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P170 Integrated psychological care in outpatients with inflammatory bowel disease

Lores T.*1, Goess C.1, Hrycek C.2, Grafton R.1, Hughes J.1, Cronin L.1, Mikocka-Walus A.3, Chur-Hansen A.4, Burke A.L.5, Collins K.L.5, Andrews J.M.1

1Royal Adelaide Hospital, Gastroenterology, Adelaide, Australia 2Royal Adelaide Hospital, Department of General Medicine, Adelaide, Australia 3University of York, Heslington, United Kingdom 4University of Adelaide, Adelaide, Australia 5Royal Adelaide Hospital, Psychology, Adelaide, Australia

Background

Psychological issues are prevalent in people with Inflammatory Bowel Disease (IBD). Anxiety and depression are associated with reduced quality of life and may even worsen disease course and impede medical management. However, psychological support is not routinely provided to people with IBD in outpatient settings. Here the need for and acceptability of integrating psychological support was examined.

Methods

Potential participants were recruited in the IBD service of a large tertiary hospital via post and in-person at scheduled outpatient appointments. Screening data were gathered by questionnaire: mental health with the Hospital Anxiety and Depression Scale (HADS) and the Kessler 6 Scale (K6), medication adherence with the Morisky Medication Adherence Scale (MMAS-8)and quality of life by the Assessment of Quality of Life measure (AQoL-8D). Psychological therapy was offered where scores indicated likely need.

Results

500 patients were approached: 67% participated in psychological screening, 38% scored within clinical ranges, and 17% accepted psychological support. Gender was a significant predictor of participation in screening; women were 62% more likely to participate than men. Analgesia and/or mental health medication significantly increased the likelihood of scoring within the clinical range nearly fivefold (analgesia OR=5.32, p=0.030; psych OR=6.04, p=0.001). Significant predictors of accepting psychological intervention included older age (OR=1.03, p=0.041), anxiety (OR=1.09, p=0.045), general distress (OR=1.11, p=0.003) and lower quality of life (OR=0.93, p=0.042).

In addition, there were small-to-moderate negative, correlations between medication adherence and anxiety (r=−0.323, p=0.000), depression (r=−0.200, p=0.000) and general distress (r=−0.250, p=0.000). There were also large, negative correlations between overall quality of life and anxiety (r=−0.708, p=0.000), depression (r=−0.787, p=0.000) and general distress (r=−0.801, p=0.000). Anxiety, depression and general distress were not related to IBD disease activity.

Conclusion

Psychological issues were prevalent in patients with IBD and were associated with lower quality of life and reduced medication adherence. Integrating psychological screening into outpatient care was widely accepted, although women were more likely to participate. Furthermore, high proportions of patients reported clinical levels of distress (irrespective of IBD activity) and accepted psychological intervention. These outcomes support the need for psychological screening and intervention in routine IBD care. Follow-up data are currently being collected to determine whether targeted psychological care improves mental health, physical health and/or healthcare utilisation.