Journal Articles

Abstract:

An adverse relationship between coeliac disease and the development of disordered eating patterns is well established. The aim of this study was to replicate and extend Satherley et al.‘s (2016) study exploring coeliac-specific and non-specific factors predicting disordered eating. An online survey was completed by 187 adults with coeliac disease (90.4% female; Mean age = 48.92; Mean years living with coeliac disease = 11.86). Results indicated that greater disordered eating correlated with being female, poorer dietary adherence, greater gastrointestinal and psychological symptoms, and more coeliac-related food concerns. Hierarchical regression analyses found that psychological distress remained the only predictor of disordered eating when both coeliac-specific and non-specific factors were considered. Age, body mass index, psychological distress, years with coeliac disease and dietary nonadherence were found to significantly predict binge eating severity. The findings suggest that psychological distress is a risk factor for disordered eating in coeliac disease and that binge eating behaviours may be a particularly relevant factor for dietary nonadherence in those living with coeliac disease.

 URL: https://doi.org/10.1016/j.appet.2021.105744

URL: https://doi.org/10.1111/apt.16639

Abstract:

The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (χ2 (9) = 17.06, p = .05, χ2/N = 1.90, RMSEA = 0.05, SRMR = 0.04, CFI = .99, TLI = .97, GFI = 0.99), indicating the influence of gastrointestinal symptoms on QoL was mediated by illness perceptions, fear of COVID-19, adaptive and maladaptive coping, and psychological distress. Interventions targeting the fear of COVID-19 in the context of an individual’s perceptions will likely enhance QoL during the pandemic.

URL: https://doi.org/10.1007/s10880-021-09823-y

Abstract:

This study aimed to explore the association between perceived isolation and symptoms of distress in people with GI disorders at the time of the pandemic; and to examine factors which moderate this relationship. This online cross-sectional survey was advertised in May–September 2020 via patient organisations and associated social media. Overall, 831 people (82% female, mean age 49 years) from 27 countries participated. A significant relationship between social isolation and psychological distress was noted (r = .525, p < .001). GI symptoms moderated the association between isolation and distress (B = .047, t = 2.47, p = .015). Interventions targeting these factors may help to reduce distress in people with GI disorders at the time of major stressors such as the COVID-19 pandemic.

URL: https://doi.org/10.1007/s10880-021-09818-9

Abstract:

This paper describes the development and validation of the Gastrointestinal Unhelpful Thinking scale (GUTs). The purpose of the research was to develop the GUTs to assesses in tandem the primary cognitive-affective drivers of brain-gut dysregulation, gastrointestinal-specific visceral anxiety and pain catastrophizing.  The research involved three phases which included undergraduate and community samples. In the first phase, an exploratory factor analysis revealed a fifteen-item two-factor (visceral sensitivity and pain catastrophizing) scale (N=323), which then was confirmed in the second phase (N=399, χ²(26)=2.08, p=.001, Tucker Lewis index=0.94, Comparative fit index=.96, Standardized root mean square residual=.05, and Root mean square error of approximation=.07). Demonstrating convergent validity, GUTs total and subscales were strongly correlated with the modified Manitoba index, Irritable Bowel Syndrome Symptom Severity Scale scores and the Visceral Sensitivity Index and Pain Catastrophizing Scale. A third phase (N=16) established test-retest reliability for the GUTs (total and subscales). The test-retest reliability correlation coefficient for the GUTs total score was 0.93 (p < 0.001) and for the GUTs subscales were 0.86 (p < 0.001) and 0.94 (p < 0.001). The GUTs is a brief psychometrically valid measure of visceral anxiety and pain catastrophizing that might be useful in the future for both clinicians and researchers who wish to measure these thinking patterns and relate them to changes in gastrointestinal and psychological symptoms.

URL: TBA

Abstract:

Introduction: Non-government organisations (NGOs) often represent people who are underserved or experiencing vulnerability. Crohn’s & Colitis Australia (CCA) is aware that many Australians with inflammatory bowel disease (IBD) are not reached by current communication and engagement activities. The aim of the CCA IBD project is to implement the Optimising Health Literacy and Access (Ophelia) process over 3 years to collaboratively codesign ways to improve delivery of information, services and resources for people with IBD and their carers.

Methods and analysis: Health literacy and other data for phase 1 will be collected using the Health Literacy Questionnaire, eHealth Literacy Questionnaire, IBD-related questions and qualitative interviews with people with IBD and their carers to ascertain their lived experience. Quantitative data will be analysed using descriptive statistics and cluster analysis. Identified clusters will be combined with qualitative data to develop vignettes (narratives of people’s experiences of living with IBD) for stakeholder workshops to generate ideas for useful, accessible and sustainable solutions for identified health literacy needs. Selection and testing of health literacy actions happens in phase 2 and implementation and evaluation in phase 3 (2021-2023). Outcomes of this project include giving voice to people living with IBD, their carers and frontline healthcare practitioners. Genuine codesign informs the development and implementation of what is needed and wanted to improve access to and availability and quality of information and resources that support people to manage their health. There is potential for other NGOs to use the CCA Ophelia model in other health contexts to improve engagement with and understanding of the needs of the people they serve and to reduce health inequalities and improve health outcomes.

Ethics and dissemination: Ethics approval for Ophelia phase 1 has been obtained from the Human Research Ethics Committee of Swinburne University of Technology (Ref: 20202968-4652) and by the South West Sydney Local Health District Research and Ethics Office for the purposes of questionnaire recruitment at Liverpool Hospital (Ref: 20202968-4652). Dissemination of the study findings will be the national codesign process and ownership development across the CCA community and through the genuine engagement of clinicians and relevant managers across Australia. The model and process will be directly distributed to international IBD associations and to other NGOs. It will also be disseminated through publication in a peer-reviewed journal, conference presentations and public reports on the CCA and Swinburne University of Technology website.

URL: https://bmjopen.bmj.com/content/11/8/e045059

Abstract:

A robust scale capable of assessing illness-related experiential avoidance (EA) in any given medical condition is currency lacking. Further, there is no available measure that assesses EA related to illness behaviours, i.e., actions and/or reactions in relation to feeling unwell that have the purpose of defining one’s state of health and obtaining physical or emotional relief from perceived or actual illness. This study intends to fill this significant gap by presenting the development and psychometric test of a measure of EA related to illness behaviour, the Illness Behaviour Avoidance Scale (IBAS). A total of 370 Portuguese adults with chronic illness participated in the study. The structure and validity of the IBAS was tested through an Exploratory Factor Analysis (EFA; n = 185), a Confirmatory Factor Analysis (CFA; n = 185), and reliability analyses. The IBAS presented a 7-item unifactorial structure, with good global (CMIN/DF = 2.08; CFI = 0.97; TLI = 0.94; SRMR = 0.04; RMSEA = 0.08, p = 0.139) and local adjustments (SRWs 0.56–0.73; SMCs 0.31–0.53). It also presented a good internal consistency (with αs = 0.82), and construct and discriminant validity. The IBAS appears to be a significant improvement from the use of previous EA measures in illness contexts. This scale can provide a measurement of whether the behavioural response to any given condition is a manifestation of EA.

URL: https://doi.org/10.1007/s12144-021-02219-z

Abstract:

Background and aims: Using the Common Sense Model (CSM), this study aimed to examine the extent to which illness beliefs, coping styles, self-efficacy, and mindfulness mediate this relationship.

Methods: Two hundred and sixty-one adults (198 females; 169 with Crohn’s Disease) with IBD participated in this cross-sectional study. Measures used in this study were the short Crohn’s Disease Activity Index, Ulcerative Colitis Lichtiger Index, Inflammatory Bowel Disease Questionnaire, New General Self-Efficacy Scale, Carver Brief COPE scale, Mindful Attention Awareness Scale, Brief Illness Perceptions Questionnaire, and the Depression and Anxiety Stress Scales.

Results: Using structural equation modelling, the final model indicated IBD symptoms had a significant direct influence only on illness perceptions (β = 0.66, p < .001). In turn, illness perceptions had a significant direct influence on depression and anxiety (β = 0.34, p < .001) and QoL (β = -0.67, p < .001), and was also linked to higher maladaptive coping (β = 0.28, p < .001) and lower self-efficacy (β = -0.49, p < .001), but not with mindfulness or adaptive coping (p > .05). Maladaptive coping (β = 0.46, p < .001) and mindfulness (β = 0.23, p < .001) were linked with increased distress. QoL was influenced by distress (β = -0.40, p < .001).

Conclusions: Consistent with the predictions of the CSM, the relationships between IBD symptoms and depression and anxiety, and between IBD symptoms and quality of life, are statistically mediated via psychological variables including illness perceptions and maladaptive coping.

URL: https://doi.org/10.1016/j.jpsychores.2021.110596

Abstract

Introduction: Endometriosis is a debilitating chronic inflammatory condition highly burdensome to the healthcare system. The present trial will establish the efficacy of (1) yoga and (2) cognitive-behavioural therapy (CBT), above (3) education, on quality of life, biopsychosocial outcomes and cost-effectiveness.

Methods and analysis: This study is a parallel randomised controlled trial. Participants will be randomly allocated to yoga, CBT or education. Participants will be English-speaking adults, have a diagnosis of endometriosis by a qualified physician, with pain for at least 6 months, and access to internet. Participants will attend 8 weekly group CBT sessions of 120 min; or 8 weekly group yoga sessions of 60 min; or receive weekly educational handouts on endometriosis. The primary outcome measure is quality of life. The analysis will include mixed-effects analysis of variance and linear models, cost-utility analysis from a societal and health system perspective and qualitative thematic analysis.

Ethics and dissemination: Enrolment in the study is voluntary and participants can withdraw at any time. Participants will be given the option to discuss the study with their next of kin/treating physician. Findings will be disseminated via publications, conferences and briefs to professional organisations. The University’s media team will also be used to further disseminate via lay person articles and media releases.

URL: http://dx.doi.org/10.1136/bmjopen-2020-046603

Abstract:

Background and Aims:  The aim of the cross-sectional study was to extend the Common Sense Model (CSM) to explore the impact of inflammatory bowel disease (IBD) activity on quality of life (QoL), and the potential mediating roles of illness perceptions, visceral sensitivity, coping styles, acceptance, and psychological distress.

Materials and Methods: One hundred and forty-one IBD patients (86 with Crohn’s disease, 74 males, mean age 40.43 years) from two metropolitan hospital IBD outpatient clinics participated. Measures included disease activity (Crohn’s Disease Activity Index, Simple Clinical Colitis Activity Index), illness perceptions (Brief Illness Perceptions Questionnaire), visceral sensitivity (Visceral Sensitivity Index), coping styles (Brief COPE), acceptance (Acceptance and Action Questionnaire-II), psychological distress (Depression, Anxiety and Stress Scale), and QoL (EUROHIS-QOL).

Results:  A structural equation model of the extended CSM was found to have a good fit (χ2 (10) = 10.07, p = .43, χ2/N = 1.01, root mean square error of approximation (RMSEA) = 0.01, standardized root mean residual (SRMR) = 0.04, comparative index fit (CFI) = 1.00, tucker-lewis index (TLI) = 1.00, goodness-of-fit (GFI) = 0.98). After controlling for irritable bowel syndrome diagnosis, the impact of disease activity on QoL was statistically mediated by illness perceptions, maladaptive coping styles, and psychological distress. In addition, visceral sensitivity bordered on influencing the impact of disease activity and illness perceptions on QoL through psychological distress.

Conclusion: This study demonstrates that together with illness perceptions and coping styles, visceral sensitivity plays an important role in an individual’s adaption to living with IBD.

URL: TBA

Abstract:

Objective: To explore the subjective experiences of student circus arts performers with atraumatic shoulder instability undertaking a 12-week shoulder rehabilitation program during the COVID-19 pandemic lockdown, in Melbourne, Australia.

Methods: Using a qualitative design, 14 circus arts students from the National Institute of Circus Arts (Australia) were individually interviewed via teleconsultation. All interviews were recorded, transcribed, and analysed using inductive thematic analysis.

Results: Five overarching themes were identified: (i) impact (physical and mental), (ii) opportunity, (iii) developing routine, (iv) client-therapist relationship, and (v) transformation. All participants reported positive physical changes to their shoulder including increases in strength, stability, range of motion, less pain, “clicking” and “clunking,” improved posture, muscle memory, as well as carry-over to functional circus activities. The pandemic’s mental impact varied across the cohort, with positive and negative experiences described in relation to cognitive, social, and affective factors. Most performers felt the pandemic provided an opportunity to focus on rehabilitation of their shoulder. The program effects were also underpinned by positive client-therapist relationships and a progressive transformation of learning where students gained knowledge of their condition, developed tools to manage their current shoulder impairment, and learned how to apply this new knowledge to future management of their condition.

Conclusion: A shoulder exercise intervention delivered via teleconsultation during the COVID-19 pandemic resulted in subjective reports of positive physical changes to the participants’ shoulder health complaint. This was facilitated through client-physiotherapist relationships, providing structure during uncertain times, and by providing education to help in understanding their condition and its future management.

URL: https://doi.org/10.21091/mppa.2021.3019

Abstract:

Background: Individuals living with coeliac disease generally experience a remission of symptoms after adopting the gluten-free diet but often report substantial treatment burden and ongoing quality of life issues. Psychosocial factors have been suggested to play a significant role in post-diagnosis quality of life but have yet to be systematically reviewed.

Aim: To review the evidence for psychosocial factors associated with quality of life in adult coeliac disease cohorts.

Methods: Studies were identified via systematic searches of eight databases (MEDLINE, Embase, Emcare, PsycINFO, Ovid Nursing, CINAHL, Informit Health Collection, Cochrane Library) in May 2019.

Results: Fourteen studies were included involving 3372 participants (80.2% female, mean age = 46.4 years). Symptoms of depression and anxiety were the most examined psychosocial factors across all studies. Quality of life was differentially associated with psychological distress, illness perceptions, coping, and attitudes/behaviours regarding food and the gluten-free diet.

Conclusion: Several psychosocial factors are associated with quality of life in adults living with coeliac disease. Current evidence suggests these factors are interrelated and may influence quality of life directly, via reduced psychological well-being, and indirectly, via reduced adherence to the gluten-free diet. Future research is needed to examine these processes concurrently, with the aim of elucidating the psychosocial mechanisms underlying post-diagnosis well-being and identifying potential targets for psychosocial intervention.

URL: https://doi.org/10.1016/j.jpsychores.2021.110537

Abstract:

Background: The mental health response to the coronavirus (COVID-19) pandemic-related product shortages in those living with chronic gastrointestinal (GI) disorders has received little attention. We aimed to explore the association between the pandemic-related product shortages and psychological distress in people with GI disorders.

Methods: This online cross-sectional survey was nested within an ongoing, international, prospective study of well-being in people with GI disorders. The study was advertised in multiple countries in May-September 2020 via patient organizations and social media. The primary outcome measure was distress, evaluated by the Depression Anxiety Stress Scale. We utilized linear regressions, adjusting for covariates and testing individual moderation effects.

