Q&A: Posttraumatic stress symptoms afflict patients with IBD
Survey results supported prior research that found one-quarter to one-third of patients with inflammatory bowel diseases report posttraumatic stress symptoms linked to their disease experience.
To better characterize posttraumatic stress (PTS) in patients with IBD, researchers surveyed 797 patients registered with the Crohn’s and Colitis Foundation/University of North Carolina IBD Partners database (Crohn’s disease n = 452; ulcerative colitis n = 345). The Post Traumatic Stress Disorder Checklist-5th edition supplemented this survey. According to study results, 5.6% of respondents reported existing PTS diagnoses as a direct result of IBD experiences while 9.6% of respondents met IBD-related PTS diagnostic criteria. Researchers noted female sex, younger age and less education as well as non-white race and Hispanic race correlated with higher levels of PTS symptoms. Further, increased PTS correlated with increased rates of anxiety, depression, pain interference, fatigue and health care use.
Healio Gastroenterology spoke with study author Tiffany Taft, PsyD, MIS, Northwestern University Feinburg School of Medicine, to gain a better understanding of the implications these results have on the care of patients with IBD going forward.
Healio Gastroenterology: Why did your team undertake this study?
Tiffany N. Taft: Through patient encounters and social media posts, we realized undiagnosed posttraumatic stress is likely occurring in some patients with IBD. When we looked at the existing research, we were very surprised to see only one study existed in Switzerland.
The present research is a follow-up to our first study with a much smaller group of patients that found around 30% had clinically significant symptoms of posttraumatic stress. We wanted to replicate the study in a larger group, so we used the IBD Partners database and were able to recruit almost 800 patients.
In addition to assessing if the rate of PTS symptoms remained high, which it did, we also wanted to evaluate how other patient outcomes already captured in the IBD Partners database like disease severity hospitalizations, and surgeries are related to PTS symptoms.
Healio: What is the most important take-home message?
Taft: If you treat IBD patients, screen them for medical PTS. Ask them questions about PTS symptoms, especially if they report anxiety, trouble sleeping or are having difficulty with following their treatment plan. Alternatively, you can use the Primary Care PTSD screener, which is free and available online.
Patients do not have to have an extensive number of hospital stays or surgeries to have PTS, rather it can come from a single traumatic incident including IBD symptoms; screening is especially important after a bad flare up, hospitalization or surgery.
When diagnosed early and treated properly, the prognosis is good for people with PTS. If left untreated, it can last for decades and undermine many physical and mental health outcomes.
Healio: How do these results inform IBD/post-traumatic stress care going forward?
Taft: We hope that any clinician involved in treating patients with IBD will become mindful of how routine procedures can be very anxiety provoking, even terrifying, to patients.
Check in with how your patients are doing emotionally during their encounters, especially difficult procedures like nasogastric tube placement. Communication and information quality are vital to easing patient fears, making a point to ask patients if they understand what they were just told and filling in any gaps can go a long way to mitigate PTS development.
Healio: Is there anything else you’d like to mention about the topic?
Taft: It is a good idea for any practice working with IBD patients to connect with therapists in their area who specialize in posttraumatic stress disorder. Thankfully, there are many more trauma-focused psychologists and social workers than those who specialize in psychogastroenterology.