Characterizing Kessler Psychological Distress Scale scores and psychosocial stressors in an Australian inflammatory bowel disease cohort

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Gounden, S
Brett, L
Mcivor, C
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Background and Aims: Depression and anxiety occur in patients with inflammatory bowel disease (IBD) at a higher frequency than in the general population. It remains contentious whether the etiology of this is due to a systemic inflammatory response or the disease state causing a reactive mood change. Psychological distress adversely affects patients' lives and ability to manage their IBD. Our patient cohort currently has limited access to support services for psychological conditions. They may then be at risk of poorer disease outcomes related to the adverse impact of psychological distress. We aimed to compare Kessler Psychological Distress Scale (K10) scores from an IBD cohort with K10 data from the 2017–2018 Australian National Health Survey. We sought to correlate K10 to fecal calprotectin data, as a marker of disease activity, and to compare domains of patient self‐reported stressors with K10 scores

Methods: Patients were recruited from the IBD outpatient clinic at Logan Hospital. Informed consent was obtained from all patients (HREC/2019/QMS/47040). Exclusion criteria were pediatric patients, patients unable to consent, and patients without a confirmed histological diagnosis of IBD. Participants completed a paper survey containing quality‐of‐life information, K10 scoring, and demographic data. Fecal calprotectin levels were obtained from medical records. A fecal calprotectin level of > 100 μg/g was suggestive of a flare of IBD. A thematic analysis was performed on patient self‐reported stressors. These were divided into lifestyle (restriction in foods, access to health care, recreation, and financial losses) and symptom (fatigue, pain, and fecal urgency) domains. K10 scores were indexed as low (10–15), moderate (16–21), or high–very high (22–50).

Results: We recruited 68 patients from the IBD outpatient clinic (40 with Crohn's disease, 28 with ulcerative colitis). Patients with IBD, on average, had K10 scores indicating high levels of psychological distress (23.98 ± 8.23) (Fig. 1). There was no difference in K10 scores between patients with Crohn's disease (25.5 ± 9) and those with ulcerative colitis (22.1 ± 6.6; P > 0.05). Patients with IBD had a higher proportion of K10 scores that fell into the high–very high band compared with the general population (K10 > 22 in 54% of patients with IBD vs 14% of patients in the National Health Survey; P < 0.05). There was no difference in K10 scores for patients with a fecal calprotectin level > 100 μg/g compared with those with a level < 100 μg/g (P > 0.05). Patients reporting impacts in both lifestyle and symptom domains tended to having higher K10 scores compared with those with lifestyle‐only or symptom‐only domain impacts. However, this failed to reach statistical significance.

Conclusion: Patients in this IBD cohort are at a higher risk of having comorbid depression or anxiety than the general community. Although preliminary findings suggest that this does not correlate with disease extent, further research is needed in this area. These patients may benefit from further assessment through a mental health professional or being linked in with community support services by their primary care provider.

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Gounden, S; Brett, L; Mcivor, C, Characterizing Kessler Psychological Distress Scale scores and psychosocial stressors in an Australian inflammatory bowel disease cohort, Journal of Gastroenterology and Hepatology, 2020, 35, pp. 146-147