P712 Examination of the relationship between disease activity, psychological distress and patient-reported outcome measures in an inflammatory bowel disease cohort
B. Jackson*1, D. Con1, A. Gorelik2, D. Liew2, P. De Cruz1
1Austin Health, Gastroenterology, Melbourne, Australia, 2Melbourne Health, Melbourne, Australia
Inflammatory bowel disease (IBD) care has focused on disease activity management. Patient-reported outcome measures (PROs) reflect the effect of IBD on patients’ ability to function beyond the effects of disease activity alone. The extent to which disease activity affects PROs is unclear. The purpose of this study was to examine the relationship between disease activity, psychological distress, and PROs.
Adult IBD patients attending a tertiary clinic from May to June 2015 were included. Disease activity was evaluated using the Harvey–Bradshaw Index (HBI) and patient-reported Simple Clinical Colitis Activity Index (p-SCCAI). IBD knowledge was assessed using CC-KNOW, and medication adherence was evaluated using the Morisky adherence scale. PROs included psychological distress via the Hospital Anxiety & Depression Scale (HADS); work productivity and activity impairment index; and quality of life (IBD-Q and SF-12). Spearman’s correlation determined correlations between disease activity, knowledge, adherence, psychological distress, and PROs. Bonferroni correction was used to keep the overall level of significance at a p-value of 0.05.
In total, 62/72 participants completed all surveys and included: 44% (32/72) female; 57% (41/72) Crohn’s disease (CD); 40% (29/72) UC; and 3% (2/72) IBD unclassified (IBD-U); all with a mean age of 35 (SD 11.05, range 18–76). Further, 11/23 (48%) of CD patients were in remission; 5/23 (22%) had mild-to-moderate disease; and 7/23 (30%) had severe disease. Of the UC and IBD-U patients, 31/38 (82%) patients were in clinical remission; 7/38 (18%) patients had mild-to-moderate disease; and none had severe disease. Based on HADS, at least mild levels of depression were present in 19/62 (31%) of patients, and 31/62 (50%) expressed some level of anxiety. No correlation was found between disease activity and psychological distress (Rho = 0.4, p = 0.07 [UC]; Rho = 0.4, p = 0.14 [CD]). Moreover, neither patient knowledge nor medication adherence correlated with disease activity nor level of psychological distress; however, patients’ knowledge did correlate with medication adherence (Rho = 0.96, p = 0.008). Medication adherence was inversely correlated with overall work impairment because of health (Rho = 0.80; p = 0.04) and health-related impairment while working (Rho = 0.99; p = 0.03). The latter only remained significant for UC when stratified by disease subtype.
High levels of depression and anxiety exist within our IBD cohort, irrespective of disease activity. Although knowledge of disease and medication adherence do not appear to significantly correlate with disease activity and psychological distress, medication adherence seems to keep UC patients engaged in work. Strategies to increase adherence should, therefore, be prioritized to optimise patients’ day-to-day function.