P721 Psychological care is needed and welcomed by patients with inflammatory bowel disease under routine care. (16th January 2018)

• Record Type: Journal Article
• Authors: Lores, T; Goess, C; Hrycek, C; Grafton, R; Hughes, J; Cronin, L; Burke, A L; Collins, K L; Chur-Hansen, A; Mikocka-Walus, A; Andrews, J M
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S475
• Page End: S476
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.848
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: Mental Health issues (MHIs) are common in people with inflammatory bowel disease (IBD) and are associated with reduced quality of life and poor disease course. Despite this, psychological support is not routinely provided in IBD outpatient settings. We report on a two-year trial of integrated psychological care in IBD management. Methods: Potential participants were recruited from an established IBD service over 12 months. Psychological screening questionnaires included the Hospital Anxiety and Depression Scale, Kessler 6 Scale of Psychological Distress, Morisky Medication Adherence Scale and Assessment of Quality of Life measure. Psychological therapy was offered where scores indicated likely need via either an on-site psychologist or an external referral. Follow-up data were collected 12 months after initial screening. Results: In total, 490 patients were approached: 68% participated in screening and more than half scored within clinical range (55%). Opiate or psychological drug use significantly increased the likelihood of distress (OR = 5.80, p = 0.010, OR = 11.26, p < 0.000, respectively). Half of those with likely MHIs accepted psychological support. Anxiety, depression and general distress were negatively related to quality of life and medication adherence. Anxiety was associated with greater numbers of emergency presentations ( r = 0.123, p = 0.025) and appointment cancellations ( r = 0.154, p = 0.005). 63% of patients who accepted support saw the on-site psychologist; 57% of these completed or are continuing treatment. Patients were 5.8 times more likely to engage in treatment if allocated support within service compared with externally. At 12 month follow-up patients who accepted support experienced significant improvements across most MH outcomes: Patients who needed but declined support demonstrated a similar pattern of improvement. There was no overall change in IBD activity over 12 months. Conclusions: Psychological screening was widely accepted and easily integrated within the service, with a high proportion of patients needing support. Whilst support was generally accepted, engagement was greater within service compared with external. At 12 months those who accepted support had significant improvements. This trial highlights the need, feasibility and acceptance of psychological care being integrated into routine IBD management. Further follow-up is needed to examine whether better psychological support might reduce healthcare utilisation or enhance IBD outcomes.