Key results: Overall, 831 people completed the survey from 27 countries, of whom 82% were female (mean age = 49 years). The most common disorders included inflammatory bowel disease (n = 322), celiac disease (n = 273), and irritable bowel syndrome (n = 260). Significant problems accessing food were reported by 19.8%, non-medical therapies by 16%, toilet paper by 10.8%, and essential medication by 8.9% of the sample (>5% pain medication). There was a positive association between toilet paper and pain medication shortages and distress, and a negative association between food shortages and distress. Significant moderation effects were identified for COVID-19 prevalence and toilet paper and food shortages, and between COVID-19 fear and pain medication shortages.

Conclusions and inferences: The study documented a significant relationship between product shortages and psychological distress, which were associated with COVID-19 prevalence and fear. Strategies addressing COVID-19 fear could potentially modify the relationship between shortages and distress.

URL: https://doi.org/10.1111/nmo.14198

Abstract:

Background: Gastrointestinal ultrasound is increasingly used for point of care assessment of inflammatory bowel disease.

Aims: To explore the utility of gastrointestinal ultrasound as a point-of-care assessment tool from the perspectives of the clinician and patient.

Methods: A prospective, observational cohort study was designed utilising routine outpatient consultations. Adult patients with inflammatory bowel disease were allocated to receive gastrointestinal ultrasound or not at the discretion of their treating clinician. Patients completed self-reported session experience questionnaires at study entry, immediately after their consultation, and 4 and 16 weeks later. Clinicians reported disease activity status, therapeutic decisions and clinical management.

Results: Of 259 participants, mean age 40 (SD: 13) years, 54% male, 73 (28%) underwent ultrasound. Time since diagnosis was 9.2 (8.5) years (ultrasound) and 11.3 (9.2) years (no ultrasound). Immediately after ultrasound, patients who self-reported active disease reported better understanding of all aspects of their disease and disease symptoms were more confident in their ability to make informed decisions about managing their disease and had improved knowledge domain scores compared with the non-ultrasound group (all P < 0.05). Ultrasound had no influence over the patients’ ability to manage their own healthcare but tended to be associated with transient improvement in medication adherence. After the ultrasound, the clinician’s assessment of patient’s disease activity changed in 22% (16/73) and management was altered in 56% (41/73) with anti-inflammatory therapy escalated in 33. About 47% (23/49) patients with Crohn’s disease had their medication changed in the ultrasound group, compared to only 22% (25/112) in the nonultrasound group (P = 0.002). For patients with ulcerative colitis, medications were altered in 68% (15/22) compared to 26% (24/70) in the nonultrasound group (P = 0.005) When stratified for disease activity, medication change was more likely in those having ultrasound (P = 0.024).

Conclusions: Point-of-care gastrointestinal ultrasound has the potential to enhance the clinical management of inflammatory bowel disease by contributing to clinician decision-making and education of patients regarding their disease.

URL: https://doi.org/10.1111/apt.16452

URL: https://doi.org/10.1111/apt.16379

Abstract:

Parcopresis is a condition where individuals have trouble (or inability) defecating in restrooms due to the perceived scrutiny of others. The aim of the current research was to identify the prevalence of public toilet avoidance and explore if an extended socio-cognitive model of parcopresis predicts toilet avoidance. Seven-hundred and fourteen university students (73.2% female; mean age = 28.79 years) met criteria to participate and completed a series of questionnaires and ten restroom vignettes. On average 80.00% (gender adjusted 82.54%) of the participants chose to use an available toilet, while 16.78% (gender adjusted 14.44%) avoided a toilet for non-contamination fears. A further 3.22% (gender adjusted 3.01%) participants on average avoided using a toilet due to fears of contamination. Males were significantly more likely to use and not avoid toilets than females across all vignettes. A structural equation model (SEM) indicated the data supported the proposed model well (chi(2)p value = .185, CMIN/df = 1.359, CFI = .998, TLI = .995, RMSEA = .023, SRMR = .0207) with significant direct relationships being found between: dysfunctional attitudes influencing fear of positive and negative evaluation and fear of social reprisal, and fear of positive and negative evaluation influencing fear of social reprisal and social anxiety symptoms. Social anxiety symptoms had a direct significant influence on parcopresis symptoms, while in turn parcopresis symptoms had a direct significant influence on toilet avoidance. The current study provides evidence that toilet avoidance is underpinned by social anxiety processes and affects at least 14.44% of university students.

URL: https://doi.org/10.1007/s12144-021-01586-x

Abstract:

Background: The aim of the study was to examine the impact of diagnostic status (i.e., having a clinical diagnosis of irritable bowel syndrome (IBS) or being symptomatic but undiagnosed on quality of life (QoL)). We also examined whether the relationships between QoL and variables such as symptom frequency, pain catastrophizing, visceral sensitivity, and psychological distress are moderated by diagnostic status.

Methods: The online sample comprised 404 participants (Mage = 33.59, SD = 12.43), of which 98 had been diagnosed with IBS and 306 were symptomatic but undiagnosed.

Results: The findings suggest that even after adjusting for symptom frequency, those diagnosed with IBS experience poorer QoL, relative to those without a diagnosis. Moreover, there was evidence that the relationship between specific QoL domains (namely, sex, food avoidance, and health worry) and psychological variables (namely, pain catastrophizing, and depression) was moderated by diagnostic status.

Conclusion: The results indicate that diagnostic status in relation to IBS has psychological implications for QoL outcomes distinct from symptom frequency, age, and gender. This highlights a substantial gap in our current understanding of how a diagnosis of IBS can impact the lives of those suffering from IBS symptomology and calls into question the intended purpose of diagnosis.

URL: https://doi.org/10.5152/tjg.2021.20517

Abstract:

Aim: The current study evaluated the feasibility and preliminary efficacy of a psychosocial intervention, the Kidney Optimal Health Program, in reducing symptoms of depression and anxiety in individuals with advanced chronic kidney disease.

Methods: Patients with stage 4 or 5 chronic kidney disease were randomized to either a nine-session psychosocial intervention programme or usual care. Feasibility was assessed through recruitment and retention rates and programme acceptability. Participants completed assessments of depression, anxiety and psychosocial health at baseline and at 3-, 6- and 12-month follow-up. A repeated-measures analysis of variance was used to compare groups on outcomes over time.

Results: One hundred and twenty-eight patients were screened for eligibility; 84 consented to participant and were randomized to receive the intervention (N = 42) or usual care (N = 42). 27 (32.1%) participants withdrew prior to baseline assessment. Of those who completed the baseline assessment (N = 57), trial retention was high (75.4% at 3-month, 80.7% at 6-month and 70.2% at 12-month follow-up). Participants reported high levels of programme acceptability. The patients who completed the intervention (N = 17) demonstrated significantly decreased depression at 12-month follow-up compared to the usual care group (N = 13).

Conclusion: The results support the feasibility of the Kidney Optimal Health Program intervention in recruitment, retention and programme acceptability with an improved screening protocol. Preliminary support is provided for improvement in depressive symptoms in patients with advanced chronic kidney disease. Further investigation through a fully powered randomized controlled trial is warranted.

URL: https://doi.org/10.1111/nep.13850

Abstract:

Psychological distress is often observed in patients with gastrointestinal illness. To date, there has been limited research conducted to assess the prevalence and impact of post-traumatic stress disorder (PTSD) in gastrointestinal cohorts. The aim of this systematic review is to review the evidence for the prevalence of PTSD in gastrointestinal cohorts versus comparator groups (healthy controls and chronic illness groups), predictive factors associated with the development and management of PTSD and the impact on patient outcomes. Adult studies were identified through systematic searches of eight databases (MEDLINE, Embase, Emcare, PsycINFO, Ovid Nursing, CINAHL, Informit Health Collection, and Cochrane Library) in February 2020. The overall pooled prevalence rate of PTSD in GI cohorts was 36%; however, the prevalence rate in non-veteran-specific gastrointestinal cohorts of 18% across all GI classification groups is likely to be the more representative rate. The non-gastrointestinal chronic illness cohort PTSD prevalence rate was 11%. Predictors identified in the development of post-traumatic stress in gastrointestinal cohorts include: female gender, poor social support, life adversity, subjective pain, and dietary choices. Post-traumatic stress was found to exacerbate gastrointestinal symptoms in a Crohn’s Disease sample, whereby disease exacerbation was four times in those who met the criteria for probable PTSD. Post-traumatic stress symptoms affect around one in five individuals (non-veteran status) with a gastrointestinal condition. Further research is needed to understand the psychological and biological mechanisms by which PTSD increases the risk of developing and exacerbating gastrointestinal symptoms.

URL: https://doi.org/10.1007/s10620-020-06798-y

Abstract:

This study evaluated the mediating role of self-efficacy, coping, depression and anxiety on the relationship between illness perceptions and quality of life in stroke survivors (n = 72; 32 females; mean [SD] age 65.09 [14.14] years; male mean [SD] age 69.83 [11.81]). Illness perceptions (Brief Illness Perceptions Questionnaire; BIPQ), coping styles (Carver Brief-COPE scale; B-COPE), depression/anxiety (Hospital Anxiety and Depression Scale; HADS), self-efficacy (General Self-Efficacy Scale; GSE) and quality of life (Assessment of quality of life; AQOL-6D) were analysed. Correlation analyses showed illness perception, maladaptive coping, self-efficacy, depression and anxiety to have a significant negative relationship with quality of life. Mediation analyses showed that while maladaptive coping and self-efficacy did not mediate the relationship between illness perception and quality of life, depression and anxiety did. The final model explained 76.74% of the variance in quality of life. Although based on a relatively small sample size, these results provide evidence for the important role of psychosocial factors in quality of life in post-stroke cohorts.

URL: https://doi.org/10.1007/s10880-020-09700-0  

Abstract:

Background and Purpose: Stroke can have a devastating impact on the mental and physical health of stroke survivors and their carers. We aimed to evaluate the effectiveness of a novel psychosocial intervention designed to improve health outcomes in both groups.

Methods: We conducted a randomized controlled trial of a personalized psychosocial intervention (eight 1-hour weekly sessions plus one booster) compared to usual care for adult stroke survivors and carers. Participants recruited from hospital services and community referrals completed questionnaires at baseline, 3, 6, and 12 months. Primary outcomes were quality of life and self-efficacy; secondary outcomes were depressive and anxiety symptoms, coping, illness perception, work and social adjustment, carer strain, and carer satisfaction. Mixed-effect model repeated measures analysis between groups and across time was conducted.

Results: Of the 173 participants recruited (89 stroke survivors; 84 carers), a total of 137 participants – 73 stroke survivors (intervention n = 42; usual care n = 31) and 64 carers (intervention n = 35; usual care n = 29) – underwent analysis up to 12 months. No statistically significant differences were found in the primary outcomes between groups over time, though a significant improvement in carer satisfaction was found at 6 months in the intervention group compared to the usual care group.

Conclusion: A personalized psychosocial intervention resulted in a significant improvement in carer satisfaction at 6 months but in no other outcomes. A lack of available services and barriers to social engagement may have impeded the effectiveness of this intervention.

URL: https://doi.org/10.1080/10749357.2020.1738677

Abstract:

This study evaluated the mediating role of self-efficacy, coping, depression and anxiety on the relationship between illness perceptions and quality of life in stroke survivors (n = 72; 32 females; mean [SD] age 65.09 [14.14] years; male mean [SD] age 69.83 [11.81]). Illness perceptions (Brief Illness Perceptions Questionnaire; BIPQ), coping styles (Carver Brief-COPE scale; B-COPE), depression/anxiety (Hospital Anxiety and Depression Scale; HADS), self-efficacy (General Self-Efficacy Scale; GSE) and quality of life (Assessment of quality of life; AQOL-6D) were analysed. Correlation analyses showed illness perception, maladaptive coping, self-efficacy, depression and anxiety to have a significant negative relationship with quality of life. Mediation analyses showed that while maladaptive coping and self-efficacy did not mediate the relationship between illness perception and quality of life, depression and anxiety did. The final model explained 76.74% of the variance in quality of life. Although based on a relatively small sample size, these results provide evidence for the important role of psychosocial factors in quality of life in post-stroke cohorts.

URL: https://doi.org/10.1080/13548506.2019.1695865

Abstract:

Irritable bowel syndrome (IBS) affects up to 20% of the global population and is associated with impaired health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to investigate differences in HRQoL of those with IBS compared with healthy controls and to examine whether HRQoL improves following psychological intervention. Online databases were searched for articles from 2002 to 2017. Studies were screened and data extracted according to predetermined criteria. A total of 4,154 citations were identified from which 36 were eligible for inclusion. Eight studies compared HRQoL of those with IBS (n = 822) with that of healthy individuals (n = 3,809). Those with IBS suffered significant impairment across all HRQoL domains compared with healthy individuals, with the majority of effects (Cohen’s d) being moderate to large. Twenty-eight studies investigated HRQoL in IBS following psychological intervention (n = 1,308) relative to controls (n = 1,006). All HRQoL domains improved with large effects following treatment; however, maintenance of these effects was inconsistent. Those with IBS experience poorer HRQoL than the wider community; nevertheless, psychological interventions are associated with improved HRQoL across all domains. High-quality studies are needed to better inform gastroenterological nurses of which interventions are most efficacious in alleviating the burden of IBS, and which IBS subpopulations would benefit.

URL: https://doi.org/10.1097/SGA.0000000000000530

Abstract:

Background: Quality of care in inflammatory bowel disease (IBD) has received much attention internationally; however, the available surveys focus on health professionals rather than patients.

Aims: To assess the experiences of healthcare for people living with IBD against established Australian IBD Standards.

Methods: An online cross-sectional survey was conducted with Australians ≥16 years old recruited via Crohn’s & Colitis Australia membership, public and private clinics and the Royal Flying Doctor Service. Participants completed a questionnaire incorporating items addressing the Australian IBD Standards 2016, the Picker Patient Experience Questionnaire, IBD Control Survey and the Manitoba Index.

Results: Complete data were provided by 731 respondents (71.5% female, median age 46 years, ranging from 16 to 84 years). While the majority (74.8%) were satisfied with their IBD healthcare, the care reported did not meet the Australian IBD Standards. Overall, 32.4% had access to IBD nurses, 30.9% to a dietician and 12% to a psychologist in their treating team. Participants managed by public IBD clinics were most likely to have access to an IBD nurse (83.7%), helpline (80.7%) and research trials (37%). One third of respondents reported waiting >14 days to see a specialist when their IBD flared. Participants received enough information, mostly from medical specialists (88.8%) and IBD nurses (79.4%). However, 51% wanted to be more involved in their healthcare.

Conclusions: These data show discordance between expectations of patients and national standards with current levels of service provision, which fail to deliver equitable and comprehensive IBD care.

URL: https://doi.org/10.1111/imj.14683

Abstract:

This article reviews the differences and similarities in medication adherence between adolescent and adult cohorts with inflammatory bowel disease. The review covers the rates of medication adherence, as well as predictors, consequences, and related interventions. Rates of adherence were more favorable among adolescents (65%-90%) than among adults (55%-70%). Major risk factors for poor adherence in adolescents include low medication knowledge, not establishing good medication habits initially, and peer victimization with low social support. For adults, nonadherence is more frequently unintentional (e.g., forgetting) and occurs more often in the context of a poor-quality patient-physician relationship, low medication knowledge, infrequent/missed appointments, busy lifestyle, and concurrent mental health concerns. Nonadherence to medication is associated with worsening of symptoms and risk of relapse in adults and adolescents. Nurses can play a significant role in influencing adherence to medication in patients with inflammatory bowel disease. In particular, nurses can help to impart knowledge on the importance of medication and identify factors that may help or hinder an individual in terms of adherence. Based on the current review, implications for practice and recommendations for nurses to promote medication adherence across both adolescent and adult cohorts are provided. Limitations of the currently available evidence and suggestions for future research are discussed.

