. Fourteen patients (28.6%) had a confirmed COVID-19 infection in the last year. The most common COVID-19-related symptoms were a fever and rhinorrhoea. A third of patients followed the inflammatory bowel disease diet (16; 32.7%); out of these patients, 12 (34.3%) did not contract COVID-19 (OR: 0.78 (0.18; 2.98), p > 0.05). In the COVID-19-positive group, the majority of patients did not use vitamin D (11; 79% vs. 3; 21%, (OR: 0.38 (0.07; 1.51), p = 0.28) or probiotics (11; 78.6% vs. 3; 21.4%, OR: 1.33 (0.23; 6.28), p = 0.7). In the COVID-19-positive group, most patients did not smoke (12; 85.7% vs. 2; 14.3%, p = 0.475) and did not use alcohol (9; 64.3% vs. 5; 35.7%, OR: 0.63 (0.16; 2.57), p = 0.5). Most of the patients who participated in sports activities were COVID-negative (18; 51.4% vs. 6; 42.9%, p = 0.82). Conclusions: There were no statistically significant differences in the use of food supplements, probiotics, or vitamins; the lifestyle habits; or the COVID-19 status in patients with UC.
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Affiliation(s)
- Zane Straume
- Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition Clinic, Hipokrata Street 2, LV-1038 Riga, Latvia; (J.O.); (V.S.)
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Nikola Krūmiņa
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Ilze Elbere
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, LV-1067 Riga, Latvia; (I.E.); (J.K.)
| | - Maija Rozenberga
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, LV-1067 Riga, Latvia; (I.E.); (J.K.)
| | - Dace Rudzīte
- Laboratory “Gailezers”Riga East Clinical University Hospital, Hipokrata Street 2, LV-1038 Riga, Latvia;
| | - Anna Proskurina
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
- Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Juliana Ozoliņa
- Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition Clinic, Hipokrata Street 2, LV-1038 Riga, Latvia; (J.O.); (V.S.)
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Jānis Kloviņš
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, LV-1067 Riga, Latvia; (I.E.); (J.K.)
| | - Vita Skuja
- Riga East Clinical University Hospital, Gastroenterology, Hepatology and Nutrition Clinic, Hipokrata Street 2, LV-1038 Riga, Latvia; (J.O.); (V.S.)
- Department of Internal Diseases, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia; (N.K.); (A.P.)
| | - Angelika Krūmiņa
- Department of Infectology, Riga Stradins University, Dzirciema Street 16, LV-1007 Riga, Latvia;
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Kobrosli J, Tapp K, Soucie K. Construction of identity in individuals with inflammatory bowel disease across the lifespan. Psychol Health 2024:1-21. [PMID: 38173135 DOI: 10.1080/08870446.2023.2299243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
Inflammatory bowel disease (IBD) is a chronic illness that affects 10 million individuals worldwide; however, Canada has the highest rates of IBD per capita in the world. Presently, 0.7% of Canadians are diagnosed with IBD, which is expected to rise to 1% by 2030. Disease onset is typically between the ages of 15-45 years old. This is a crucial period for identity development and growth; however, IBD symptoms often disrupt these processes and cause individuals to abandon or reconstruct parts of their identity. As a result, changes in individuals' life plans and health status may cause them to grieve their former pre-IBD identities. In this qualitative narrative study, we captured the lived experiences of IBD, with a focus on what individuals have lost, gained, or accomplished across various avenues (e.g. relationships, education, and future scripts). Thirteen participants constructed IBD narratives using a holistic-form narrative approach, a method that captures various plot formulations and discourses that emerge through storytelling. We found three main plotlines: The 'journey to acceptance', which detailed a route to acceptance wherein individuals integrated IBD into their identity, 'the ambivalent story', which exemplified individuals who were unsure of IBD and the resulting impacts of the diagnosis on their identity, and 'the grief story', which outlined grief and loss surrounding one's pre-IBD self. These results illuminate the role of narrative in shaping meaning-making and identity processes over the life course. We urge future researchers to explore narrative inquiry as a route to further understand the integration of IBD into one's life story/identity.
