1. Clinical Correlates of Mental Health Issues in Outpatients with Inflammatory Bowel Disease under Routine Care
Taryn Lores
Health Psychologist, IBD Service
Royal Adelaide Hospital

2. Acknowledgements
Study is funded by research grant from Janssen Australia, adjudicated and administered by GESA (Gastroenterological Society of Australia)

3. Inflammatory Bowel Disease
Inflammatory Bowel Disease (IBD): chronic inflammation of the gastrointestinal system (Crohn’s disease, ulcerative colitis)
Prevalence: >75,000 Australians
Causes: combination of genetic, environmental and immunological factors
Symptoms: urgency/frequency, diarrhoea, bleeding, abdominal pain, fatigue
Treatment: medication, surgery
Relapsing / remitting, unpredictable

4. Psychology and IBD
People with Inflammatory Bowel Disease commonly experience psychological and social issues1
These factors may worsen disease course and impede successful management2
However, psychological issues are not routinely addressed in IBD care3
Current research at the RAH is investigating integrated psychological care for IBD outpatients
Mikocka-Walus AA et al. (2008) Clin Pract Epidemiol Ment Health
Van Langenberg DLK et al. (2008) J Gastro & Hep
Mikocka-Walus A et al. (2012) J Psychosom Res

5. Biological Psychological Social
Symptoms
Pain
Fatigue
Medical treatments
Side-effects
Why address psychological issues in IBD care?
Psychological
Anxiety, worry, fear
Depression
Stress
Grief and loss
Body image concerns
Social
Relationships
Communication
Support
Isolation
Stigmatisation

6. Research So Far Psychological issues may worsen disease outcomes:
Earlier disease4
Increased relapse5
Exacerbation of symptoms6
Increased hospitalisation7
Poor adherence to therapy7
4. Bonaz & Bernstein (2013), Gastroenterology, 144(1)
6. Triantafillidis et al. (2013), Expert Review Gastro & Hep, 7(3)
5. Mikocka-Walus et al. (2016), Clin Gastro & Hep
7. Van Langenberg et al. (2008), Jour Gastro Hep

7. Research So Far Evidence for psychological intervention is mixed
Good evidence for CBT
Increases mental QoL8
Improves medication compliance9
Reduces anxiety & depression10,11
Decreases hospitalisation rates9
In particular for those who are young, recently diagnosed, worse disease severity
8. Mikocka-Walus et al. (2015), BMC Gastro, 15:54
10. Knowles, Monshat & Castle (2013), Inflamm Bowel Dis, 19(12)
9. McCombie, Mulder & Gearry (2013), Jour Crohn’s Col, 7(12)
11. Diaz Sibaia et al. (2007), Rev Esp Enferm Dig, 99(10)

8. Current Research at the RAH
“Does the provision of co-located, contemporaneous
psychological care improve outcomes or decrease
healthcare utilisation in IBD patients? An evaluation of
a new initiative in IBD care”
Design: prospective cohort design
Aims: assess practicality, acceptability and outcomes of integrated psychological screening and intervention
Participants: from 1200 patients of IBD service

9. Current Research at the RAH
Psychological screening questionnaires:
HADS – anxiety and depression
K6 – general psychological distress
AQoL – quality of life
MMAS-8 – medication adherence
Background & healthcare utilisation data
Delivery – via mail, approached in person
Clinical cut-off – HADS, K6
Support offered to those in need

10. Results So Far Potential participants: 50.6% male 70.8% Crohn’s
Mean age 40 years
Mean duration 11 years
43% in clinical remission
9.8% current smokers

11. Results So Far Correlates of participation in psychological screening:
Gender: Disease Duration:

12. Results So Far
Correlates of clinical results (scoring within clinical range)

13. Results So Far

14. Results So Far
Correlates of acceptance of psychological support

15. Current Research – Next Steps
Initial data collection phase completed (Sept 2016)
12 month follow-up phase underway (to Sept 2017)
Analysis of:
Acceptability of in-clinic screening
Psychological distress
Quality of life, medication adherence
Healthcare utilisation
Implications for future integrated IBD care?

16. Clinical Implications and Summary
Psychological issues are common in patients with IBD, but are not routinely addressed
Some factors associated with participation in screening & intervention, high psychological distress – but need is widespread
Disease activity and medication use (pain, psych) associated with higher psychological distress – important to address
Integrated psychological care can improve access and reduce barriers to treatment
Results to inform best practice and holistic approach to patient care