Youth IBD services urged to provide in-house psychological support

Psychosocial screening should be an integral part of care for adolescents and young adults with IBD because they have a significant burden of depression and difficulty in coping, Australian researchers say.

A Queensland study compared psychosocial measures in 51 young people with IBD and 210 with CF, juvenile rheumatic disease, phenylketonuria, renal transplants and craniomaxillofacial conditions.

All participants in the study were 15-25 years of age and from the same youth-specific medical centre.

The study, led from Brisbane’s Mater Young Adult Health Centre, found 41% of the young people with IBD reported poor wellbeing and 37.3% were in the at-risk category for depression.

In comparison only 23.2% of young people with other conditions were at-risk for depression, based on the Kessler Psychological Distress Scale (K-10).

The IBD group had worse illness perception and a significantly lower internal locus of control regarding their condition than the comparison group.

The young people with IBD had a mean score of 44.1 on the Short Quality of Life Questionnaire for Inflammatory Bowel Disease (SIBDQ) – indicating a significant impairment in IBD-specific quality of life.

“These findings further highlight the significance and magnitude of the impairment in quality of life amongst AYAs living with IBD,” the study authors said.

And many young people with IBD experience their condition as unpredictable and difficult to manage, they added.

“This was reflected in young people with IBD having a more threatening view of their illness compared to peers with other conditions. This indicates that young people with IBD see their illness as more severe along dimensions such as severity of symptoms, self-efficacy, efficacy of treatment,”

“Further, our locus of control results are likely to correlate with a sense of helplessness and/or powerlessness, an established correlate of depression.”

The study authors said IBD-specific issues such as the embarrassing nature of IBD symptoms, and generic issues for adolescents and young adults around their social lives and intimate relationships, compounded the impact of the disease on their mental health.

“Given the high rates of comorbid depression and anxiety in youth with IBD, significantly impaired quality of life and the bidirectional link between IBD and mental health, it is important to include psychosocial screening and care in IBD treatment pathways,” they wrote in the Internal Medicine Journal.

They said there is evidence suggesting that antidepressants are effective in improving depression, anxiety and quality of life as well as reducing IBD activity, whilst psychological treatments are effective at improving depression, anxiety and quality of life – but their impact on IBD activity has been inconclusive.

“Our findings suggest that intervention supporting self-efficacy and shifting locus of control and perception of the illness, such as education about the microbiome-gut-brain-axis and stress management, may be particularly relevant to this patient cohort,” they concluded.

The study noted also that such psychological interventions were more accessible when offered in-service rather than externally.

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