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Affiliation(s)
- Jasmine Kobrosli
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Kenzie Tapp
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Kendall Soucie
- Department of Psychology, University of Windsor, Windsor, ON, Canada
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Ke S, Hartmann J, Ressler KJ, Liu YY, Koenen KC. The emerging role of the gut microbiome in posttraumatic stress disorder. Brain Behav Immun 2023; 114:360-370. [PMID: 37689277 PMCID: PMC10591863 DOI: 10.1016/j.bbi.2023.09.005] [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: 04/15/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) occurs in some people following exposure to a terrifying or catastrophic event involving actual/threatened death, serious injury, or sexual violence. PTSD is a common and debilitating mental disorder that imposes a significant burden on individuals, their families, health services, and society. Moreover, PTSD is a risk factor for chronic diseases such as coronary heart disease, stroke, diabetes, as well as premature mortality. Furthermore, PTSD is associated with dysregulated immune function. Despite the high prevalence of PTSD, the mechanisms underlying its etiology and manifestations remain poorly understood. Compelling evidence indicates that the human gut microbiome, a complex community of microorganisms living in the gastrointestinal tract, plays a crucial role in the development and function of the host nervous system, complex behaviors, and brain circuits. The gut microbiome may contribute to PTSD by influencing inflammation, stress responses, and neurotransmitter signaling, while bidirectional communication between the gut and brain involves mechanisms such as microbial metabolites, immune system activation, and the vagus nerve. In this literature review, we summarize recent findings on the role of the gut microbiome in PTSD in both human and animal studies. We discuss the methodological limitations of existing studies and suggest future research directions to further understand the role of the gut microbiome in PTSD.
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Affiliation(s)
- Shanlin Ke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Jakob Hartmann
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
| | - Yang-Yu Liu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Center for Artificial Intelligence and Modeling, The Carl R. WoeseInstitute for Genomic Biology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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Yoo JY, McSkimming D, Rajan K, Sarkar A, Labbé N, Groer M, Menon U. A Preliminary Study Exploring the Relationship between Occupational Health Hazards and Gut Microbiota among Firefighters. Life (Basel) 2023; 13:1928. [PMID: 37763331 PMCID: PMC10533145 DOI: 10.3390/life13091928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Firefighters are exposed to occupational hazards and have a higher prevalence of health issues. The gut microbiota plays a crucial role in the immune, endocrine, and neural systems, and disruptions in its composition can impact health outcomes. This pilot study aimed to investigate the potential association between occupational factors, changes in gut microbiota, and the development of adverse health outcomes in firefighters. To test this hypothesis, we recruited 15 firefighters and age/sex-matched controls to investigate the relationship between occupational environment and gut microbiota. Firefighters exhibit lower intestinal bacterial alpha diversity and a higher presence of pathogenic bacteria than the control. Moreover, unique gut bacterial taxa were observed in firefighters with high post-traumatic stress disorder (PTSD) scores, which could contribute to immune dysregulation and higher susceptibility to pathogen colonization. These preliminary findings suggest that occupational factors, including exposure to traumatic stressors and chemicals, may influence firefighters' health by modulating their gut microbiota. The observed changes in gut microbiota composition and the potential link to occupational hazards highlight the need for further research in larger sample-size studies. Understanding the role of gut microbiota in firefighter health may have implications for preventive measures and interventions to mitigate occupational health risks and improve overall well-being.
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Affiliation(s)
- Ji Youn Yoo
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN 37996, USA; (A.S.); (M.G.)
| | - Daniel McSkimming
- Interdisciplinary Unit in Data Science & Analytics, Buffalo State University, Buffalo, NY 14222, USA;
| | - Kalavathy Rajan
- Department of Plant and Soil Science, Fiber and Biopolymer Research Institute, Texas Tech University, Lubbock, TX 79403, USA;
| | - Anujit Sarkar
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN 37996, USA; (A.S.); (M.G.)