URL: https://doi.org/10.1097/SGA.0000000000000467

Abstract

The current research investigates the development and validation of the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). Over two studies, two independent samples consisting of university students and respondents from the general public were used to validate the scale (study 1 n = 226; study 2 n = 377). A 15-item, two-factor model was confirmed in study 2 where strong construct (convergent and divergent) validity was demonstrated. The BBIPSS did not display significant correlations with openness and gender (divergent validity) and displayed significant correlations with depression, anxiety and stress scores (DASS), alongside paruresis and parcopresis scores (SBBS; convergent validity) and the BoBCAtS. The BBIPSS also demonstrated strong test-retest reliability (bladder r = 0.89; bowel r = 0.86) in a small sample of adults (n = 13). Overall, this scale provides researchers and clinicians with a reliable and psychometrically valid assessment tool to measure bladder and bowel incontinence phobia severity.  

URL: https://doi.org/10.1891/0889-8391.33.4.271

Abstract

To date, research exploring the socio-cognitive processes associated with paruresis and parcopresis symptomology is lacking. The current study aimed to investigate how the socio-cognitive processes dysfunctional attitudes (DAs) and fear of negative and positive evaluation (FNE and FPE respectively) relate to paruresis and parcopresis symptomology. In total, 254 undergraduate students (74.0% female; mean age = 31.67 years) completed a cross-sectional online study. A structural equation model indicated the data fit reasonably well (χ2 p value = .209, CMIN/df = 1.514, CFI = .995, TLI = .983, RMSEA = .045, SRMR = .0272), with FPE mediating the relationship between DAs and paruresis symptom severity (p = .001) along with parcopresis symptom severity (p = .001). However, secondary analyses identified that FPE and FNE act as mediators between DAs and paruresis and parcopresis symptom severity when placed in separate models. This is the first study to provide evidence that the psychosocial-cognitive processes DAs and fear of evaluation play an important role in paruresis and parcopresis symptomology. Although this research should be replicated, the current study provides evidence that DAs, and FPE are important contributory factors in paruresis and parcopresis symptoms. 

URL: https://link.springer.com/article/10.1007/s12144-019-0125-7

Abstract:

Background and aims: The aim of this paper was to undertake a systematic review of the research utilizing the Common Sense Model (CSM) involving IBD cohorts to explain the psychosocial processes, including illness perceptions and coping styles, that underpin patient reported outcomes (PROs) – psychological distress (PD) and quality of life (QoL).

Methods: Adult studies were identified through systematic searches of 8 bibliographic databases run in August 2020 including Medline, Embase, and PsychINFO. No language or year limits were applied.

Results: Of 848 records identified, 516 were selected with seven studies evaluating the CSM mediating pathways for final review (n = 918 adult participants). Consistent with the CSM, illness perceptions were associated with PD and QoL in six and five studies respectively. Illness perceptions acted as mediators, at least partially, on the relationship between IBD disease activity and PD and/or QoL in all seven studies. Coping styles, predominantly maladaptive-based coping styles, were found to act as mediators between illness perceptions and PD and/or QoL in five studies. Perceived stress was identified in one study as an additional psychosocial process that partially explained the positive influence of illness perceptions on PD, and a negative impact on QoL. Five studies were classified as high quality and two as moderate.

Conclusions: The CSM can be utilised in IBD cohorts to evaluate key psychosocial processes that influence PROs. Future research should explore additional psychosocial processes within the CSM and evaluate the efficacy of targeting CSM processes to promote psychological well-being and QoL in IBD cohorts.

URL: https://doi.org/10.1016/j.jpsychores.2020.110283

Materials and methods: The sample comprised of 585 participants (82.4% female) who completed an online questionnaire containing the ORTO-15, Eating Attitudes test, Obsessive Compulsive Inventory Revised. A series of Confirmatory Factor Analyses were conducted to test model fit. Binary logistic linear regression and receiver-operating-characteristics (ROC) analyses were used to obtain cut-offs.

Results and conclusion: Results showed that none of the three published versions (9, 11, and 15-item) of the ORTO produced an acceptable model. Subsequent exploratory and confirmatory factor analyses yielded a seven-item version of the ORTO (ORTO-7) with a strong and stable factor structure. Analysis of cut-offs revealed that a cut-off score of equal or greater than 19 on the ORTO-7 represents probable orthorexia.

Level of evidence: Level V, descriptive study.
URL: https://link.springer.com/article/10.1007%2Fs40519-018-0515-0 

Design
Two-group, parallel-group, randomised controlled trial, conducted between September 2012 and May 2017.

Setting
Single centre study conducted at a University-affiliated, tertiary hospital.

Intervention
People with arthritis scheduled for TJA, with a well-being score <40 (Short Form-12 Survey) were randomly allocated to a pre-surgery eight-week MBSR program or treatment as usual (TAU). Outcome Measures Self-reported joint pain and function at 12 months post-surgery, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were knee stiffness and global improvement (WOMAC); physical and psychological well-being (Veterans RAND 12-item Health Survey); self-efficacy (Arthritis Self-Efficacy Scale); and mindfulness (5-Factor Mindfulness Questionnaire). Results 127 participants were randomised; 65 to MBSR and 62 to TAU, of which 45 participants allocated to the intervention and 56 participants allocated to usual care proceeded to surgery and 100 (99%) completed primary outcome measures. Greater improvements in knee pain (mean difference, -10.3 points, 95% CI -19.0 to -1.6; P = 0.021) and function (mean difference, -10.2 points, 95% CI -19.2 to -1.3; P = 0.025) at 12 months post-surgery were observed in the MBSR group compared to the TAU group. A between group difference in global scores (-9.5 points, 95% CI -17.9 to -1.1; P = 0.027) was also observed. No other differences in secondary outcomes were observed. Conclusion MBSR improves post-surgery pain and function in people with psychological distress undergoing TJA. Further research is required to examine potential barriers to broader implementation and uptake. URL: https://doi.org/10.1016/j.ctim.2019.08.010  

Methods
An online cross‐sectional survey was conducted with Australians ≥16 years old recruited via Crohn’s & Colitis Australia membership, public and private clinics, and the Royal Flying Doctor Service. K10 was used to measure psychological distress. The Chi‐square test was used to compare those with and without distress on key variables.

Results
Overall, 731 respondents provided complete data (71.5% female, mean age 46.5 years). Overall, 50% of respondents reported distress; only 15.2% were currently seeing a mental health practitioner; only 16.1% were asked about their mental health by their IBD specialist or IBD nurse; and only 12.2% reported access to a mental health practitioner as part of their IBD service. Those with psychological distress were significantly less satisfied with their IBD care; more commonly hospitalized; had an active disease, fistula or perianal disease, pain, or fatigue; and were receiving steroids, opioids, or antidepressants (all P  < 0.05). As many as 68.2% of those with severe distress were not seeing a mental health practitioner. Conclusions The integrated biopsychosocial model of health care, with regular mental health screening and good access to mental health professionals, is requested by people living with IBD to improve their outcomes. URL: https://doi.org/10.1002/jgh3.12236  

Aim: The objective of this article is to summarise the forms and causes of urinary and faecal incontinence, highlight the psychological mechanisms and psychopathology associated with incontinence, and provide management recommendations.

Conclusion: Urinary and faecal incontinence can have a significant impact on an individual’s psychological wellbeing and quality of life. Psychological factors may either contribute to or arise from incontinence and should be addressed as part of the overall management plan.

URL: https://pubmed.ncbi.nlm.nih.gov/31581179/ 

Abstract:

No abstract is available for this article 

URL: https://doi.org/10.1111/cp.12201 

Abstract:

This paper reviews the differences and similarities in medication adherence between adolescent and adult Inflammatory Bowel Disease cohorts. The review covers the rates of medication adherence, as well as predictors, consequences, and related interventions. Rates of adherence were more favorable among adolescents (65-90%) than adults (55-70%). Major risk factors for poor adherence in adolescents include low medication knowledge, not establishing good medication habits initially and peer victimization with low social support. For adults, non-adherence is more frequently unintentional (e.g., forgetting) and occurs more often in the context of a poor-quality patient-physician relationship, low medication knowledge, infrequent/missed appointments, busy lifestyle, and concurrent mental health concerns. Non-adherence to medication is associated with worsening of symptoms and risk of relapse in adults and adolescents. Nurses can play a significant role in influencing adherence to medication in patients with IBD. In particular, nurses can help to impart knowledge on the importance of medication, and identify factors that may help or hinder an individual in terms of adherence. Based on the current review, implications for practice and recommendations for nurses to promote medication adherence across both adolescent and adult cohorts are provided. Limitations of the currently available evidence and suggestions for future research are discussed.

URL: TBA

Abstract

The current research investigates the development and validation of the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). Over two studies, two independent samples consisting of university students and respondents from the general public were used to validate the scale (study 1 n = 226; study 2 n = 377). A 15-item, two-factor model was confirmed in study 2 where strong construct (convergent and divergent) validity was demonstrated. The BBIPSS did not display significant correlations with openness and gender (divergent validity) and displayed significant correlations with depression, anxiety and stress scores (DASS), alongside paruresis and parcopresis scores (SBBS; convergent validity) and the BoBCAtS. The BBIPSS also demonstrated strong test-retest reliability (bladder r = 0.89; bowel r = 0.86) in a small sample of adults (n = 13). Overall, this scale provides researchers and clinicians with a reliable and psychometrically valid assessment tool to measure bladder and bowel incontinence phobia severity.  

URL: TBA

Abstract

To date, research exploring the socio-cognitive processes associated with paruresis and parcopresis symptomology is lacking. The current study aimed to investigate how the socio-cognitive processes dysfunctional attitudes (DAs) and fear of negative and positive evaluation (FNE and FPE respectively) relate to paruresis and parcopresis symptomology. In total, 254 undergraduate students (74.0% female; mean age = 31.67 years) completed a cross-sectional online study. A structural equation model indicated the data fit reasonably well (χ2 p value = .209, CMIN/df = 1.514, CFI = .995, TLI = .983, RMSEA = .045, SRMR = .0272), with FPE mediating the relationship between DAs and paruresis symptom severity (p = .001) along with parcopresis symptom severity (p = .001). However, secondary analyses identified that FPE and FNE act as mediators between DAs and paruresis and parcopresis symptom severity when placed in separate models. This is the first study to provide evidence that the psychosocial-cognitive processes DAs and fear of evaluation play an important role in paruresis and parcopresis symptomology. Although this research should be replicated, the current study provides evidence that DAs, and FPE are important contributory factors in paruresis and parcopresis symptoms.

URL: https://link.springer.com/article/10.1007/s12144-019-0125-7

Abstract

Background

Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD). Antidepressants are taken by approximately 30% of people with IBD. However, there are no current guidelines on treating co‐morbid anxiety and depression in people with IBD with antidepressants, nor are there clear data on the role of antidepressants in managing physical symptoms of IBD.

Objectives

The objectives were to assess the efficacy and safety of antidepressants for treating anxiety and depression in IBD, and to assess the effects of antidepressants on quality of life (QoL) and managing disease activity in IBD.

Search methods

We searched MEDLINE; Embase, CINAHL, PsycINFO, CENTRAL, and the Cochrane IBD Group Specialized Register from inception to 23 August 2018. Reference lists, trials registers, conference proceedings and grey literature were also searched.

Selection criteria

Randomised controlled trials (RCTs) and observational studies comparing any type of antidepressant to placebo, no treatment or an active therapy for IBD were included.

Data collection and analysis

Two authors independently screened search results, extracted data and assessed bias using the Cochrane risk of bias tool. We used the Newcastle‐Ottawa Scale to assess quality of observational studies. GRADE was used to evaluate the certainty of the evidence supporting the outcomes. Primary outcomes included anxiety and depression. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) or the Hamilton Anxiety Rating Scale (HARS). Depression was assessed using HADS or the Beck Depression Inventory. Secondary outcomes included adverse events (AEs), serious AEs, withdrawal due to AEs, quality of life (QoL), clinical remission, relapse, pain, hospital admissions, surgery, and need for steroid treatment. QoL was assessed using the WHO‐QOL‐BREF questionnaire. We calculated the risk ratio (RR) and corresponding 95% confidence intervals (CI) for dichotomous outcomes. For continuous outcomes, we calculated the mean difference (MD) with 95% CI. A fixed‐effect model was used for analysis.

Main results

We included four studies (188 participants). Two studies were double‐blind RCTs, one was a non‐randomised controlled trial, and one was an observational retrospective case‐matched study. The age of participants ranged from 27 to 37.8 years. In three studies participants had quiescent IBD and in one study participants had active or quiescent IBD. Participants in one study had co‐morbid anxiety or depression. One study used duloxetine (60 mg daily), one study used fluoxetine (20 mg daily), one study used tianeptine (36 mg daily), and one study used various antidepressants in clinical ranges. Three studies had placebo controls and one study had a no treatment control group. One RCT was rated as low risk of bias and the other was rated as high risk of bias (incomplete outcome data). The non‐randomised controlled trial was rated as high risk of bias (random sequence generation, allocation concealment, blinding). The observational study was rated as high methodological quality, but is still considered to be at high risk of bias given its observational design.

The effect of antidepressants on anxiety and depression is uncertain. At 12 weeks, the mean anxiety score in antidepressant participants was 6.11 + 3 compared to 8.5 + 3.45 in placebo participants (MD ‐2.39, 95% ‐4.30 to ‐0.48, 44 participants, low certainty evidence). At 12 months, the mean anxiety score in antidepressant participants was 3.8 + 2.5 compared to 4.2 + 4.9 in placebo participants (MD ‐0.40, 95% ‐3.47 to 2.67, 26 participants; low certainty evidence). At 12 weeks, the mean depression score in antidepressant participants was 7.47 + 2.42 compared to 10.5 + 3.57 in placebo participants (MD ‐3.03, 95% CI ‐4.83 to ‐1.23, 44 participants; low certainty evidence). At 12 months, the mean depression score in antidepressant participants was 2.9 + 2.8 compared to 3.1 + 3.4 in placebo participants (MD ‐0.20, 95% ‐2.62 to 2.22, 26 participants; low certainty evidence).

The effect of antidepressants on AEs is uncertain. Fifty‐seven per cent (8/14) of antidepressant participants group reported AEs versus 25% (3/12) of placebo participants (RR 2.29, 95% CI 0.78 to 6.73, low certainty evidence). Commonly reported AEs include nausea, headache, dizziness, drowsiness, sexual problems, insomnia, fatigue, low mood/anxiety, dry mouth, muscle spasms and hot flushes. None of the included studies reported any serious AEs. None of the included studies reported on pain.

