Psychological Considerations and Interventions in Inflammatory Bowel Disease Patient Care

Taft, Tiffany; Ballou, Sarah; Bedell, Alyse; Lincenberg, Devin

doi:10.1016/j.gtc.2017.08.007

Cited by 46 publications

(34 citation statements)

References 83 publications

(86 reference statements)

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“…The strongest relationship was found between low self-esteem and depression [41]. Several theoretical frameworks explain this relationship, suggesting that self-esteem has an important role in a person's positive and negative affective state and that low self-esteem is a vulnerability factor for the development of depression [9,40,42]. This is important for patients with IBD because large cohort studies have shown that their rates of depression are significantly higher compared to healthy populations [43].…”

Section: Discussionmentioning

confidence: 99%

Self-esteem in patients with inflammatory bowel disease

et al. 2020

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Purpose The purpose of this study was to explore self-esteem and associations between self-esteem and sociodemographic, clinical, and psychological factors in patients with inflammatory bowel disease (IBD), a disease of chronic relapsing inflammation of the gastrointestinal tract. IBD symptoms, including pain, fatigue, and diarrhea, as well as potential lifelong medical treatment and surgery, may be demanding, cause significant challenges, and influence self-esteem. Methods In this cross-sectional multicenter study, participants were recruited from nine hospitals in the southeastern and western regions of Norway from March 2013 to April 2014. Data were collected using self-report questionnaires. Selfesteem was assessed by the Rosenberg Self-Esteem Scale, fatigue was assessed by the Fatigue Questionnaire, self-efficacy was assessed by the General Self-Efficacy Scale, and disease activity was assessed by the Simple Clinical Colitis Activity Index for ulcerative colitis (UC) and Harvey Bradshaw Index for Crohn's disease (CD). Multiple linear regression analysis was applied to examine associations between self-esteem and sociodemographic, clinical, and psychological factors. Results In total, 411 of 452 (91%) patients had evaluable data and were included in this study. The mean scores on selfesteem, self-efficacy, total fatigue, anxiety, and depression were similar between UC patients and CD patients. Male gender, being employed, and higher self-efficacy were independently associated with higher self-esteem, whereas anxiety and depression were independently associated with lower self-esteem. Neither disease activity nor fatigue were associated with self-esteem in the final multiple regression analyses. Conclusion Patient-centered interventions that improve self-esteem and reduce anxiety and depression seem to be important to optimize IBD management.

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Section: Discussionmentioning

confidence: 99%

Self-esteem in patients with inflammatory bowel disease

et al. 2020

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“…Two were study protocols (Schoultz et al, 2013;van den Brink et al, 2016). Three were reviews (McCombie et al, 2013;Fiest et al, 2016;Taft et al, 2017), along with one qualitative study (Schoultz et al, 2016) and one study which included participants <18 years of age (Jantschek et al, 1998).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Non-pharmacological Interventions for Anxiety and Depression in Adults With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

et al. 2020

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Objectives: To assess the published randomized controlled trials (RCT) of non-pharmacological interventions systematically and to synthesize the evidence of these interventions for the management of anxiety and depression in adults with inflammatory bowel disease (IBD). Background: Anxiety and depression are common symptoms in adults with IBD and can have many negative outcomes on their quality of life (QOL). Non-pharmacological interventions for anxiety and depression are important to improve the adaptive strategies of adults with IBD. Previously published reviews of non-pharmacological interventions to mitigate anxiety and depression in those with IBD have resulted in inconclusive evidence. This review is aimed to fill that gap. Design: Systematic review and meta-analysis. Method: Using a PRISMA diagram, English-language RCT published were searched using combined keywords of inflammatory bowel disease, Crohn's disease, ulcerative colitis, randomized controlled trial, anxiety, and depression. The Cochrane risk of bias tool is utilized to assess the methodological quality of each study. A meta-analysis of RCTs was conducted using Comprehensive Meta-Analysis (CMA) software. Results: The final review included 10 studies. The overall risk of bias of the selected studies varied from low risk in three studies, some concerns in four of the studies, and high risk of bias in three of the studies. Interventions included cognitive-behavioral therapy, mindfulness-based therapy, breath-body-mind-workshop, guided imagery with relaxation, solution-focused therapy, yoga, and multicomponent interventions. The pooled evidence from all non-pharmacological interventions showed that these interventions significantly helped to reduce anxiety, depression, and disease specific quality of life (QOL) in adults with IBD compared to control groups. However, the effect sizes are small. The pooled standardized mean difference (SMD) was −0.28 (95% CI [−0.47, −0.09], p = 0.004) for anxiety, −0.22 (95% CI [−0.41, −0.03], p = 0.025) for depression and 0.20 (95% CI [0.004, 0.39], p = 0.046) for disease specific QOL. Davis et al. Non-pharmacological Interventions for Anxiety and Depression in IBD Conclusion: The addressed non-pharmacological interventions were multifaceted and demonstrated positive effects on anxiety and depression, and QOL in those with IBD. Healthcare providers can facilitate a discussion with adults with IBD about the availability of these interventions to mitigate their anxiety and depression and to improve their QOL.