| | - Nicole Labbé
- Center for Renewable Carbon, The University of Tennessee Institute of Agriculture, Knoxville, TN 37996, USA;
| | - Maureen Groer
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN 37996, USA; (A.S.); (M.G.)
| | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL 33612, USA;
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Jagielski CH, Naftaly JP, Riehl ME. Providing Trauma Informed Care During Anorectal Evaluation. Curr Gastroenterol Rep 2023; 25:204-211. [PMID: 37470940 DOI: 10.1007/s11894-023-00879-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW Patients with a history of gastrointestinal (GI) conditions report high rates of psychological trauma. This review discusses the impact of previous trauma, as well as interactions with the medical system, on a patient's physical and mental health. Trauma-informed strategies for improving patient care during gastroenterology procedures are provided. RECENT FINDINGS History of trauma increases risk of developing GI conditions and re-traumatization during sensitive anorectal procedures (i.e., anorectal manometry, balloon expulsion testing). Trauma-informed strategies include consistent trauma screening for all patients, obtaining consent before and during procedures, creating a safe environment, allowing for privacy, and post-procedure debriefing. Due to high rates of psychological trauma in the gastroenterology setting and the risk of medical trauma from the GI procedures themselves, having an established trauma-informed plan of care for all patients can reduce risk of iatrogenic harm and improve quality of care for patients with GI conditions.
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Affiliation(s)
- Christina H Jagielski
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 E. Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109-5362, USA.
| | - Jessica P Naftaly
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 E. Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109-5362, USA
| | - Megan E Riehl
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 E. Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI, 48109-5362, USA
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14
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Gomez DA, Ahmad-Waqar M, Brookes MJ, Kumar A. IBD-related mental health disorders: where do we go from here? Frontline Gastroenterol 2023; 14:512-520. [PMID: 37854787 PMCID: PMC10579553 DOI: 10.1136/flgastro-2023-102403] [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: 02/09/2023] [Accepted: 06/08/2023] [Indexed: 10/20/2023] Open
Abstract
Inflammatory bowel disease is a complex and debilitating disease which is known to cause mental burden for patients. Even though few studies look at mental health disease in this cohort of patients, there is growing evidence of a correlation between disease activity and prevalence of mental health conditions such as anxiety, depression and post-traumatic stress disorder. In this literature review, the relationship between inflammatory bowel disease and mental health disorders is explored, with an emphasis on recognition, screening and therapeutic options and special considerations for these complex comorbidities. The relationship between medical and psychological disease is not often considered and less well understood and there is a need for further research in these fields. Patients would have much to gain both medically and psychologically from a multidisciplinary approach to this chronic disease association.
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Affiliation(s)
| | - Muhammad Ahmad-Waqar
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Matthew James Brookes
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
- Research Institute in Healthcare Science (RIHS), University of Wolverhampton, Wolverhampton, UK
| | - Aditi Kumar
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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15
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Taft TH, Carlson DA, Marchese SH, Pandolfino JE. Initial assessment of medical post-traumatic stress among patients with chronic esophageal diseases. Neurogastroenterol Motil 2023; 35:e14540. [PMID: 36703507 PMCID: PMC10133015 DOI: 10.1111/nmo.14540] [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: 11/11/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Diagnosis and management of chronic esophageal disease requires the use of potentially traumatic medical procedures, performed with or without sedation. Medical trauma and post-traumatic stress (PTS) are emerging as important considerations in patients with digestive illness. To date, no study assesses medical PTS from procedures in patients with esophageal disease. METHODS Adult patients with achalasia, eosinophilic esophagitis, gastroesophageal reflux disease, or functional esophageal disease at a university-based gastroenterology clinic completed: Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Gastroesophageal Disease Questionnaire, Brief Esophageal Dysphagia Questionnaire, Northwestern Esophageal Quality of Life scale (HRQoL), NIH-PROMIS Depression scale, and a study-specific questionnaire about esophageal procedures (endoscopy with sedation; functional lumen imaging probe (FLIP) with sedation; high-resolution manometry (HRM); wireless pH testing; or 24-h pH-impedance testing). KEY RESULTS Half of 149 participants reported at least one traumatic procedure, with HRM most often cited. Only 2.7% met the cutoff for PTS on PCL-5. This increased to 7.1% for patients with a traumatic procedure combined with experiencing intense fear. Rates of moderate-severe PTS ranged from 7.4%-12% for all patients and 14%-29% for those with a traumatic procedure with fear. Medical PTS was associated with poorer HRQoL, and increased esophageal symptoms, depression, and hypervigilance and symptom anxiety. CONCLUSIONS & INFERENCES Preliminary evidence suggests medical PTS affects few patients with esophageal disease. However traumatic procedures, most often associated with HRM, significantly increase PTS symptoms. The potential impacts of medical PTS on esophageal patient assessment and outcomes are considerable and warrants further study.