One study (44 participants) reported on QoL at 12 weeks and another study (26 participants) reported on QoL at 12 months. Physical, Psychological, Social and Environmental QoL were improved at 12 weeks compared to placebo (all low certainty evidence). There were no group differences in QoL at 12 months (all low certainty evidence). The effect of antidepressants on maintenance of clinical remission and endoscopic relapse is uncertain. At 12 months, 64% (9/14) of participants in the antidepressant group maintained clinical remission compared to 67% (8/12) of placebo participants (RR 0.96, 95% CI 0.55 to 1.69; low certainty evidence). At 12 months, none (0/30) of participants in the antidepressant group had endoscopic relapse compared to 10% (3/30) of placebo participants (RR 0.14, 95% CI 0.01 to 2.65; very low certainty evidence).

Authors’ conclusions

The results for the outcomes assessed in this review are uncertain and no firm conclusions regarding the efficacy and safety of antidepressants in IBD can be drawn. Future studies should employ RCT designs, with a longer follow‐up and develop solutions to address attrition. Inclusion of objective markers of disease activity is strongly recommended as is testing antidepressants from different classes, as at present it is unclear if any antidepressant (or class thereof) has differential efficacy.

URL: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012680.pub2/abstract

Abstract:

Background

Decision support tools may facilitate shared decision‐making and improve quality of care.

Aim

To assess the effectiveness of a decision support tool on improving quality of care in ulcerative colitis.

Methods

A prospective quality of care intervention was conducted at two Australian hospitals comparing out‐patient–based ulcerative colitis care with, and without, a tablet‐based decision support tool. This included questions on disease activity management; psychological well‐being; and preventive care, with 13 process indicators relevant to each domain. Participants included adult out‐patients with mild‐to‐moderate ulcerative colitis and their clinicians who were divided into two cohorts. The first cohort were followed up immediately after their clinical review to check whether their clinician had discussed the 13 process indicators during the consultation. The second cohort of patients used the decision support tool immediately prior to their consultation which then generated a suggested management plan for the patient and clinician to discuss during the consultation. Management between the 2 cohorts was compared to assess the effectiveness of the decision support tool in improving the primary outcome, defined as the proportion of quality process indicators used for ulcerative colitis care, with and without the decision support tool.

Results

Thirteen physicians and 100 patients participated. Fifty patients were managed without the decision support tool using standard care (median age 40; 44% male), and 50 patients used the decision support tool (median age 40; 46% male) over a 20‐week period. Increase in the median use of process indicators overall was observed following use of the decision support tool (27% vs 100%; P < 0.001). Improvements were seen in psychological well‐being management (30% vs 100%; P < 0.001), preventive care (16% vs 100%; P < 0.001) and process indicators related to disease activity management (50% vs 100%; P < 0.001). The decision support tool was found to be usable and acceptable. Shared decision‐making was greater in the post‐intervention group (mean decision conflict score of 18.0 vs 33.5; P = 0.002).

Conclusions

The decision support tool substantially improved the quality of the delivery of care. Decision support tools have the potential to minimise errors of omission via a standardised approach to care.

URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.15209

Abstract:

Background

Real-time collection of mental health and disease activity patient-reported outcomes (PROs) are essential to assist clinicians in delivering optimal holistic health care. The aim of this pilot study was to validate a digital support tool (DST) delivered via a tablet device in an outpatient setting to assess IBD activity and psychological distress.

Methods

48 individuals (26 females; average age: 40.04) with IBD completed the DST and a paper-based survey in a hospital IBD outpatient setting. PROs for disease activity and psychological distress (Kessler K10) were compared to paper-based gold-standard measures of disease activity (Partial Mayo Index or Harvey Bradshaw Index completed by the clinician) and psychological distress (Depression Anxiety Stress Scale; completed by the patient). Patient feedback regarding usability and acceptance of the DST was also collected.

Results

DST patient-derived disease activity scores were significantly correlated with clinician assessment of disease activity (p < 0.01). Patient DST-derived psychological well-being scores were also significantly correlated with the gold-standard measure of psychological distress (p < 0.05). Patients found the DST to be easy to use and identified a willingness to follow through with the recommendations provided by the DST in relation to their psychological distress scores.

Conclusions

The pilot study demonstrates the value in collecting disease activity and psychological distress PROs via a DST in an outpatient setting. Disease activity and psychological distress PROs were found to correlate significantly with gold standard measures. The findings provide preliminary support for the value of embedding digital technology into clinical care to promote patient engagement and optimal holistic healthcare.

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398025/

Abstract:

Background

Paruresis and parcopresis are psychogenic conditions that involve a difficulty or inability to void or defecate, respectively, in a public setting (eg public restroom). Both conditions are associated with significant psychological distress. As a result of shame, embarrassment and stigma, individuals with these conditions may not actively identify behaviours or symptoms or seek treatment in general practitioner (GP) consultations.

Objective

The objective of this article is to provide a summary of the associated psychopathology and comorbidity, and diagnostic challenges associated with paruresis and parcopresis. Treatment recommendations relating to paruresis and parcopresis are also provided.

Discussion

Paruresis and parcopresis can have a significant impact on an individual’s psychological health and overall quality of life. GPs play a part in identifying these conditions, defusing feelings of shame and embarrassment, and enabling access to psychological interventions, which are likely to provide significant benefits to individuals living with paruresis and/or parcopresis.

URL: https://www1.racgp.org.au/ajgp/2019/april/latest-thinking-on-paruresis-and-parcopresis

Abstract:

The relationship between coeliac disease and psychological comorbidity is complex, with symptoms of anxiety and depression commonly identified in coeliac cohorts1 and associated with poorer gluten‐free diet (GFD) adherence.2–4 However, while maintaining a GFD is ideal for disease management, it is also recognised to be challenging both practically and emotionally.5 The study conducted by Ludvigsson et  al6 provides a valuable exploration of the relationship between psychological comorbidity and mucosal healing associated with maintaining a GFD.

In a nationwide longitudinal population‐based cohort study involving 7648 individuals, Ludvigsson et  al6 explored the association between diagnosis of anxiety or depression and its relationship to mucosal healing. The authors found that the risk of developing anxiety was 2.8 per 1000 person‐years of follow‐up in the mucosal healing group (n = 4331) vs 2.1 per 1000 in the group identified with persistent villous atrophy (n = 3317). Likewise, rates of depression were higher in the mucosal healing vs persistent villous atrophy group (3.8 vs 3.3 per 1000 person‐years of follow‐up). Both anxiety and depression were not common in the sample (3% and 4% respectively), and as the diagnostic codes and medications rather than screening scales or psychological/psychiatric interviews were used, the low prevalence may reflect a more severe symptomatology.

While there was some evidence for a higher psychotropic prescription rates in the persistent villous atrophy group vs mucosal healing group, these findings were not significant. The authors concluded that mucosal healing was associated with a greater risk of developing anxiety and depression, and that this may be due to the burden of the treatment or individuals living with anxiety/depression being more attentive to maintaining a GFD.

Indeed, for some patients, the everyday burden to maintain a GFD may lead to depression and ongoing anxiety about food choices, potential cross‐contamination, accidental, or deliberate GFD transgressions. The development of anxiety and/or depression may also promote adherence to a GFD. This may be due to a fear of coeliac symptoms or as a way to maintain or have some control in their life. Both purported mechanisms relating to the development of anxiety and depression in mucosal healing are not necessarily independent of each other and may well also be influenced by multiple factors unexplored in the research by Ludvigsson et  al, including anxiety and depression symptom severity, other psychological and physiological comorbidities, illness perceptions, self‐efficacy, and coping styles. Further longitudinal research which accounts for the identified limitations is likely to better elucidate the mechanisms underpinning anxiety and depression in coeliac cohorts and how it relates to mucosal healing.

Nevertheless, Ludvigsson et  al6 provide important evidence for the interplay between mucosal healing and psychological comorbidity, and the significant psychological costs associated with maintaining a GFD. Given this, along with utilising a GFD as directed by dieticians and gastroenterologists, it seems that the integration of mental health professionals to identify and address psychological comorbidities is not only warranted but also likely to lead to improved physical and psychological health.

URL: https://onlinelibrary.wiley.com/doi/10.1111/apt.15021

Abstract

Objectives

To audit the quality of care received by patients admitted for inflammatory bowel disease (IBD) across Australia against national IBD Standards.

Design

Retrospective cross‐sectional survey and clinical audit assessing organisational resources, clinical processes and outcome measures.

Setting

Australian hospitals.

Participants

Hospitals that care for inpatients with Crohn’s disease or ulcerative colitis.

Main outcome measures

Adherence to national IBD Standards and comparison of quality of care between hospitals with and without multidisciplinary IBD services.

Results

71 hospitals completed the organisational survey. Only one hospital had a complete multidisciplinary IBD service and 17 had a Partial IBD Service (IBD nurse, helpline and clinical lead). 1440 inpatient records were reviewed from 52 hospitals (mean age 37 years; 51% female, 53% Crohn’s disease), approximately 26% of IBD inpatient episodes over a 12‐month period in Australia. These patients were chronically unwell with high rates of anaemia (30%) and frequent readmissions (40% within two years). In general, care was inconsistent, and documentation poor. Hospitals with a Partial IBD Service performed better in many process and outcome measures: for example, 22% reduction in admissions via emergency departments and greater adherence to standards for safety monitoring of biologic (89% vs 59%) and immunosuppressive drugs (79% vs 55%) in those hospitals than those without.

Conclusions

Patients admitted to hospital suffering from IBD are young, chronically unwell, and are subject to substantial variations in clinical documentation and quality of care. Only one hospital met accepted Standards for multidisciplinary care; hospitals with even a minimal IBD service provided improved care.

URL: https://onlinelibrary.wiley.com/doi/10.1111/imj.14187

Abstract

Background: Quality of life (QoL) is commonly assessed in IBD; the relationship of QoL within IBD states and relative to others has not been comprehensively evaluated. This systematic review, published across two papers, evaluates 5 key QoL comparisons. Part I, presented here, examines between-disease comparisons: (1) IBD/healthy(general) population (2) IBD/other medically ill groups; Part II examines within-disease comparisons: (3) active/inactive disease (4) UC/CD and (5) change over time. Outcomes using generic versus IBD-specific QoL measures were also examined.

Methods: Adult and paediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015. Results: Of 6,173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement; 30 unique studies (23 adult, 7 paediatric) addressed the between-disease comparisons. The pooled mean QoL scores were: (1) lower in adult and paediatric IBD samples compared to healthy controls (n=19), and for both mental and physical QoL, where measured; and (2) higher but not significant for those with IBD compared to various medically ill controls (n=15). Findings were consistent across IBD-specific and generic QoL measures. Study quality was generally low to moderate. The most common measures of QoL were the disease-specific IBDQ and generic SF-36 (adults), and the generic PedsQL (children).

Conclusions: There was robust confirmation that QoL for individuals with IBD was poorer than for healthy individuals, for both adults and children. QoL in IBD may be better relative to some other GI and non-GI medical conditions for children.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29562277

Abstract

Background: There has been burgeoning interest in quality of life (QoL) in IBD in recent decades, with hundreds of studies each year now assessing this outcome. This paper is Part II of a systematic review evaluating 5 key QoL comparisons within IBD states and relative to others without IBD. Part I examined QoL comparing IBD and healthy/general population, and other medically ill groups. Part II, presented here, examines within-disease comparisons of active/inactive disease, UC/CD, and change over time. Outcomes using generic versus IBD-specific QoL measures were also examined.

Methods: Adult and paediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015.  Results:  Of 6,173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement, of which 83 unique studies (75 adult, 8 paediatric) addressed the within-disease comparisons. The pooled mean QoL scores were significantly lower in active versus inactive IBD (n=26) and for those with CD versus UC (n=37), consistently across IBD-specific and generic QoL measures, for almost all comparisons. There was significant improvement in QoL over time (n=37). Study quality was generally low to moderate. The most common measures of QoL were the disease-specific IBDQ and generic SF-36 (adults), and the IBD-specific IMPACT (children).

Conclusions: For adults in particular, there was strong confirmation that QoL is poorer during active disease, and may be poorer for those with CD. The finding that QoL can improve over time may be encouraging for individuals with this chronic disease.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29688466 

Abstract

The current research investigates the development and validation of the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). Over two studies, two independent samples consisting of university students and respondents from the general public were used to validate the scale (study 1 n = 226; study 2 n = 377). A 15-item, two-factor model was confirmed in study 2 where strong construct (convergent and divergent) validity was demonstrated. The BBIPSS did not display significant correlations with openness and gender (divergent validity) and displayed significant correlations with depression, anxiety and stress scores (DASS), alongside paruresis and parcopresis scores (SBBS; convergent validity) and the BoBCAtS. The BBIPSS also demonstrated strong test-retest reliability (bladder r = 0.89; bowel r = 0.86) in a small sample of adults (n = 13). Overall, this scale provides researchers and clinicians with a reliable and psychometrically valid assessment tool to measure bladder and bowel incontinence phobia severity.

URL: TBA

URL: https://www.ncbi.nlm.nih.gov/pubmed/30132938

Social anxiety disorder is a mental health condition that affects 4.7% of Australians each year. The complex interplay between psychoevolutionary and cognitive models has become the focus of research in recent years, particularly with the development of the bivalent fear of evaluation model (i.e., negative and positive evaluation fears). The present study aimed to test a model of social anxiety symptoms using structural equation modelling, integrating previously fragmented evidence. A sample of 255 participants (75.3% female; Mage = 31.9, SD = 10.3) undertook an online survey, including Social Phobia Scale, Brief Fear of Negative Evaluation—Straightforward, Fear of Positive Evaluation, Concerns of Social Reprisal, and Disqualifications of Positive Social Outcomes measures. The hypothesised model for social anxiety symptoms described the data reasonably well (χ2(1) = 4.917, p = .027, CFI = .995, GFI = .992, SRMR = .017), explaining 57.1% of social anxiety variance. Study hypotheses were supported with bivalent fear of evaluation accounting for unique variance in cognitive distortions, which in turn accounted for unique variation in social anxiety symptoms. Effect sizes indicate bivalent fears of evaluation and disqualification of positive social outcomes as important predictors of social anxiety symptoms. Although replication in a clinical cohort and experimental confirmation are needed, the findings suggest a focus on disqualification of positive social outcomes to alleviate social anxiety symptoms.

URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/ajpy.12215

Abstract

Aims: To explore the validity and recommend cut-off scores in an English-speaking sample for 9, 11, and 15-item versions of the ORTO measure for orthorexia, a proposed eating disorder characterised by a pathological obsession with consuming only ‘healthy’ foods.

Materials and methods: The sample comprised of 585 participants (82.4% female) who completed an online questionnaire containing the ORTO-15, Eating Attitudes test, Obsessive Compulsive Inventory Revised. A series of Confirmatory Factor Analyses were conducted to test model fit. Binary logistic linear regression and receiver-operating-characteristics (ROC) analyses were used to obtain cut-offs.

Results and conclusion: Results showed that none of the three published versions (9, 11, and 15-item) of the ORTO produced an acceptable model. Subsequent exploratory and confirmatory factor analyses yielded a seven-item version of the ORTO (ORTO-7) with a strong and stable factor structure. Analysis of cut-offs revealed that a cut-off score of equal or greater than 19 on the ORTO-7 represents probable orthorexia.

