Negative hospital experience for IBD linked to development of posttraumatic stress
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Patients with poorly managed anxiety and pain during hospitalization had the highest risk for developing inflammatory bowel disease-related posttraumatic stress, according to research published in Inflammatory Bowel Diseases.
“Recent research by our group into [posttraumatic stress] related to IBD experiences (IBD-PTS) finds approximately 25% of patients report significant PTS symptoms, with women and racial and ethnic minorities disproportionately affected,” Tiffany H. Taft, PsyD, MIS, research associate professor of medicine and psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, and colleagues wrote. “We found in both survey data and in-depth patient interviews with IBD patients that frightening hospital experiences may be a contributor to the development of IBD-PTS.”
They added, “Patients with chronic IBD-PTS report poorer quality of life, more depression and are less likely to report their disease as being in remission.”
In a cross-sectional observational study, Taft and colleagues aimed to identify aspects of hospitalizations that may increase the risk for the development of IBD-PTS. They enrolled 639 adult patients with IBD who had at least one IBD-related hospitalization and administered various questionnaires evaluating PTSD symptoms (PCL-5), patient experience and hospital-induced stressors.
Approximately two-thirds of study patients had Crohn’s disease, and the majority reported being in remission or having minimal IBD symptoms. At the time of the study, 6.1% of patients self-reported an IBD-PTS diagnosis identified by a mental health provider.
According to analysis, the average number of traumatic events was 2.54. More than half of patients (55%) reported IBD symptoms or flares as the source of trauma, 40% reported hospitalization, 30% reported procedures or tests, 28% reported medications and 27% reported surgery.
Similar to previous study results, 11% of patients met the diagnostic cutoff score for IBD-PTS (PCL-5 > 32), with more women than men meeting this metric. The most frequent moderate to severe symptom was re-experiencing (29%), followed by hyperarousal (24%), avoidance behaviors (22%) and mood or cognitive changes (22%).
Patients who reported poorer hospital experiences, including length of stay, ICU use and surgery, were 1.3 times more likely to have severe IBD-PTS. Additionally, patients with longer lengths of stay were 1.4 (95% CI, 1.15-1.7) times more likely to report moderate to severe symptoms of re-experiencing and 1.38 (95% CI, 1.12-1.7) times more likely to experience “significant” behaviors of avoidance. Frequent anxiety while hospitalized more than doubled the odds of IBD-PTS.
Female patients who felt physicians listened to their concerns were less likely to experience full IBD-PTS (OR = 1.45; 95% CI, 1.21-1.63). Similarly, feeling respected by nurses (OR = 1.95; 95% CI, 1.42-2.68), listened to by physicians (OR = 1.7; 95% CI, 1.34-2.15) and having controlled pain (OR = 1.48; 95% CI, 1.17-1.89) and anxiety (OR = 1.28; 95% CI, 1.08-1.51) were associated with the greatest odds of a “more positive” hospital rating.
“As in other chronic conditions, a close working relationship with the medical team can increase the likelihood of better outcomes for patients,” Taft and colleagues concluded. “The hospitalization experience, specifically, can lead patients to feel physically and emotionally vulnerable, setting the stage for PTS to develop.”
They added, “In the interim, we recommend all IBD patients be screened for PTS symptoms at their first clinical visit after discharge using the Primary Care PTSD-Screen.”
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