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Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dustin A Carlson
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sara H Marchese
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John E Pandolfino
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Jagielski CH, Harer KN. Working with Trauma in the Gastroenterology Setting. Gastroenterol Clin North Am 2022; 51:867-883. [PMID: 36376001 DOI: 10.1016/j.gtc.2022.07.012] [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: 11/15/2022]
Abstract
Patients with gastrointestinal (GI) complaints report high rates of previous psychological trauma such as physical, emotional abuse and neglect, sexual trauma, and other traumatic experiences. History of trauma is considered a risk factor for the development of disorders of gut-brain interaction, including irritable bowel syndrome. This article discusses key points for providers in understanding how various aspects of trauma can affect patients' physical and mental health and medical interactions, as well as trauma-informed strategies providers can use to increase patient comfort, improve communication, and improve effectiveness of treatment.
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Affiliation(s)
- Christina H Jagielski
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, 3912, SPC 5362, Ann Arbor 48109 - 5362, USA.
| | - Kimberly N Harer
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, 3912, SPC 5362, Ann Arbor 48109 - 5362, USA
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17
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Use of Benzodiazepines and Z-Drugs in Inflammatory Bowel Disease. Am J Gastroenterol 2022; 117:2046-2054. [PMID: 36288107 DOI: 10.14309/ajg.0000000000001955] [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: 03/20/2022] [Accepted: 07/29/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We estimated the incidence and prevalence of benzodiazepine and Z-drug (separately and jointly as BZD) use in the inflammatory bowel disease (IBD) population compared with matched controls without IBD and examined the association of mood/anxiety disorders (M/ADs) with the use of BZD from 1997 to 2017. METHODS Using administrative data from Manitoba, Canada, we identified 5,741 persons with incident IBD who were matched in a 1:5 ratio to controls on sex, birth year, and region. Validated case definitions were used to identify M/AD. Dispensations of BZD were identified. Multivariable generalized linear models were used to assess the association between IBD, M/AD, and BZD use. RESULTS In 2016, the incident age/sex-standardized benzodiazepine use rates per 1,000 were 28.06 (95% confidence interval [CI] 26.41-29.81) in the IBD cohort and 16.83 (95% CI 16.28-17.39) in controls (adjusted rate ratio = 1.69 [95% CI 1.56-1.79]). Benzodiazepine incidence rates were higher for women with IBD than men, but the RR between cases and controls were similar for men and women. The incident age/sex-standardized Z-drug use rate per 1,000 was 21.07 (95% CI 19.69-22.41) in the IBD cohort. This was 1.87-fold higher than in controls (95% CI 1.73-2.01). In 2017, approximately 20% of persons with IBD used benzodiazepines and 20% used Z-drugs. There was a subadditive effect of both benzodiazepine and Z-drug uses between IBD and M/AD after adjusting for covariates. DISCUSSION The use of BZD is more common in people with IBD than in population controls. Strategies to reduce the use of BZDs in persons with IBD and to offer alternative management strategies for M/ADs, sleep disorders, and other symptomatic concerns are needed.