Level of evidence: Level V, descriptive study.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29796780

The aim of the current study was to use Structural Equation Modelling (SEM) to examine whether psychological flexibility (i.e. mindfulness, acceptance, valued-living) mediates the relationship between distress, irritable bowel syndrome (IBS) symptom frequency, and quality of life (QoL). Ninety-two individuals participated in the study (12 male, 80 female, Mage = 36.24) by completing an online survey including measures of visceral sensitivity, distress, IBS-related QoL, mindfulness, bowel symptoms, pain catastrophizing, acceptance, and valued-living. A final model with excellent fit was identified. Psychological distress significantly and directly predicted pain catastrophizing, valued-living, and IBS symptom frequency. Pain catastrophizing directly predicted visceral sensitivity and acceptance, while visceral sensitivity significantly and directly predicted IBS symptom frequency and QoL. Symptom frequency also had a direct and significant relationship with QoL. The current findings suggest that interventions designed to address unhelpful cognitive processes related to visceral sensitivity, pain catastrophizing, and psychological distress may be of most benefit to IBS-related QoL.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29882424

Abstract

BACKGROUND: A gluten-free diet treats coeliac disease, but its efficacy depends on strict adherence. A variety of patient factors may influence adherence but have not been well described at a population level.

AIM: To comprehensively assess the patient factors that influence gluten-free diet adherence in patients with coeliac disease.

METHODS: Patients with coeliac disease completed an online survey comprising the validated Celiac Dietary Adherence Test in addition to data on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. Survey data were analysed for predictors of adherence and quality of life.

RESULTS: Of 7393 responses, 5310 completed the Celiac Dietary Adherence Test and 3230 (61%) were adherent to a gluten-free diet. Multivariate regression showed older age, being male, symptoms after gluten ingestion, better food knowledge and lower risk of psychological distress were independent predictors of adherence (each P ≤ 0.008). Additionally, dietary adherence was associated with better quality of life (P < 0.001; multiple regression). Respondents who considered themselves to have poor food knowledge were more likely to incorrectly identify gluten-free foods, but could still recognise gluten-containing foods, suggesting that poor knowledge may lead to over-restriction of diet.

CONCLUSIONS: Poor knowledge of a gluten-free diet and psychological wellbeing were independent modifiable risk factors for inadequate adherence to a gluten-free diet in patients with coeliac disease. Involvement of both a dietitian and mental health care professional, in the presence of psychological distress, is likely to be necessary to improve adherence and health outcomes.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29733115

Abstract

BACKGROUND: The extent to which disease activity impacts patient-reported outcomes (PRO) is unclear.

AIMS: To examine the relationship between disease activity and PRO.

METHODS: Adult inflammatory bowel disease (IBD) patients attending a tertiary clinic from May to June 2015 were included. Assessment of disease activity (Simple Clinical Colitis Activity Index (SCCAI), Harvey Bradshaw Index (HBI)), IBD knowledge (CCKNOW), medication adherence (MMAS8), psychological distress (Hospital Anxiety and Depression Scale (HADS)), work productivity (WPAI) and quality of life (IBDQ) was performed to investigate any correlations between disease activity and PRO.

RESULTS: A total of 81 participants was included: 49% female, 57% Crohn disease (CD), 38% ulcerative colitis (UC) and 5% IBD-unclassified, with a median age of 34 years. At least mild levels of depression were present in 21 of 81 (26%) of patients; 37 of 81 (46%) expressed some level of anxiety. A moderate-to-strong correlation was found between disease activity and depression in UC (r = 0.84, P = 0.002) but not in CD (r = 0.53, P = 0.29). Disease activity correlated with: overall work impairment due to health (r = 0.85, P = 0.001), health-related impairment while working (r = 0.76, P = 0.02) and percentage of activity impaired due to health (r = 0.83, P = 0.002) in UC only.

CONCLUSIONS: Disease activity significantly affects mood and work productivity in patients with UC. Monitoring patients’ ability to function and work, rather than minimising disease activity alone, should become a routine part of IBD care.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29733115

Abstract

As many as 1 in 5 individuals currently experience mental health issues, and that only a minority seek help from mental health professionals. This paper outlines the development and validation of the Mental Health Seeking Apprehension Scale (MHSAS). MHSAS was validated across three studies using both university and community samples. In the first study, exploratory factor analysis revealed a nine-item two-factor scale (N=231), which was confirmed in the second study (N=208). The first factor related to mental health stigma (e.g., embarrassed about help-seeking, not wanting others to know) while the second was related to ambivalence toward seeking help (e.g., nothing changes problems, professional may not be helpful). Based on a combination of Study 1 and 2 datasets, the third study (N=439) analysed MHSAS and help-seeking behaviour. Results suggest that greater perceived stigma and ambivalence were associated with not seeking mental health support and also greater psychological distress. The research provides good preliminary evidence that the MHSAS is a brief psychometrically valid measure of mental health help seeking apprehension. MHSAS can be utilised by health professionals and researchers to screen for apprehension relating to seeking mental health support and identify potential barriers preventing utilisation of mental health services when needed. 

URL: https://researchbank.swinburne.edu.au/file/2837ad4f-16aa-45a5-9d35-fde34d3aeb73/1/2018-knowles-development_and_validation.pdf

Abstract

INTRODUCTION: A strict lifelong gluten free diet (GFD) is the only treatment for coeliac disease (CD). Theory-based research has focused predominantly on initiation, rational, and motivational processes in predicting adherence. The aim of this study was to evaluate an expanded collection of theoretical constructs specifically relevant to the maintenance of behaviour change, in the understanding and prediction of GFD adherence.

METHODS: Respondents with CD (N = 5573) completed measures of GFD adherence, psychological distress, intentions, self-efficacy, and the maintenance-relevant constructs of self-regulation, habit, temptation and intentional and unintentional lapses (cognitive and behavioural consequences of lowered or fluctuating psychological resources and self-control), motivation, social and environmental support, and goal priority, conflict, and facilitation. Correlations and multiple regression were used to determine their influence on adherence, over and above intention and self-efficacy, and how relationships changed in the presence of distress.

RESULTS: Better adherence was associated with greater self-regulation, habit, self-efficacy, priority, facilitation, and support; and lower psychological distress, conflict, and fewer self-control lapses (e.g., when busy/stressed). Autonomous and wellbeing-based, but not controlled motivations, were related to adherence. In the presence of distress, the influence of self-regulation and intentional lapses on adherence were increased, while temptation and unintentional lapses were decreased.

DISCUSSION: The findings point to the importance of considering intentional, volitional, automatic, and emotional processes in the understanding and prediction of GFD adherence. Behaviour change interventions and psychological support are now needed so that theoretical knowledge can be translated into evidence-based care, including a role for psychologists within the multi-disciplinary treatment team.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29481913

Abstract

AIMS: This study aimed to examine the relationships between gastroparesis symptom severity, illness perceptions, coping styles, quality of life (QoL), and psychological distress in patients with gastroparesis, guided by the common sense model.

METHODS: One hundred and seventy-nine adults with gastroparesis (165 females, 14 males; mean age 41.82 years) completed an online questionnaire. The Gastroparesis Cardinal Symptom Index was used to measure gastroparesis symptom severity, QoL was explored using the PAGI-QOL, illness perceptions were measured using the Brief Illness Perception Questionnaire, the Carver Brief COPE scale assessed coping styles, and psychological distress was investigated using the DASS21.

RESULTS: Structural equation modeling resulted in a final model with excellent fit. Gastroparesis symptom severity directly influenced illness perceptions (β = .52, p < .001) and QoL (β = .30, p < .001). Illness perceptions directly influenced maladaptive coping (β = – .64, p < .001), psychological distress (β = – .32, p < .001), and QoL (β = .30, p = .01). Maladaptive coping directly influenced psychological distress (β = .62, p < .001), which in turn had a direct influence on QoL (β = – .38, p < .001).

CONCLUSIONS: The final model showed that the influence of gastroparesis symptom severity on psychological distress was fully mediated by illness perceptions, while the influence on QoL was partially mediated by illness perceptions. The study provides guidance for the development of psychological interventions targeted toward improving mediating psychological factors.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29468373

Abstract

This study explored the possible factors associated with psychological distress in adults with inflammatory bowel disease (IBD) and also engagement in mental health services (MHS) in those reporting distress in a large Australian cohort. Participants with IBD completed an online survey assessing perceived IBD activity (Manitoba Index; MI), mental health status (K10), demographic details, and engagement with MHS for IBD-associated issues. Of 336 participants, 76.5% perceived themselves as having active disease over the past 6 months, and on K10 scores, 51.8% had a mental health issue. Of participants with a mental health issue, only 21.3% were currently receiving mental health support. A stepwise logistic regression analysis correctly classified 78.7% of the status of receiving mental health support, with lower income (<$60,000 per annum) the only significant predictor. Paradoxically, the degree of psychological distress did not correlate with seeking mental health support. The data show that in individuals with ongoing symptoms attributed to active IBD, mental health issues are highly prevalent, with older age and higher income being additional drivers of mental health issues. The greater challenge, however, seems not to be identifying mental health issues, but in getting those in need to engage in MHS.

URL: https://www.ncbi.nlm.nih.gov/pubmed/29373354

Abstract

Purpose: In a previous paper focusing on the common sense model (CSM) for ostomies in people with inflammatory bowel disease, cancer, and diverticular disease, we reported that (1) illness perceptions were directly related to illness status, and both illness perceptions and coping strategies (maladaptive coping) directly influenced anxiety and depression; (2) self-efficacy and emotion-focused coping style ameliorated depression but not anxiety; and (3) time since surgery was associated with improved health status, a reduction in negative illness perceptions, and increased emotional-focused coping. The purpose of this article was to perform a secondary analysis with the addition of a stoma quality-of-life measure.

Subjects and setting: One hundred fifty adults with ostomies (54 males, and 96 females; mean age = 44 years) completed an online survey.

Design: Descriptive, cross-sectional, questionnaire-based study.

Methods: Participants completed the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Stoma Quality-of-Life Scale.

Results: Using structural equation modeling, the final model provided an excellent fit to the data (χ27 = 19.20, P = .37, χ/N = 1.08, Standardized Root Mean Square Residual (SRMR) <0.03, Steiger-Lind Root Mean Square Error of Approximation (RMSEA) <0.03, Goodness of Fit Index (GFI) >0.98). Extending upon our previous paper, self-efficacy, anxiety, and depression were found to have a significant direct influence on stoma-specific quality of life (β= .47, P < .001, β=-.25, P < .001, and β=-.35, P < .001, respectively).

Conclusions: The findings of this secondary analysis extends our previous report by identifying that, consistent with the CSM, illness status, illness perceptions, and coping influence health-related quality of life via self-efficacy, anxiety, and depression. The results suggest that to improve an individual’s quality of life, psychological interventions should target the psychological processes underpinning mental illness and also help develop and maintain an individual’s self-efficacy in relation to ostomy care.

URL: https://www.ncbi.nlm.nih.gov/pubmed/28060005 

Background: Quality of life (QoL) is commonly assessed in IBD; the relationship of QoL within IBD states and relative to others has not been comprehensively evaluated. This systematic review, published across two papers, evaluates 5 key QoL comparisons. Part I, presented here, examines between-disease comparisons: (1) IBD/healthy(general) population (2) IBD/other medically ill groups; Part II examines within-disease comparisons: (3) active/inactive disease (4) UC/CD and (5) change over time. Outcomes using generic versus IBD-specific QoL measures were also examined. Methods: Adult and paediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015. Results: Of 6,173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement; 30 unique studies (23 adult, 7 paediatric) addressed the between-disease comparisons. The pooled mean QoL scores were: (1) lower in adult and paediatric IBD samples compared to healthy controls (n=19), and for both mental and physical QoL, where measured; and (2) higher but not significant for those with IBD compared to various medically ill controls (n=15). Findings were consistent across IBD-specific and generic QoL measures. Study quality was generally low to moderate. The most common measures of QoL were the disease-specific IBDQ and generic SF-36 (adults), and the generic PedsQL (children). Conclusions: There was robust confirmation that QoL for individuals with IBD was poorer than for healthy individuals, for both adults and children. QoL in IBD may be better relative to some other GI and non-GI medical conditions for children.

URL: TBA

Background: There has been burgeoning interest in quality of life (QoL) in IBD in recent decades, with hundreds of studies each year now assessing this outcome. This paper is Part II of a systematic review evaluating 5 key QoL comparisons within IBD states and relative to others without IBD. Part I examined QoL comparing IBD and healthy/general population, and other medically ill groups. Part II, presented here, examines within-disease comparisons of active/inactive disease, UC/CD, and change over time. Outcomes using generic versus IBD-specific QoL measures were also examined. Methods: Adult and paediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015.  Results:  Of 6,173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement, of which 83 unique studies (75 adult, 8 paediatric) addressed the within-disease comparisons. The pooled mean QoL scores were significantly lower in active versus inactive IBD (n=26) and for those with CD versus UC (n=37), consistently across IBD-specific and generic QoL measures, for almost all comparisons. There was significant improvement in QoL over time (n=37). Study quality was generally low to moderate. The most common measures of QoL were the disease-specific IBDQ and generic SF-36 (adults), and the IBD-specific IMPACT (children). Conclusions: For adults in particular, there was strong confirmation that QoL is poorer during active disease, and may be poorer for those with CD. The finding that QoL can improve over time may be encouraging for individuals with this chronic disease.

URL: TBA

A key component of cognitive behaviour therapy (CBT) is to identify and challenge unhelpful thinking patterns (also known as cognitive distortions, thinking errors, or distorted automatic negative thoughts) in interventions that foster more reality-oriented thinking. This paper describes the development and validation of the Brief Unhelpful Thinking Scale (BUTs). Four studies were conducted of which three included mixed undergraduate and community samples (Studies 1-3) and one was a clinical sample of individuals diagnosed with Social Anxiety Disorder (SAD). An 11-item two-factor model of unhelpful thinking emerged in Study 1 (N=223), which was confirmed in Study 2 (N=203). The first factor focused on negative self-bias (e.g., generalised, negative, emotional), and the second factor focused on expectations of others (e.g., expectations others will act fairly, change, follow rules). Study 3 (N=23) established test-retest reliability for the BUTs and the final study (N=9) examined BUTs in a group-based CBT intervention for SAD. This study showed the BUTs to be sensitive to changes in unhelpful thinking after a CBT intervention. In conclusion, the BUTs is a brief psychometrically valid measure of unhelpful thinking that can be utilised by both clinicians and researchers who wish to measure individual unhelpful thinking patterns and relate them to changes in psychological distress in CBT-based interventions.

