Medical Trauma in Patients With IBD

Medical Trauma in Patients With IBD

August 2, 2022 0 By Jennifer Walker

Patients with inflammatory bowel disease (IBD) cited hospitalizations, as well as poorly managed anxiety and pain, as possible sources of post-traumatic stress (PTS), a cross-sectional, observational study showed.

Among over 600 patients who were hospitalized at least once, 55% said IBD symptoms or flares were a source of trauma, and 40% named hospitalizations as a source, reported Tiffany Taft, PsyD, MIS, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

Furthermore, those who experienced frequent anxiety during their hospital stay had two to four times greater odds of developing IBD-related PTS, with similar associations for pain and pain control, they noted in Inflammatory Bowel Diseases.

“As was found in the original 2019 study on IBD-PTS, ‘global hospital rating’ remained the most significant predictor of all IBD-PTS symptoms — and the only predictor for mood, cognitive changes, and hyperarousal,” Taft and team wrote.

“The key takeaway is that hospitalizations are relatively common for people living with IBD and come with the risk for frightening or even life-threatening experiences,” Taft told MedPage Today. “Medical team members can help mitigate some of this by showing patients respect, listening to their concerns, and ensuring the person understands information about their treatment, surgery, etc.”

“Anxiety receives considerably less attention during hospital care,” the authors noted. “This is in part due to limited psychiatric resources in and out of the hospital setting in most areas of the United States, but this is also likely due to stigmatization toward mental health issues and a prioritization of ‘medical’ problems despite the widespread adoption of the biopsychosocial model of illness.”

About a quarter of IBD patients experience PTS, and repeated hospitalizations can lead to more complex and severe PTS that can result in destructive behavior or suicidal ideation, Taft and team said.

Notably, only 6.1% of patients reported being diagnosed with IBD-related PTS. Moreover, only 11% of patients met the diagnostic cutoff score for IBD-PTS (PTSD Checklist, 5th edition [PCL-5] >32), with women more likely than men to meet this criterion (P=0.002).

Younger patients (P<0.001) and women (P=0.003) were most likely to report common events related to IBD as possible sources of PTS.

Among this cohort, the average number of traumatic events was 2.54. As this number increased, so did the severity of PTS symptoms (r=0.338; P<0.001). Patients who reported more traumas also ranked all aspects of their most stressful hospitalization as poorer (Range of r -0.16 to -0.28; all P<0.001).

The most frequent moderate-to-severe IBD-related PTS symptoms included:

  • Re-experiencing (29%)
  • Hyperarousal (24%)
  • Avoidance behaviors (22%)
  • Changes in mood or cognition (22%)

Women were more likely to experience symptoms of re-experiencing and avoidance behaviors than men, while no differences were seen for hyperarousal or mood/cognitive changes.

For this study, Taft and colleagues examined data on 639 patients from the IBD Partners database who were hospitalized at least once or had surgery for IBD from February to August 2020. All participants completed the PCL-5, the patient experience questionnaire, and other items about most stressful hospitalization and non-hospital sources of medical trauma.

Mean participant age was 49 years, 73% were women, and 95% were white. About two-thirds had Crohn’s disease, and 38% had ulcerative colitis; 35% were in disease remission, and 33% had minimal symptoms at the time of the study. Overall, 42% had undergone surgery, and 14% had been admitted to the intensive care unit.

Taft and team acknowledged several limitations to the data, including patient recruitment by self-selection, which may have introduced bias. In addition, the number of traumatic events that preceded the most stressful hospital stay could not be confirmed and may have influenced patient responses.

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    Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

This study was supported by the Digestive Health Foundation of Northwestern Medicine.

Taft disclosed ownership interest in Oak Park Behavioral Medicine, LLC, and consultant work for Healthline.

Co-authors reported relationships with AbbVie, Arena Pharmaceuticals, Boehringer Ingelheim, Genentech-Roche, Hollister, Janssen, and Takeda.