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18
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Salwen-Deremer JK, Ballou S. Painful GI Conditions and Their Bidirectional Relationships with Sleep Disturbances. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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19
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Bianchi R, Mamadou-Pathé B, von Känel R, Roth R, Schreiner P, Rossel JB, Burk S, Dora B, Kloth P, Rickenbacher A, Turina M, Greuter T, Misselwitz B, Scharl M, Rogler G, Biedermann L. Effect of closed and permanent stoma on disease course, psychological well-being and working capacity in Swiss IBD cohort study patients. PLoS One 2022; 17:e0274665. [PMID: 36112586 PMCID: PMC9481029 DOI: 10.1371/journal.pone.0274665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background Little is known about the impact of ostomy formation in inflammatory bowel disease patients on course of disease, psychological well-being, quality of life and working capacity. Methods We analyzed patients over a follow-up of up to 16 years in the Swiss inflammatory bowel disease cohort study (SIBDCS) with prospective data collection. We compared Ulcerative colitis and Crohn’s disease patients with and without ostomy as well as permanent and closed stoma formation before and after surgery, investigating disease activity, psychological wellbeing and working capacity in a case-control design. Results Of 3825 SIBDCS patients, 176 with ostomy were included in the study and matched with 176 patients without ostomy using propensity score, equaling 352 patients for the analysis. As expected, we observed a lower mean and maximal disease activity in patients after stoma surgery compared with control patients without stoma. Overall, psychological wellbeing in patients with stomas vs. controls as well as patients with permanent vs. closed stoma was similar in terms of disease-specific quality of life (total score of the Inflammatory Bowel Disease Quality of Life questionnaire), psychological distress (total score of the Hospital Anxiety and Depression Scale), and stress at work (effort-reward-imbalance ratio), with the exception of a higher Posttraumatic Diagnostic Scale total score in patient with vs. without stoma. Compared to IBD patients without stoma, the adverse impact on working capacity in overall stoma IBD patients appeared to be modest. However we observe a significantly higher reduction in working capacity in permanent vs. closed stoma in CD but not UC patients. Conclusion As to be expected, IBD patients may benefit from closed and permanent stoma application. Stoma surgery appears to only modestly impact working capacity. Importantly, stoma surgery was not associated with adverse psychological outcomes, with comparable psychological well-being regardless of presence and type of stoma.
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Affiliation(s)
- Rahel Bianchi
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Barry Mamadou-Pathé
- Department of Epidemiology and Health System, Unisanté, Lausanne, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - René Roth
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Internal Medicine, Limmattalspital, Schlieren, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jean-Benoit Rossel
- Department of Epidemiology and Health System, Unisanté, Lausanne, Switzerland
| | - Sabine Burk
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Babara Dora
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrizia Kloth
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Rickenbacher
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Turina
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Medicine, University Hospital Bern, Bern, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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20
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Taft TH, McGarva J, Omprakash TA, Tomasino K, Pandit A, Mutlu EA, Hanauer SB. Hospitalization Experiences and Post-traumatic Stress in Inflammatory Bowel Disease: Opportunities for Change. Inflamm Bowel Dis 2022; 29:675-683. [PMID: 35894686 DOI: 10.1093/ibd/izac148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Medical trauma related to IBD (IBD-PTS) affects approximately 25% of patients and is associated with poor outcomes. Prior studies identify common hospitalization experiences as potentially traumatic but have not measured risk relationships for the development of IBD-PTS. We aim to investigate what aspects of hospitalizations may increase the chance of medical trauma and IBD-PTS development. METHODS Adult patients with IBD enrolled in the IBD Partners database were recruited. Study specific questionnaires included PTSD checklist, 5th edition (PCL-5), patient experience questionnaire, and items about the patient's most stressful hospitalization and nonhospital sources of medical trauma. Established criteria for the PCL-5 identified significant IBD-PTS symptoms (re-experiencing, avoidance, mood change, hyperarousal, global diagnosis). Select disease and treatment information was obtained from the main IBD Partners dataset. Univariate and multivariate statistics evaluated the relationships between hospitalization data and IBD-PTS. RESULTS There were 639 participants with at least 1 hospitalization for IBD included. Approximately two-thirds had Crohn's disease; most were White, non-Hispanic, female, middle-aged, and reported their IBD as being in remission. Forty percent of patients stated a hospitalization was a source of IBD-PTS. Frequent anxiety while hospitalized increased the odds of IBD-PTS 2 to 4 times; similar relationships existed for pain/pain control. Higher quality communication, information, and listening skills reduced the odds of IBD-PTS, albeit marginally. CONCLUSIONS Patients with IBD consistently cite hospitalizations as potential sources of medical trauma. Poorly managed anxiety and pain demonstrate the greatest chance for IBD-PTS development. Gender and racial/ethnic differences emerged for these risks. Positive interactions with the medical team may help mitigate in-hospital IBD-PTS development.