URL: TBA

Patients with greater inflammatory bowel disease activity readily identify poorer psychosocial outcomes; however, the role of gender, disease type, and individual illness perceptions facets are less well known. This study aimed to characterize the role of illness perceptions, gender, and disease type on anxiety, depression, and quality of life. Eighty-one patients diagnosed with inflammatory bowel disease (39 men, mean age 35 years) attending a tertiary hospital outpatient clinic were studied. Questionnaires used included the Manitoba Index, the Brief Illness Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and the World Health Organization Brief Quality of Life Scale. Female patients with active disease tended to report increased anxiety, depression, and reduced quality of life. Regarding illness perceptions, patients with Crohn disease reported significantly more concerns about its chronicity, while female patients reported being significantly more concerned about the impact of their illness on identity, chronicity, overall concern, and having a greater emotional impact. Hierarchical regression indicated that 36% of depression, 42% of anxiety, and 57% of quality of life could be accounted for by disease activity and type, gender, and illness perceptions. The findings suggest that in addition to a patient’s perceived disease status, gastroenterology nurses should also be aware that patient gender and their perceptions of illness play a significant impact not only on anxiety and depression but also on quality of life. Increased disease activity is associated with more severe anxiety and depression and reduced quality of life. Female patients are also at a greater risk of reporting negative illness perceptions and increased levels of anxiety, depression, and lower quality of life.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28746114

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

Primary objectives

1. To assess the efficacy and safety of antidepressants for managing anxiety and depression in IBD
2. To assess the efficacy and safety of antidepressants for managing quality of life in IBD
Secondary objectives
3. To assess the efficacy and safety of antidepressants for managing disease activity in IBD

URL: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012680/full

Objective: Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others. The aim of this systematic review was to evaluate four key questions: (1) What is the prevalence of paruresis and its associated demographic features; (2) What is the prevalence of psychopathology in paruresis cohorts, how does it compare to other chronic-health conditions, and what percentage of paruresis patients also have social anxiety disorder? (3) How does quality of life, and levels of anxiety and depression compare between those with and without paruresis; and (4) do psychological interventions for paruresis patients reduce paruresis symptoms, or, anxiety, or depression, or improve quality of life?
Method: A review was conducted using PRISMA protocol for search strategy, selection criteria, and data extraction. Searched databases included PubMed, CINAHL, and PsychINFO. Over the 1418 studies screened, ten were found relating to at least one review question.
Results: The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder. Paruresis symptoms were shown to reduce in one intervention study. Paruresis was also associated with poorer quality of life. A key limitation of the research to date has been the notable methodological problems and lack of standardisation relating to the measurement of paruresis.

Conclusion: Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required. Recommendations in terms of clinical implications, diagnostic criteria and future research relating to paruresis are discussed.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28554367

Aims and objectives: To build on the understanding of how individuals experience gastroparesis, how gastroparesis impacts on their lives and how they adapt to living with gastroparesis.

Background: Gastroparesis is a neurogastroenterological disorder associated with increased psychological distress and reduced quality of life. Research shows that gastroparesis poses a significant burden across many facets of life; however, less is known about how individuals cope and adapt to living with the condition.

Design: The study employed an interpretive phenomenological approach with semistructured interviews and thematic analysis.
Methods: Ten gastroparesis patients were interviewed over the telephone (n = 8), Skype (n = 1) or face-to-face (n = 1). All interviews were audio-recorded and transcribed.

Results: Key themes identified: (1) frustration, (2) identity and (3) coping and adaptation. Gastroparesis patients experience significant frustration around their diagnostic journey, being misunderstood and the burden of living with the illness. Patients differed in how they identified with the illness, and this appeared to be associated with adaptation and whether they remained socially engaged.
Conclusions: Gastroparesis is associated with significant frustration and burden; however, some patients adapt to living with the condition more effectively than others. Identity appears to play an important role in this relationship. Support aimed at fostering a health-focused and resilient identity may assist gastroparesis patients in adaptation.

Relevance to clinical practice: The findings of this study can help nurses and other healthcare professionals better understand the experience of living with gastroparesis and the factors that help patients best adapt to living with the condition. Nurses can help promote resilience in patients by discussing the importance of being health-focused rather than illness-focused. Nurses can also support patients by helping them problem-solve issues that may arise around social eating and remaining socially engaged.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28071866

Methods: A comprehensive search of PubMed, CINAHL, and PsycINFO databases was performed to identify literature addressing the relationship between gastroparesis and psychological factors. Two researchers independently screened all references. Inclusion criteria were: an adult sample of gastroparesis patients, a quantitative methodology, and at least one of the following: (1) evaluation of the prevalence of psychopathology; (2) an outcome measure of anxiety, depression, or quality of life; and (3) evidence of a psychological intervention. Case studies, review articles, and publications in languages other than English were excluded from the current review.

Results: Prevalence of psychopathology was evaluated by three studies (n = 378), which found that combined anxiety/depression was present in 24% of the gastroparesis cohort, severe anxiety in 12.4%, depression in 21.8%-23%, and somatization in 50%. Level of anxiety and depression was included as an outcome measure in six studies (n = 1408), and while limited research made it difficult to determine the level of anxiety and depression in the cohort, a clear positive relationship with gastroparesis symptom severity was evident. Quality of life was included as an outcome measure in 11 studies (n = 2076), with gastroparesis patients reporting lower quality of life than population norms, and a negative relationship between quality of life and symptom severity. One study assessed the use of a psychological intervention for gastroparesis patients (n = 120) and found that depression and gastric function were improved in patients who received psychological intervention, however the study had considerable methodological limitations.

Conclusion: Gastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=28275310

Irritable Bowel Syndrome (IBS) is a common condition affecting around 10-20% of the population and associated with poorer psychological well-being and quality of life. The aim of the current study was to explore the efficacy of the Common Sense Model (CSM) using Structural Equation Modelling (SEM) in an IBS cohort. One hundred and thirty-one IBS patients (29 males, 102 females, mean age 38 years) participating in the IBSclinic.org.au pre-intervention assessment were included. Measures included IBS severity (Irritable Bowel Syndrome Severity Scoring System), coping patterns (Carver Brief COPE), visceral sensitivity (Visceral Sensitivity Index), illness perceptions (Brief Illness Perceptions Questionnaire), psychological distress (Depression, Anxiety and Stress Scale), and quality of life (IBS Quality of Life scale; IBS-QoL). Using SEM, a final model with an excellent fit was identified (χ2 (8) = 11.91, p = .16, χ2/N = 1.49, CFI > .98, TLI > .96, SRMR < .05). Consistent with the CSM, Illness perceptions were significantly and directly influenced by IBS severity (β = .90, p < .001). Illness perceptions in turn directly influenced maladaptive coping (β = .40, p < .001) and visceral sensitivity (β = .70, p < .001). Maladaptive coping and visceral sensitivity were significantly associated with psychological distress (β = .55, p < .001; β = .22, p < .01) and IBS-QoL (β = -.28, p < .001; β = -.62, p < .001). Based on these findings, we argue that to augment the adverse impact of IBS severity on IBS-QoL and psychological distress, psychological interventions will be best to target the mediating psychological processes including illness beliefs, visceral sensitivity and maladaptive coping.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=27045996

Currently research exploring paruresis and parcopresis, anxiety relating to urinating and having bowel motions in public respectively is limited. While there are several validated measures of paruresis, no valid measure assessing parcopresis is currently available. The present study investigates the development and validation of the Shy Bladder and Bowel Scale (SBBS) which assesses both paruresis and parcopresis. Two participant groups were utilised to validate this scale, a student psychology cohort (n = 387) and a public cohort (n = 334). An eight-item two-factor model was identified in the psychology cohort and confirmed in the public cohort. The two-factor SBBS was found to be a valid and reliable measure of paruresis and parcopresis. Paruresis and parcopresis-related concerns were associated with social anxiety in both cohorts. Subscales for both paruresis and parcopresis (i.e. difficulty, interference and distress) were positively correlated, suggesting individuals are likely to report similar levels of concerns across both conditions. Further, individuals self-identifying with either paruresis or parcopresis reported significantly higher scores on the respective SBBS subscales than non-identifying paruresis and parcopresis individuals. The SBBS also demonstrated strong test-retest reliability in a small sample of adults (n = 13). Overall, the developed scale provides clinicians and researchers with a valuable tool to evaluate both paruresis and parcopresis.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=27216857

Background: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are serious and growing health problems with enormous impact on psychological and social functioning. Despite high rates of comorbid depression and anxiety in these patient populations, and the adverse impact these have upon treatment adherence, quality of life, social connectedness and healthcare costs there has been little attention focused on the prevention or management of these problems. Thus, our aim was to evaluate the Dialysis Optimal Health Program (DOHP) that adopts a person-centred approach and engages collaborative therapy to educate and support those diagnosed with ESKD who are commencing dialysis.

Methods: The study design is a randomised controlled trial. Ninety-six adult patients initiating haemodialysis or peritoneal dialysis will be randomly allocated to either the intervention (DOHP) or usual care group. Participants receiving the intervention will receive nine (8 + 1 booster session) sequential sessions based on a structured information/workbook, psychosocial and educational supports and skills building. The primary outcome measures are depression and anxiety (assessed by the Hospital Anxiety and Depression Scale; HADS). Secondary outcomes include health-related quality of life (assessed by the Kidney Disease Quality of Life instrument; KDQOL), self-efficacy (assessed by General Self-Efficacy Scale) and clinical indices (e.g. albumin and haemoglobin levels). Cost-effectiveness analysis and process evaluation will also be performed to assess the economic value and efficacy of the DOHP. Primary and secondary measures will be collected at baseline and at 3-, 6-, and 12-month follow-up time points.

Discussion: We believe that this innovative trial will enhance knowledge of interventions aimed at supporting patients in the process of starting dialysis, and will broaden the focus from physical symptoms to include psychosocial factors such as depression, anxiety, self-efficacy, wellbeing and community support. The outcomes associated with this study are significant in terms of enhancing an at-risk population’s psychosocial health and reducing treatment-related costs and associated pressures on the healthcare system.

Trial registration: ANZCTR no. 12615000810516. Registered on 5 August 2015.

URL: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1558-z

Background: After a diagnosis of diabetes mellitus, people not only have to cope with the physical aspects and common complications that require daily self-management, they are also faced with ongoing psychosocial challenges. Subsequently they find themselves having to navigate the health system to engage multidisciplinary supports; the combination of these factors often resulting in reduced health-related quality of life. To maintain optimal diabetes control, interventions need to incorporate psychosocial supports and a skill base for disease management. Therefore, our aim was to evaluate an ‘Optimal Health Program’ that adopts a person-centred approach and engages collaborative therapy to educate and support the psychosocial health of people diagnosed with type I or II diabetes.

Methods: This prospective randomised controlled trial will include 166 people diagnosed with diabetes: 83 in the intervention (Optimal Health Program) and 83 in the control (usual care) group. Participants with type diabetes mellitus will be recruited through hospital outpatient clinics and diabetes community organisations. Participants in the intervention group will receive nine (8 + 1 booster session) sequential sessions, based on a structured treatment manual emphasising educational and psychosocial support self-efficacy and skills building. The primary outcome measures will be generalised self-efficacy (GSE) and health-related quality of life (AQoL-6D and EQ-5D). Secondary measures will be anxiety and depression (HADS), social and workplace functioning (WSAS), diabetes-related quality of life (DQoL), diabetes-related distress (PAID), and type of coping strategies (Brief COPE). In addition, a health economic cost analysis and process evaluations will be performed to assess the economic cost and efficacy of the program’s operations, implementation and service delivery.

Discussion: We envisage that the Optimal Health Program’s emphasis on self-efficacy and self-management will provide participants with the skills and knowledge to achieve increased empowerment and independence in aspects of health, which in turn, will help participants deal more effectively with the physical and psychosocial complexities of diabetes.

TRIAL REGISTRATION: ACTRN12614001085662. Registered on 10 October 2014.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=27612943

Background: Stroke is a leading cause of disability and distress, and often profoundly affects the quality of life of stroke survivors and their carers. With the support of carers, many stroke survivors are returning to live in the community despite the presence of disability and ongoing challenges. The sudden and catastrophic changes caused by stroke affects the mental, emotional and social health of both stroke survivors and carers. The aim of this study is to evaluate a Stroke and Carer Optimal Health Program (SCOHP) that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of stroke survivors and their carers.

Methods: This study is a prospective randomised controlled trial. It will include a total of 168 stroke survivors and carers randomly allocated into an intervention group (SCOHP) or a control group (usual care). Participants randomised to the intervention group will receive nine (8 + 1 booster) sessions guided by a structured workbook. The primary outcome measures for stroke survivors and carers will be health-related quality of life (AQoL-6D and EQ-5D) and self-efficacy (GSE). Secondary outcome measures will include: anxiety and depression (HADS); coping (Brief COPE); work and social adjustment (WSAS); carer strain (MCSI); carer satisfaction (CASI); and treatment evaluation (TEI-SF and CEQ). Process evaluation and a health economic cost analysis will also be conducted.

Discussion: We believe that this is an innovative intervention that engages the stroke survivor and carer and will be significant in improving the psychosocial health, increasing independence and reducing treatment-related costs in this vulnerable patient-carer dyad. In addition, we expect that the intervention will assist carers and stroke survivors to negotiate the complexity of health services across the trajectory of care and provide practical skills to improve self-management.
Trial registration: ACTRN12615001046594. Registered on 7 October 2015.

URL: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1559-y

Objective: This study explored the possible factors associated with psychological distress in adults with Inflammatory Bowel Disease (IBD) and also engagement in mental health services (MHS) in those reporting distress in a large Australian cohort.

Methods: Participants with IBD completed an online survey assessing perceived IBD activity (Manitoba Index; MI), mental health status (K10), demographic details and engagement with MHS for IBD-associated issues.

Results: Of 336 participants, 76.5% perceived themselves as having active disease over the past 6 months, and on K10 scores, 51.8% had a mental health issue. Of participants with a mental health issue, only 21.3% were currently receiving mental health support. A stepwise logistic regression analysis correctly classified 78.7% of the status of receiving mental health support, with lower income (<$60,000p.a.) the only significant predictor. Paradoxically, the degree of psychological distress did not correlate with seeking mental health support.

Conclusions: The data show that in individuals with ongoing symptoms attributed to active IBD, mental health issues are highly prevalent, with older age and higher income being additional drivers of mental health issues. The greater challenge however, seems not to be identifying mental health issues, but in getting those in need to engage in MHS.

URL: TBA

Background and Aims: Electronic-health technologies (eHealth) such as Web-based interventions, virtual clinics, smart-phone applications, and telemedicine are being used to manage patients with inflammatory bowel disease (IBD). We aimed to: (1) Evaluate the impact of eHealth technologies on conventional clinical indices and patient-reported outcome measures (PROs) in IBD; (2) assess the effectiveness, cost-effectiveness and feasibility of using eHealth technologies to facilitate the self-management of individuals with IBD, and; (3) provide recommendations for their design and optimal use for patient care.

Methods: Relevant publications were identified via a literature search, and 17 publications were selected based on predefined quality parameters.

Results: Six randomized controlled trials and nine observational studies utilizing eHealth technologies in IBD were identified. Compared with standard outpatient-led care, eHealth technologies have led to improvements in: Relapse duration [( n = 1) 18 days vs 77 days, p < 0.001]; disease activity ( n = 2); short-term medication adherence ( n = 3); quality of life ( n = 4); IBD knowledge ( n = 2); healthcare costs ( n = 4); the number of acute visits to the outpatient clinic due to IBD symptoms ( n = 1), and; facilitating the remote management of up to 20% of an IBD cohort ( n = 2). Methodological shortcomings of eHealth studies include heterogeneity of outcome measures, lack of clinician/patient input, lack of validation against conventional clinical indices and PROs, and limited cost–benefit analyses.

