Urban, rural environments impact eosinophilic esophagitis-related anxiety, depression
Key takeaways:
- Urban and rural populations showed low resilience scores.
- Rural populations showed a prolonged time to diagnosis compared with urban populations.
WASHINGTON — Urban and rural environments differed in eosinophilic esophagitis time to diagnosis and disease-related anxiety and depression, according to a poster at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“Eosinophilic esophagitis, or EoE, is considered a rare disease, but prevalence has increased over the last decade,” Evie K. Cannon, medical student at University of Arkansas for Medical Sciences and clinical research coordinator at Arkansas Children’s, said during her presentation. “EoE is associated with a decreased quality of life, higher stress and anxiety in adults, but has not been well studied in adolescents.”
“In addition,” she continued, “patients living in rural environments experience disparities that may overall worsen their mental health. Our study sought to determine the effect of EoE in urban vs. rural environments on resilience, anxiety, depression and quality of life and patient-parent dyads.”
The cross-sectional study included adolescents (mean age, 15 years; age range, 13-17 years) with an EoE diagnosis recruited from the Arkansas Children’s Hospital eosinophilic gastrointestinal disorder clinic.
The cohort was divided into urban (n = 8; four girls; seven white) and rural (n = 6; four girls; five white) subgroups based on the participant’s county of residence within the state of Arkansas.
The participants completed a series of questionnaires to evaluate anxiety, depression, resiliency and severity of their EoE symptoms, including the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 Item (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), Pediatric Eosinophilic Esophagitis Symptom Severity Modules (PEESS v2.0), and the Pediatric Quality of Life Questionnaire for patients with Eosinophilic Esophagitis (PedsQL). The questionnaires were obtained at baseline and then repeated at 12 months.
“Our study showed us three main results,” Cannon said. “First, both urban and rural participants experience prolonged time to diagnosis with EoE, with rural having an increased time to diagnosis compared to urban. Second, urban had a higher record of anxiety and lower reported depression compared to the rural participants. Third, compared to the overall U.S. general population, both urban and rural participants had overall decreased resiliency.”
Average time to diagnosis from symptom onset was 46.5 months for the urban subgroup and 51.2 months for rural.
Three questionnaires showed no significant differences in quality of life, resiliency, depression or anxiety results between the groups in GAD-7 (P = .022), PHQ-9 (P = 0.385) and CD-RISC (P = 0.371).
However, the urban subgroup showed a trend toward worsening symptom severity with a mean PEESS v2.0 score of 23 ± 13.4 compared with a mean PEESS v2.0 score of 11 ± 7.6 for the rural group.
The National Population Resiliency score was 80.7 overall, as compared with 73.5 in the urban subgroup and 70.3 in the rural subgroup.
Cannon discussed the limitations of the study as well as future considerations.
“First, EoE is a rare disease,” she said. “We recruited all the patients from a small clinic that are explicitly seen at the Arkansas Children’s hospital. Clinic visits have been solely performed over the phone and we had a hard time getting participants to call us back and show up for their visit. Third, only 14 total patients were enrolled in this study, therefore potentially affecting any statistical significance.
“Therefore, larger studies are needed to evaluate the true impact of EoE in urban versus rural environments on anxiety, depression and resilience in adolescence,” Cannon concluded.