National Prevalence of Psychological Distress and Use of Mental Health Care in Inflammatory Bowel Disease

Abstract

Background Individuals with inflammatory bowel disease (IBD) have elevated symptoms of anxiety and depression. The burden of such symptoms, accompanied by functional impairment in IBD, is not well documented, nor is utilization of mental health care in this population. Methods Adults ≥18 years were identified in the cross-sectional 2015–2016 National Health Interview Survey. Responses from the Kessler Index were used to estimate the national prevalence of psychological distress with impairment and mental health-care use in IBD. Factors associated with psychological distress with impairment in IBD were analyzed using logistic regression. Results The prevalence of psychological distress with impairment was significantly higher in IBD than non-IBD adults (7.69% vs. 3.50%, respectively; P < .01). Among those with IBD and psychological distress with impairment, only a third (36.29%) had seen or talked to a mental health provider in the preceding 12 months. About half of these found the cost of mental health care unaffordable. On multivariable analysis, factors associated with psychological distress in IBD included increasing emergency room visits and trouble finding a health provider. Conclusions A significant number of adults with IBD in the United States have psychological distress accompanied by functional impairment. However, mental health care is underutilized in this population. Many of these individuals find the cost of mental health care unaffordable, struggle to find a health provider, and experience repeated emergency room visits. Ongoing efforts to improve mental health care in IBD should address issues of access and cost. Additionally, these efforts should seek to understand other barriers to mental health-care use.

Psychological symptoms and quality of life in patients with inflammatory bowel disease in China: A multicenter study

“…In recent years, the prevalence of IBD has been increasing worldwide and is projected to reach 1% by 2030, creating a significant global burden 2,23 . The study showed that the proportion of mental disorders in IBD patients was 7.69%, which was significantly higher than that in non‐IBD people 24 . There is a mutual influence on the mental and physical health of IBD patients, 25 and this psychological burden not only increases the physical burden of the disease but is also related to direct and indirect costs 11–14 .…”

“… 2 , 23 The study showed that the proportion of mental disorders in IBD patients was 7.69%, which was significantly higher than that in non‐IBD people. 24 There is a mutual influence on the mental and physical health of IBD patients, 25 and this psychological burden not only increases the physical burden of the disease but is also related to direct and indirect costs. 11 , 12 , 13 , 14 Therefore, it is very important to identify and intervene in the psychological abnormalities of IBD patients.…”

Barriers to optimizing inflammatory bowel disease care in the United States

“… 39 It has further been shown that early intervention, before psychological distress spirals out of control, can lead to improved outcomes. 40 , 41 Due to this, it is recommended to address mental health and make referrals for support during the routine IBD visit 42 ; yet, a patient’s ability to follow through on these recommendations is limited in the United States by scarcity and out-of-pocket expense. While the Affordable Care Act (ACA) extended the insurance plans that needed to comply with the federal parity requirement for treatment of mental health conditions, 43 co-payments, and in-network requirements maintain strict conditions that present barriers for patient access.…”

Integrating Virtual Mindfulness-Based Stress Reduction Into Inflammatory Bowel Disease Care: Mixed Methods Feasibility Trial

“…Further, a meta-analysis of over 30,000 patients with IBD estimated the prevalence of anxiety and depression symptoms in patients with active IBD to be 57.6% and 38.9%, respectively [ 8 ]. On top of these comorbid psychiatric risks, approximately 25%-33% of patients with IBD experience symptoms of psychological distress and posttraumatic stress symptoms from medical procedures, hospital stays, disease symptoms, and pain [ 9 ]. Despite these associations, most IBD patients’ mental health concerns often remain untreated [ 1 , 9 ].…”

“…On top of these comorbid psychiatric risks, approximately 25%-33% of patients with IBD experience symptoms of psychological distress and posttraumatic stress symptoms from medical procedures, hospital stays, disease symptoms, and pain [ 9 ]. Despite these associations, most IBD patients’ mental health concerns often remain untreated [ 1 , 9 ].…”