Conclusions: EHealth technologies have the potential for promoting self-management and reducing the impact of the growing burden of IBD on health care resource utilization. A theoretical framework should be applied to the development, implementation, and evaluation of eHealth interventions.

URL: https://academic.oup.com/ecco-jcc/article/10/9/1103/2605214

Objective: The aim was to evaluate the utility of the common sense model (CSM) in characterizing contributors to psychological well-being and quality of life (QoL) in patients with end-stage OA.

Methods: One hundred and twenty patients [34 males, 86 females; mean (s.d.) age 65.52 (9.14) years] with end-stage OA (57.5% hip, 42.5% knee) were recruited. OA symptom severity was evaluated according to the WOMAC; coping styles were assessed with the Carver Brief COPE scale; illness perceptions were explored with the Brief Illness Perceptions Questionnaire; self-efficacy was assessed with the Arthritis Self-efficacy scale; anxiety, depression and overall distress were measured using the Hospital Anxiety and Depression Scale; and QoL was assessed using the WHO Quality of Life-short version. The CSM was used to explore the interrelationships between OA symptom severity, illness perceptions and coping strategies in patients.

Results: Two structural equation models were developed, with both found to have good fit. Consistent with the CSM, the standard model indicated that self-reported OA symptom severity directly influenced illness perceptions, which in turn had direct impacts upon maladaptive coping, distress and QoL. The addition of self-efficacy to the CSM resulted in a complex interaction, with OA severity directly influencing self-efficacy and self-efficacy influencing maladaptive coping, distress and QoL.

Conclusion: We found interrelationships amongst OA activity, illness perceptions, coping strategies, self-efficacy, psychological distress and QoL broadly consistent with the CSM. The CSM may help inform the approach to the psychological support that patients with end-stage OA often require.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26961745

Background: The aim of this study was to explore the effect of kidney transplantation (KT) on psychological distress and quality of life (QoL) in patients with end-stage kidney disease using the Common Sense Model of illness adjustment.

Materials and Methods: A total of 52 individuals (35 men and 17 women) with an average age of 53.54 years from a large metropolitan nephrology outpatient clinic participated.

Results: Poorer health status, illness perceptions and increased engagement in maladaptive coping were associated with psychological distress (specifically anxiety and depression) and poorer QoL. Hierarchical regression, after correcting for KT characteristics (years since most recent KT, number of transplants) indicated that poorer illness status and illness perception predicted QoL. After controlling for KT characteristics, poorer illness status and greater engagement in maladaptive coping predicted depression. In contrast, poorer illness perceptions and greater engagement in maladaptive coping predicted anxiety. Adaptive problem-focused and emotion-focused coping styles were not found to predict anxiety, depression or QoL.

Conclusions: The finding of the present study emphasize on the importance of exploring and understanding the effect of illness status, illness perceptions and coping patterns in patients who have underwent KT.

URL: http://www.amjmedsci.com/article/S0002-9629(15)00065-8/fulltext

Background: Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies.

Methods: Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research.

Results: (1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohn’s disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset.

Conclusions: The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatment.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26841224

Background: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a mindfulness-based intervention for patients with inflammatory bowel disease (MI-IBD).

Design: Treatment-as-usual control versus mindfulness-based stress reduction intervention.

Methods: Sixty patients participated in either the MI-IBD (n = 33) or treatment-as-usual group (n = 27) conditions. The MI-IBD consisted of an 8-week mindfulness-based stress reduction training group. Outcome measures were administered at baseline (before intervention), immediately after intervention, and 6 months after intervention. Primary outcomes included measures of quality of life, psychological distress (depression and anxiety), and mindfulness. Data for MI-IBD group participants also included weekly attendance, daily minutes meditated, and satisfaction with the program.

Results: There were no baseline differences between intervention and control groups on demographic variables or inflammatory bowel disease severity. Compared with the control group, the MI-IBD group reported significantly greater improvements in anxiety, quality of life, and mindfulness at after intervention, with reduction in depression and improvements in quality of life and mindfulness maintained at 6 months after intervention.

Conclusions: Results demonstrate the feasibility, acceptability, and efficacy of a mindfulness intervention for patients with inflammatory bowel disease, with medium-to-large effects on psychological distress, quality of life, and mindfulness.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26529560

Background: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a mindfulness-based intervention for patients with inflammatory bowel disease (MI-IBD).

Design: Treatment-as-usual control versus mindfulness-based stress reduction intervention.

Methods: Sixty patients participated in either the MI-IBD (n = 33) or treatment-as-usual group (n = 27) conditions. The MI-IBD consisted of an 8-week mindfulness-based stress reduction training group. Outcome measures were administered at baseline (before intervention), immediately after intervention, and 6 months after intervention. Primary outcomes included measures of quality of life, psychological distress (depression and anxiety), and mindfulness. Data for MI-IBD group participants also included weekly attendance, daily minutes meditated, and satisfaction with the program.

Results: There were no baseline differences between intervention and control groups on demographic variables or inflammatory bowel disease severity. Compared with the control group, the MI-IBD group reported significantly greater improvements in anxiety, quality of life, and mindfulness at after intervention, with reduction in depression and improvements in quality of life and mindfulness maintained at 6 months after intervention.

Conclusions: Results demonstrate the feasibility, acceptability, and efficacy of a mindfulness intervention for patients with inflammatory bowel disease, with medium-to-large effects on psychological distress, quality of life, and mindfulness.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=26529560

Background: This study aimed to characterize prevalence of anxiety and depressive conditions and uptake of mental health services in an Australian inflammatory bowel disease (IBD) outpatient setting.

Methods: Eighty-one IBD patients (39 males, mean age 35 years) attending a tertiary hospital IBD outpatient clinic participated in this study. Disease severity was evaluated according to the Manitoba Index. Diagnosis of an anxiety or depressive condition was based upon the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale.

Results: Based on Hospital Anxiety and Depression Scale subscale scores >8 and meeting Mini-International Neuropsychiatric Interview criteria, 16 (19.8%) participants had at least one anxiety condition, while nine (11.1%) had a depressive disorder present. Active IBD status was associated with higher prevalence rates across all anxiety and depressive conditions. Generalized anxiety was the most common (12 participants, 14.8%) anxiety condition, and major depressive disorder (recurrent) was the most common depressive condition reported (five participants, 6.2%). Seventeen participants (21%) reported currently seeking help for mental health issues while 12.4% were identified has having at least one psychological condition but not seeking treatment.

Conclusion: We conclude that rates of anxiety and depression are high in this cohort, and that IBD-focused psychological services should be a key component of any holistic IBD service, especially for those identified as having active IBD.

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512611/

Objectives: Very little is known about mechanisms of idiosyncratic sensitivity to the damaging effects of mercury (Hg); however, there is likely a genetic component. The aim of the present study was to search for genetic variation in genes thought to be involved in Hg metabolism and transport in a group of individuals identified as having elevated Hg sensitivity compared to a normal control group.

Materials and methods: Survivors of pink disease (PD; infantile acrodynia) are a population of clinically identifiable individuals who are Hg sensitive. In the present study, single nucleotide polymorphisms in genes thought to be involved in Hg transport and metabolism were compared across two groups: (i) PD survivors (n = 25); and (ii) age- and sex-matched healthy controls (n = 25).

Results: Analyses revealed significant differences between groups in genotype frequencies for rs662 in the gene encoding paraoxanase 1 (PON1) and rs1801131 in the gene encoding methylenetetrahydrofolate reductase (MTHFR).

Conclusions: We have identified two genetic polymorphisms associated with increased sensitivity to Hg. Genetic variation in MTHFR and PON1 significantly differentiated a group formerly diagnosed with PD (a condition of Hg hypersensitivity) with age- and gender-matched healthy controls.

URL: https://www.ncbi.nlm.nih.gov/pubmed/25948960

Purpose: We employed the Common Sense Model (CSM) of illness perceptions to examine the relative contribution of illness perceptions, stoma self-efficacy, and coping strategies in explaining anxiety and depression symptoms in patients with a fecal ostomy. The CSM suggests that the consequences of illness activity, such as psychological distress, are influenced by an individual’s illness perceptions as well as what coping strategies they engage in.

Design: Descriptive, cross-sectional questionnaire-based study.

Subjects and setting: One hundred fifty adults with a stoma (54 males, and 96 females; mean age 44 years) completed an online survey.

Methods: Several instruments were used to measure study outcomes, including the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-Efficacy Scale, and the Hospital Anxiety and Depression Scale. Participants were advised of the study through online forums containing a link to the survey. Outcome measures used in the current study are valid and reliable and have been extensively used in medically ill patients.

Results: Using structural equation modeling, the final model provided an excellent fit to the data (χ23= 16.53, P = .22, χ/N = 1.27, SRMR < 0.03, RMSEA < 0.05, GFI > 0.97, CFI > 0.99). There was a direct pathway from health status to illness perceptions months since surgery directly influenced health status, illness beliefs, and adaptive emotion-focused coping (β= .81, P < .001). Several indirect (mediating) pathways were also identified. Illness perceptions mediated the relationship between health status and stoma self-efficacy and maladaptive and adaptive emotion-focused coping. Maladaptive coping mediated the relationship between illness perceptions and depression and anxiety, and adaptive emotion-focused coping mediated the relationship between illness perception and depression. The final model provided support for the CSM, in that illness perceptions were directly related to illness status, and that both illness perceptions and coping strategies directly influenced anxiety and depression. More specifically, maladaptive coping style (eg, ignore problems) exacerbated depression and anxiety symptoms, while self-efficacy and emotion-focused coping style (eg, seek advice) ameliorate depression, but not anxiety. Months since surgery was associated with improved health status, reduced poorer illness perceptions, and increased emotional-focused coping.

Conclusions: Illness perceptions and coping were found to mediate anxiety and depression. The results confirm that how individuals perceive their illness and what coping strategies they engage in impacts their psychological well-being. Study findings support the need for designing targeting psychological interventions based on individual illness perceptions and self-efficacy rather than exclusively focusing on coping strategies in patients with a stoma.

URL: https://www.ncbi.nlm.nih.gov/pubmed/25377108

Background: Osteoarthritis is a leading cause of disability in developed nations. In Australia it afflicts 16.5% of the adult population. Total joint arthroplasty is considered the treatment of choice for end stage osteoarthritis. The number of total joint arthroplasties undertaken in Australia has doubled over the last decade (more than 80,000 procedures in 2011). The incidence of pre-operative psychological distress in this group of patients is reported between 30% and 60% and pre-operative psychological distress is associated with poorer pain and functional outcomes after surgery. This study will use a mindfulness-based psychological intervention to enhance outcomes in people undergoing total joint arthroplasty and, in addition, will test hypotheses about coping with chronic illness in an aged population. This study is the first of its kind and will provide a greater understanding of the role of a mental health enhancement program on the physical recovery of total joint arthroplasty patients.

Methods/design: One hundred and fifty people with end-stage arthritis on the waiting list for total hip or knee arthroplasty will be recruited and randomly allocated to one of two groups using computer-generated block randomisation. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of a mindfulness training program (weekly group-based classes in mindfulness practice, 2 ½ hours, for 8 weeks plus a 7-hour Saturday session in Week 6) prior to total joint arthroplasty, compared to a “standard care” group who will undergo routine total joint arthroplasty. Primary outcomes will be evaluated by a blinded examiner at baseline, 3 and 12 months post-surgery, using a validated self-reported pain and physical function scale. Secondary outcomes will include i) a range of validated measures of psychological wellbeing and ii) health economic analysis. All analyses will be conducted on an intention to treat basis using linear regression models. Health economic modelling will be applied to estimate the potential cost-effectiveness of mindfulness training and total joint arthroplasty.

Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTRN12611001184965). Date of registration; 15th November 2011.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24899242

Background: Using the common sense model of illness adjustment, this study aimed to explore the impact of chronic kidney disease (CKD) on individual illness perceptions, coping styles and psychological well-being.

Methods: Eighty individuals (50 men and 30 women) with an average age of 62.66 years (standard deviation, 11.98) were included in the study. All participants were under the care of the Renal Unit of a metropolitan tertiary referral hospital. Twenty-nine patients (36%) had CKD stage 3b-4, and 51 (64%) had CKD stage 5 (or end stage kidney disease [ESKD]). Disease severity was evaluated using the health perceptions questionnaire, coping styles assessed with the Carver brief COPE scale, illness perceptions explored with the brief illness perceptions questionnaire and anxiety and depression measured using the hospital anxiety and depression scale.

Results: The hospital anxiety and depression scale assessment revealed 13 patients (16.3%) with moderate or severe anxiety and 6 (7.5%) with moderate depression. Consistent with the common sense model, disease activity had a significant direct influence on illness perceptions, while, in turn, illness perceptions had a significant direct influence on depression and anxiety. Adaptive and maladaptive coping were found to mediate the relationship between illness perceptions, and anxiety and depression.

Conclusions: The results provide evidence that it is the perception of an illness rather than the actual symptoms themselves that best account for adaption to CKD. These findings suggest that intervention strategies aimed at increasing psychological well-being need to focus on changing illness perceptions rather than improving symptoms of CKD or coping mechanisms.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24751421

Objective: While there have been several reviews exploring the outcomes of various eHealth studies, none have been gastroenterology-specific. This paper aims to evaluate the research conducted within gastroenterology which utilizes internet-based eHealth technology to promote physical and psychological well-being.

Material and methods: A systematic literature review of internet-based eHealth interventions involving gastroenterological cohorts was conducted. Searched databases included: EbSCOhost Medline, CINAHL, and PsycINFO. Inclusion criteria were studies reporting on eHealth interventions (both to manage mental health problems and somatic symptoms) in gastroenterology, with no time restrictions. Exclusion criteria were non-experimental studies, or studies using only email as primary eHealth method, and studies in language other than English.

Results: A total of 17 papers were identified; seven studies evaluated the efficacy of a psychologically oriented intervention (additional two provided follow-up analyses exploring the original published data) and eight studies evaluated disease management programs for patients with either irritable bowel syndrome, inflammatory bowel disease (IBD) or celiac disease. Overall, psychological eHealth interventions were associated with significant reductions in bowel symptoms and improvement in quality of life (QoL) that tended to continue up to 12 months follow up. The eHealth disease management was shown to generally improve QoL, adherence, knowledge about the disease, and reduce healthcare costs in IBD, although the studies were associated with various methodological problems, and thus, this observation should be confirmed in well-designed interventional studies.

Conclusions: Based on the evidence to date, eHealth internet-based technology is a promising tool that can be utilized to both promote and enhance gastrointestinal disease management and mental health.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24494974

Objectives: A large body of research has demonstrated that patient factors are strong predictors of recovery from surgery. Mind-body therapies are increasingly targeted at pre-operative psychological factors. The objective of this paper was to evaluate the efficacy of pre-operative mind-body based interventions on post-operative outcome measures amongst elective surgical patients.

Methods: A systematic review of the published literature was conducted using the electronic databases MEDLINE, CINAHL and PsychINFO. Randomised controlled trials (RCTs) with a prospective before-after surgery design were included.