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“…Psychiatric comorbidity has also been associated with hospital readmissions and unnecessary, costly diagnostic testing in this population . We found that behavioral health outcomes were not limited to disease, and therefore, it is important to consider patients with IBD for brain–gut psychotherapies despite limited research …”

Section: Discussionmentioning

confidence: 99%

“…24,25 We found that behavioral health outcomes were not limited to disease, and therefore, it is important to consider patients with IBD for brain-gut psychotherapies despite limited research. 6 Recognizing the positive impact on many digestive diseases, both gastroenterologists and patients are increasingly seeking…”

Section: Discussionmentioning

confidence: 99%

“…Crohn's disease and ulcerative colitis have a similar prevalence of mood disorders compared with those with DGBIs . Brain–gut psychotherapies are effective for improving quality of life and disease experience for a wide range of GI conditions targeting the multifactorial nature of DGBIs, upper GI conditions (eg, heartburn, dysphagia, and globus), and inflammatory bowel disease (IBD) . As a result, “psychogastroenterology” has organically emerged as an effective treatment modality necessary for holistic GI care …”

Section: Introductionmentioning

confidence: 99%

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Nuances of the psychogastroenterology patient: A predictive model for gastrointestinal quality of life improvement

Riehl

Kinnucan

Chey

et al. 2019

Neurogastroenterology Motil

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Background Gastrointestinal conditions are multifactorial in nature, and certain patients can benefit greatly from brain–gut psychotherapies delivered by mental health professionals who specialize in psychogastroenterology. This study aimed to identify features associated with improvements in GI‐specific quality of life scores following behavioral health interventions (BHI). The second aim was to create a psychogastroenterology referral care pathway incorporating identified characteristics for greatest benefit from GI‐specific behavioral therapy. Methods We performed a prospective observational study of 101 (63 women; median age, 45 years) gastroenterology patients referred for psychogastroenterology consultation at a single center. Patients attended an average of seven sessions with a single GI psychologist where evidence‐based brain–gut psychotherapies were employed. GI‐specific quality of life (IBS‐QOL) and psychological distress (BSI‐18) were assessed before and after BHI. Patients completed self‐reported questionnaires. We performed a multivariable analysis to determine predictors associated with IBS‐QOL score improvement. Key Results A total of 53 (52.5%) patients experienced improvement in IBS‐QOL score. Patients with improved IBS‐QOL scores had significantly higher baseline BSI general domain T‐scores (61.9 vs. 56.9, P = 0.002). Female gender (odds ratio [OR], 3.2), pretreatment BSI somatization T‐score ≥63 (OR, 3.7), and a diagnosis of depression (OR, 4.2) were associated with greater odds of IBS‐QOL score improvement following BHI. Conclusions and Inferences We identified factors associated with response to GI‐specific BHI to aid in optimizing the utilization of psychogastroenterology services and provide referring providers with information to inform treatment recommendations. Female patients with disorders of gut–brain interaction (DGBIs), high somatization, and depression should be considered a priority for brain–gut psychotherapies.

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Psychological Considerations and Interventions in Inflammatory Bowel Disease Patient Care

Cited by 46 publications

References 83 publications

Self-esteem in patients with inflammatory bowel disease

Self-esteem in patients with inflammatory bowel disease

Non-pharmacological Interventions for Anxiety and Depression in Adults With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Nuances of the psychogastroenterology patient: A predictive model for gastrointestinal quality of life improvement

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