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Affiliation(s)
- Tiffany H Taft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | - Josie McGarva
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | | | - Kathryn Tomasino
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | - Anjali Pandit
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
| | - Ece A Mutlu
- University of Illinois, Division of Gastroenterology, Chicago, Illinois, USA
| | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, Illinois, USA
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21
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Glynn H, Mikocka-Walus A, Knowles SR. Editorial: Hospitalization Experiences and Post-traumatic Stress in Inflammatory Bowel Disease: Opportunities for Change. Inflamm Bowel Dis 2022; 29:839-841. [PMID: 35894682 DOI: 10.1093/ibd/izac166] [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: 06/25/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Heidi Glynn
- Department of Psychology, Swinburne University of Technology, Melbourne, VIC, Australia
| | | | - Simon R Knowles
- Department of Psychology, Swinburne University of Technology, Melbourne, VIC, Australia
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22
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Ferrarese D, Spagnolo G, Vecchione M, Scaldaferri F, Armuzzi A, Chieffo D, Belella D, Petito C, Mirijello A, Gasbarrini A, Addolorato G. Signs of Dissociation and Symptoms of Post-Traumatic Stress Disorder in Inflammatory Bowel Disease: A Case-Control Study. Dig Dis 2021; 40:701-709. [PMID: 34923490 DOI: 10.1159/000521424] [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: 06/26/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several psychological disorders have been described in patients affected by inflammatory bowel disease (IBD). Few studies have focused on the relationship between IBD and post-traumatic stress disorder (PTSD) symptoms, and no data are available on the relationship between IBD and dissociative symptoms. The aim of the present study was to evaluate the prevalence of PTSD and dissociative symptoms in a sample of IBD patients compared to healthy controls. A possible relationship with disease activity was also investigated. METHODS A total of 112 IBD patients, 55 Crohn's disease (CD) and 57 ulcerative colitis (UC), and 114 healthy individuals were evaluated. IBD patients were divided into 3 subgroups according to disease activity (remission, mild, and moderate). The revised version of the Impact of Event Scale (IES-R) and the Dissociative Experience Scale (DES) were administered to patients and controls. RESULTS IBD patients showed significantly higher rates of PTSD and dissociative symptoms compared to healthy controls. No differences were found between CD and UC patients. PTSD and dissociative symptoms were higher among CD patients with mild to moderate-severe activity compared to the remission group. No differences were found among UC patients with different activity levels. CONCLUSION IBD patients show a high prevalence of dissociative and traumatic affective disorders. Future studies are needed to investigate the role of these disorders in the clinical course and management of IBD patients according to the different disease activity phase.
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Affiliation(s)
- Daniele Ferrarese
- Unit of Internal Medicine, Gastroenterology and Hepatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Unit of Clinical Psychology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgia Spagnolo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Vecchione
- Department of Social and Developmental Psychology, Sapienza, University of Rome, Rome, Italy
| | - Franco Scaldaferri
- Unit of Internal Medicine, Gastroenterology and Hepatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Armuzzi
- Unit of Internal Medicine, Gastroenterology and Hepatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Chieffo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniela Belella
- Unit of Clinical Psychology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Petito
- Unit of Clinical Psychology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza General Hospital, San Giovanni Rotondo, Italy
| | - Antonio Gasbarrini
- Unit of Internal Medicine, Gastroenterology and Hepatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Addolorato
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.,Internal Medicine Unit, Department of Internal Medicine and Gastroenterology, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
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