Prevalence of Anxiety and Depression in Persons With Ostomies: A Cross-sectional Study

Comparison of adjustment to a temporary or permanent ostomy using the OAI-23

AIM

The aim of this work was to compare adjustment between those with a new temporary or permanent ostomy in a cohort of Australian adults.

METHOD

This is a multicentre, longitudinal observational study. Ostomy adjustment was measured using the Ostomy Adjustment Inventory (OAI-23) at six possible time points ending at 9 months postsurgery or at the time of ostomy closure in those with a temporary stoma. The OAI-23 includes four domains: anger, acceptance, anxious preoccupation and social engagement.

RESULTS

Eligibility criteria were met by 1230 patients, with 849 (69%) recruited and consented. Of these, 108 were excluded as their surgery did not result in the formation of an ostomy and a further 41 were excluded due to there being no data on ostomy type (temporary or permanent). This left a study population of 700, of whom 397 had a temporary and 303 a permanent ostomy. Only small differences were observed between the temporary and permanent ostomy groups at most time points within the four OAI-23 domains. There were no statistically significant differences found beyond 2 weeks postdischarge and the differences were of small size. While no difference was found between the groups in the domain of anxious preoccupation, both groups demonstrated an increase in anxious preoccupation over time. Neither group regained their presurgery confidence to attend social engagements.

CONCLUSION

We found only minor differences in adjustment in those with a new temporary ostomy compared with a new permanent ostomy. Both groups demonstrated increasing anxious preoccupation and problems with social engagement. This suggests that access to education, training and support should be equitable between these two groups in clinical practice, and needs to incorporate a focus on psychological as well as physical outcomes.

The prevalence of anxiety and depression in patients with ostomy: A systematic review and meta-analysis

AIM

The prevalence of anxiety and depression in patients with ostomy is reported differently. The aim of this systematic review and meta-analysis is to estimate the global prevalence of anxiety and depression in patients with ostomy.

METHOD

A systematic search of Embase, Proquest, Scopus, PubMed and Web of Science (ISI) databases was conducted from January 1990 up to 5 May 2021. A total of 3392 records were retrieved and 18 studies were ultimately included. Two reviewers independently assessed full-text of articles according to predefined criteria. A random-effects model was used to estimate the prevalence of anxiety and depression and I² index was used to assess the heterogeneity of the studies. Subgroup analysis and mea-regression were conducted to explore potential sources of heterogeneity. The review protocol is registered in PROSPERO and is available online. Data analysis was performed using R software version 4.3.1.

RESULTS

In this study, the pooled prevalence of anxiety was 47.60% (95% CI, 29.94-65.26) and the pooled prevalence of depression was 38.86% (95% CI, 29.29-48.43). The subgroup analysis showed the prevalence of anxiety and depression in different regions was not significantly different (p = 0.854, p = 0.143 respectively). Nevertheless, the highest and lowest prevalence of anxiety were in Asia and the America 51.79% and 32.69%, respectively and the highest and lowest prevalence depression were in Asia with 49.80% and Europe with 26.77%, respectively.

CONCLUSION

The finding of this study showed the global prevalence of anxiety and depression in patients with ostomy is high. Therefore, all health care providers who deal with these patients should use appropriate psychological strategies, techniques and interventions to reduce anxiety and depression in these patients.

Prevalence of depression and its potential contributing factors in patients with enterostomy: A meta-analytical review

OBJECTIVE

In patients with intestinal pathologies, the placement of a stoma bag affects multiple aspects of their perceived quality of life. This meta-analysis aims to evaluate the prevalence of depression among patients with enterostomy and to determine the underlying factors that could explain the potential heterogeneity of this prevalence.

METHODS

Relevant published studies were identified by searching PubMed, Embase, PsycINFO, Cochrane, CINAHL, Scopus, and Web of Science until May 2022. The random-effects model was used to determine the pooled prevalence of depression among patients with enterostomy using cross-sectional studies from various countries. Meta-regression and subgroup analysis were performed to identify factors contributing to heterogeneity. Quality assessment of the included studies was conducted using the Newcastle-Ottawa scale for nonrandomized studies.

RESULTS

The pooled prevalence of depressive symptoms among patients with enterostomy, as calculated using the random-effects model, was 41.6% (95% confidence interval [CI]: 25.4-59.7%, Q-value = 145.794, df = 8, p < 0.001, tau^∧2 = 1.124, I^∧2 = 94.513). The meta-regression found that mean age and gender were not significant moderators for the observed heterogeneity in prevalence. Subgroup analysis according to the indications for enterostomy formation showed that the prevalence of depression was highest in patients with colorectal cancer, at 34.4% (95% CI: 27.2-42.4%). Subgroup analysis by region showed that patients in Africa had the highest prevalence of depression, at 88.2% (95% CI: 76.1-94.6%), compared to other regions. Subgroup analysis by stoma indication was not significant.

CONCLUSION

This meta-analysis reports that the pooled prevalence of depression among patients with enterostomy is 41.6%. Indications for enterostomy formation, as well as geographical region, were identified as potential sources of heterogeneity. These findings highlight the need for appropriate psychosocial support and interventions at different stages of enterostomy placement.

Prevention and Management of Pseudoverrucous Lesions: A Review and Case Scenarios

GENERAL PURPOSE

To present the associated risk factors, prevention measures, and assessment and management of pseudoverrucous lesions specific to a surgically created ileal conduit, as well as three clinical scenarios illustrating this condition.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Define pseudoverrucous lesions.2. Identify the risk factors for stoma complications such as pseudoverrucous lesions.3. Select the appropriate routine care procedures to teach patients following stoma creation to help prevent pseudoverrucous lesions.4. Choose the recommended treatment options for patients who develop pseudoverrucous lesions.