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Negative experiences common in children with IBD, but may not increase health care use
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Adverse childhood experience appeared more common than previously estimated in patients with inflammatory bowel disease, according to a recent analysis.
Charles N. Bernstein, MD, from the University of Manitoba IBD Clinical and Research Centre, and colleagues hypothesized that these events, like abuse or parental upheaval, could impact mental health, which then could influence their disease.
“These types of mental health outcomes are also commonly associated with [adverse childhood events (ACE),” they wrote in Inflammatory Bowel Diseases. “Therefore, it is possible that ACEs could impact persons with IBD including their disease activity and overall health care use.”
Of the 345 patients from the Manitoba IBD Cohort Study who participated in the study, 74.2% reported exposure to at least one ACE at a median of 5.3 years following IBD diagnosis. The most commonly reported ACEs were death of a close friend or family member (51.3%), any upheaval thought to significantly shape one’s life or personality (29%) and experience of a severe illness or injury (20.9%). Approximately 20% of patients reported upheaval between parents while 14% reported sexual abuse and 12.2% reported physical abuse.
Bernstein and colleagues found that there was no statistically significant association between experiencing an ACE and health care use, but patients who were exposed to physical or sexual abuse had more non-IBD-related general practitioner visits compared with those not exposed to abuse.
Patients who experienced parental upheaval actually had lower rates of IBD-related health care use. Bernstein and colleagues wrote that this could be due to an uneasiness around authority figures or because they were taken to the doctor less often by their parents during childhood and that pattern of seeking health care persisted into adulthood.
Although they were not able to find a link between ACEs and health care use, Bernstein and colleagues wrote that more outcomes should be explored.
“Descriptive statistics suggest that perceived psychological stress and social functioning may be significantly associated with ACE exposure. These are important outcomes to consider as people with IBD often report that their symptoms increase during periods of high stress,” they wrote. “Inquiry into ACEs may allow clinicians to better counsel their IBD patients in terms of managing psychosocial factors, including stress, anxiety, and depression, and seeking out the appropriate supports.” – by Alex Young
Disclosures: Bernstein reports being on advisory boards for AbbVie Canada, Ferring Canada, Janssen Canada, Napo Pharmaceuticals, Pfizer Canada, Shire Canada and Takeda Canada. He also reports receiving educational grants from AbbVie Canada, Janssen Canada, Shire Canada and Takeda Canada. Additionally, he reports being on speakers’ panels for Ferring Canada, Medtronic Canada, Shire Canada and Takeda Canada. He reports consulting for 4D Pharma and Mylan Pharmaceuticals. The authors report no relevant financial disclosures.
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