Results: Twenty studies involving 1297 patients were included. Mind-body therapies were categorised into relaxation, guided imagery and hypnotic interventions. The majority of studies did not adequately account for the risk of bias thus undermining the quality of the evidence. Relaxation was assessed in eight studies, with partial support for improvements in psychological well-being measures, and a lack of evidence for beneficial effects for analgesic intake and length of hospital stay. Guided imagery was examined in eight studies, with strong evidence for improvements in psychological well-being measures and moderate support for the efficacy of reducing analgesic intake. Hypnosis was investigated in four studies, with partial support for improvements in psychological well-being measures. Evidence for the effect of mind-body therapies on physiological indices was limited, with minimal effects on vital signs, and inconsistent changes in endocrine measures reported.

Conclusions: This review demonstrated that the quality of evidence for the efficacy of mind-body therapies for improving post-surgical outcomes is limited. Recommendations have been made for future RCTs.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=24280480

Due to the critical shortage and continued need of blood and organ donations (ODs), research exploring similarities and differences in the motivational determinants of these behaviors is needed. In a sample of 258 university students, we used a cross-sectional design to test the utility of an extended theory of planned behavior (TPB) including moral norm, self-identity and in-group altruism (family/close friends and ethnic group), to predict people’s blood and OD intentions. Overall, the extended TPB explained 77.0% and 74.6% of variance in blood and OD intentions, respectively. In regression analyses, common contributors to intentions across donation contexts were attitude, self-efficacy and self-identity. Normative influences varied with subjective norm as a significant predictor related to OD intentions but not blood donation intentions at the final step of regression analyses. Moral norm did not contribute significantly to blood or OD intentions. In-group altruism (family/close friends) was significantly related to OD intentions only in regressions. Future donation strategies should increase confidence to donate, foster a perception of self as the type of person who donates blood and/or organs, and address preferences to donate organs to in-group members only.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23943782

Background and aims: Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort.

Methods: Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

Results: Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping.

Conclusions: The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23541738

Background and aims: This study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD.

Methods: Seventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale.

Results: Exploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ(2) (25)=27.84, p=.32, χ(2)/N=1.11, CFI>0.99, RMSEA<0.04, SRMR<0.07, GFI>0.93). Illness perceptions had a significant direct influence on depression (β=0.49, p<0.001), anxiety (β=0.55, p<0.001), and family functioning (β=-0.17, p<0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction.

Conclusions: The findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23453888

Previous researchers have postulated that gastrointestinal bacteria may contribute to the development and maintenance of Autism Spectrum Disorders (ASD). There is evidence based on quantitative evaluation of the gastrointestinal bacterial population in ASD that this is unlikely and an alternate mechanism will be examined where the bacteria may contribute to the development of ASD via their metabolic products and the role of biogenic amines (BAs) will be investigated. In humans, BAs influence a number of physiological processes via their actions as neurotransmitters, local hormones and gastric acid secretion. Various amines have been implicated in several medical conditions such as schizophrenia and colon cancer. To date, the relationship between BAs and autism has not been explored. This study has been designed to identify differences (and/or similarities) in the level of Bas in faecal samples of autistic children (without gastrointestinal dysfunction: n = 14; with gastrointestinal dysfunction; n = 21) and their neurotypical siblings (n = 35) by LC-MS/MS. Regardless of the diagnosis, severity of ASD and gastrointestinal dysfunction there were no significant differences found between the groups. The findings suggest that BAs in the gastrointestinal tract do not play a role in the pathophysiology of gastrointestinal dysfunction associated with ASD.

URL: http://dro.deakin.edu.au/view/DU:30058758

Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=23846488

University students represent one target population with great potential to serve as volunteers. The primary focus on describing the characteristics of students who choose to volunteer, however, has resulted in limited understanding of the psychosocial factors impacting on students’ decisions to volunteer. To bridge this gap, we used an extension of a well-known theoretical framework, the theory of planned behaviour (TPB), to predict students’ intentions to volunteer for community service. Using content and thematic analysis, we explored also students’ motivations and constraints for volunteering. Students (N = 235; M age = 22.09 years) self-reported their attitude, normative influences, control perceptions, moral obligation, past behaviour, demographic characteristics, and intentions for volunteering via questionnaire. Regression analyses showed that the extended TPB explained 67% of the variance in students’ volunteering intentions. In qualitative analyses, themes primarily represented the factors contributing to low efficacy for volunteering (e.g., time constraints). Control perceptions and perceived moral obligations related to volunteering represent important future targets to encourage student volunteering for organisations providing critical services for those most in need.

URL: http://onlinelibrary.wiley.com/doi/10.1111/ajpy.12014/full

Purpose: The aims of this research were to explore associations among elective versus emergency surgery, type of ostomy (permanent vs temporary), illness perceptions and coping style, anxiety, depression, and health-related quality of life in persons with Crohn’s disease. A further aim was to determine the extent of current and past use of psychological care and use of psychotropic medications.
Subjects and setting: The sample comprised 31 persons (17 men and 14 women; mean age 45 years) with Crohn’s disease and an ostomy from 2 large teaching hospitals in Melbourne, Australia.

Methods: Data were collected using a descriptive, cross-sectional design. The questionnaire incorporated 3 validated instruments: the Brief Illness Perceptions Questionnaire, the Hospital Anxiety and Depression Scale, and the Stoma Quality of Life Scale.

Results: Poor illness perception correlated significantly with increased anxiety, depression, and reduced health-related quality of life (specifically, sexuality and body image, work and social functioning, stoma function, and financial concerns). Forty-eight percent of patients scored more than the cutoff for anxiety, and 42% scored more than the cutoff for depression on the Hospital Anxiety and Depression Scale. Of these, only 20% and 31%, respectively, reported currently receiving psychological care. The timing of ostomy surgery (planned vs emergency) or ostomy type (permanent vs temporary) was not significantly associated with anxiety, depression, or health-related impaired quality of life.

Conclusions: In this exploratory, cross-sectional study, patients with Crohn’s disease and a stoma had high rates of psychological comorbidity and low scores on quality of life. Adverse illness perception appeared to explain some of these findings, but most were not receiving psychological help. Psychological care is indicated for many of these patients and further research is indicated.

URL: https://www.ncbi.nlm.nih.gov/pubmed/24202226

Many children with autism spectrum disorders (ASDs) suffer from gastrointestinal problems such as diarrhoea, constipation and abdominal pain. This has stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. Therefore, we designed this study to identify differences (and/or similarities) in the microbiota of children with autism (without gastrointestinal dysfunction: n = 23; with gastrointestinal dysfunction: n = 28) and their neurotypical siblings (n = 53) who share a similar environment using bacterial tag-encoded FLX amplicon pyrosequencing. Regardless of the diagnosis and sociodemographic characteristics, overall, Firmicutes (70%), Bacteroidetes (20%) and Proteobacteria (4%) were the most dominant phyla in samples. Results did not indicate clinically meaningful differences between groups. The data do not support the hypothesis that the gastrointestinal microbiota of children with ASD plays a role in the symptomatology of ASD. Other explanations for the gastrointestinal dysfunction in this population should be considered including elevated anxiety and self-restricted diets.

URL: http://onlinelibrary.wiley.com/doi/10.1002/aur.1253/full

An extended theory of planned behavior (TPB) was used to predict young people’s intentions to donate money to charities in the future. Students (N = 210; 18–24 years) completed a questionnaire assessing their attitude, subjective norm, perceived behavioral control (PBC), moral obligation, past behavior, and intentions toward donating money. Regression analyses revealed that the extended TPB explained 61% of the variance in intentions to donate money. Attitude, PBC, moral norm, and past behavior predicted intentions, representing future targets for charitable-giving interventions.

URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.2012.00932.x/full

Background: An individual’s psychological adjustment to illness is influenced by disease severity, illness perceptions, and coping strategies. A more precise understanding of the contribution of each of these factors to a patient’s well-being may influence the kind of psychological support required by patients. This study therefore aimed to characterize the contributors to psychological well-being in patients with Crohn’s disease (CD). The design was a cross-sectional questionnaire-based study.

Methods: Ninety-six CD patients (34 males, 62 females, mean age 38 years) attending a tertiary hospital inflammatory bowel disease outpatient clinic were studied. Disease severity was evaluated according to the Crohn’s Disease Activity Index (CDAI), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS).

Results: Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (7) = 10.42, P = 0.17, χ(2) /N = 1.49, root mean square error of approximation (RMSEA) < 0.07, comparative fit index (CFI) > 0.97, Goodness-of-fit index (GFI) > 0.97). Disease activity had a significant direct influence on illness perceptions (β = 51, P < 0.001). In turn, illness perceptions had a significant direct influence on depression and anxiety (β = 41, P < 0.001, β = 0.40, P < 0.001, respectively). Use of emotional coping strategies was associated significantly (P < 0.001) with the presence of anxiety and depression.

Conclusions: There is an interrelationship between disease activity, illness perceptions, coping strategies, and depression and anxiety. These aspects of psychological processing provide a framework and direction for the psychological support that patients with CD require.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=21425208

Cases of autism have frequently been reported in association with gastrointestinal problems. These observations have stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. The objectives of this paper were to review the possible involvement and mechanisms of gastrointestinal microbiota in autistic spectrum disorder and explain the possible role of gastrointestinal microbiota in the condition. This review addresses the possible involvement of bacteria, viruses and fungi, and their products in autism. Direct viral damage of neurons or disruption of normal neurodevelopment by immune elements such as cytokines, nitric oxide and bacterial products, including lipopolysaccharides, toxins and metabolites, have been suggested to contribute to autistic pathology. Numerous intestinal microbial abnormalities have been reported in individuals with autism. Research to date exploring possible gastrointestinal problems and infection in autism has been limited by small and heterogeneous samples, study design flaws and conflicting results. Furthermore, interventions designed to modify the intestinal microbial population of autistic patients are few and limited in their generalisation. In order to bring clarity to this field, high-quality and targeted investigations are needed to explore the role of gastrointestinal microbiology in autism. To this end, several promising avenues for future research are suggested.

URL: http://journals.lww.com/revmedmicrobiol/Abstract/2010/07000/Gastrointestinal_microbiology_in_autistic_spectrum.2.aspx

Many children with autistic spectrum disorders (ASDs) suffer from gastrointestinal problems such as diarrhoea, constipation and abdominal pain. Such symptoms may be due to a disruption of the indigenous gut microbiota promoting the overgrowth of potentially pathogenic micro-organisms. These observations have stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. The purpose of the present study was to determine if a relationship exists between ASD severity (mild – severe) and GI microbial populations. The faecal microbiota of 22 male and 6 female participants with ASDs (aged 7 ± 6 years) were analyzed by standard microbial culture methods and compared within-group (based on ASD severity) and with a standard laboratory reference range. Comparisons between children with mild ASD and those with moderate to severe ASD, as well as comparisons to a neurotypical control group previously reported, revealed that no significant differences appear to exist in the composition of the gut microbiota. Nevertheless, examination of each individual’s gut microbial composition showed 10 cases of unusual findings witch means 1out of 3 cases have unusual microbiota. Our data do not support consistent GI microbial abnormalities in ASD children, but the findings do suggest that aberrations may be found in a minority subset of ASD children. Further studies are required to determine the possible association between the microbiota and gastrointestinal dysfunctions in a subset of children with both ASD and gastro-intestinal problems.

URL: http://pandora.nla.gov.au/pan/51365/20110812-0020/ojs.lib.swin.edu.au/index.php/ejap/article/view/213.html

Objective: Compare evaporation techniques in the work-up procedure of saliva samples for cortisol analysis by a previously validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method.

Design and methods: Samples were evaporated using freeze drying, centrifugal concentration, and nitrogen flow and analyzed by LC-MS/MS.

Results: Cortisol concentrations detected using each technique did not significantly differ. Factors other than the recovery of cortisol were evaluated.

Conclusions: Evaporation using freeze drying/centrifugal concentration is an automated process, reducing overall processing time for analysis of numerous samples.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=18789315

Extending the 2002 stress-appraisal model of Chappell and Reid, we examined the relationships between caregiver stressors (e.g., cognitive impairment and functional dependency of the recipient), appraisal (informal hours of caregiving), and protective factors (e.g., social support, self-esteem, and quality of the caregiver-recipient relationship) associated with the burden and quality of life of Parkinson’s disease caregivers. There were 136 caregivers (M = 64.59 years) who completed an online survey. Using structural equation modeling, we found that the extended stress-appraisal model of Chappell and Reid provided a good fit to the data (chi2 = 67.87, df = 55, p >.05; chi2/df = 1.23, Comparative Fit Index = 0.98, Root Mean Square Error of Approximation = 0.04). This study provides an important contribution to a growing field of research that applies theoretical models to investigate the stressors, appraisals, and protective factors that impact caregiver well-being.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=19092040

The Standard Shiftwork Index (SSI) provides shiftwork researchers with a standardised battery for assessing the impact of shiftwork on psychological and physiological well-being. We review the published SSI literature and evaluate the extent to which the results of these publications support the model underpinning the SSI. A total of 70 SSI publications were identified, of which 41 were selected. The 41 studies were published between 1993 and 2006 and had a combined total of 21,420 respondents. The analysis indicated support for parts of the SSI model, particularly in relation to the impact of shift systems design on individual well-being, as well as the role of individual factors (e.g., personality, coping style). However, evidential support for the model as a whole is incomplete. The findings of the reviewed studies are summarised and methodological limitations are discussed.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=18348885

This study examined the impact of academic stress on salivary cortisol concentrations and lactic acid bacteria activity. Whole, unstimulated saliva samples and faecal samples were collected from 23 healthy undergraduate students (23.0+/-6.8 years; range 18-44) over two 1-week periods: during the beginning of semester (low-stress baseline condition) and during the first week of exams (high-stress condition). Students also completed a series of questionnaires measuring perceived levels of stress, gastrointestinal symptoms, and nutritional intake. Significant findings indicated that faecal lactic acid bacterial levels were lower during the high-stress condition. Paralleling this, students rated perceived levels of stress as being greater during the exam period compared to the baseline condition. The findings from this study have provided further insight into the link between stress and gastrointestinal flora activity in humans.

URL: https://www.ncbi.nlm.nih.gov/pubmed/?term=18023961

The GHQ12 has become a popular screening instrument used by both clinicians and researchers. To date there have been a number of studies investigating the factor structure of the GHQ12. Most have identified a factorial structure to the instrument but there has been little consistency in the factors identified. One reason for this may be that different investigators are using different scoring methods and this could impact the structure identified. This study used structured equation modeling (LISREL 8.7) to carry out a confirmatory factor analysis, with a large sample of 8,732 university staff, on four 3-factor and one unitary model solutions using the three most common scoring methods (Classical, Corrected, and Likert). It was found that the method of scoring substantially affects model estimation and suggestions were made as to the best scoring method for future use.

URL: http://econtent.hogrefe.com/doi/abs/10.1027/1015-5759.23.1.2

A survey of public attitudes showed that there is significant stigma perceived to be associated with Parkinson’s disease (PD), as well as significant misconceptions about the course and outcomes of the disease. Negative attitudes to PD were associated with perceived stigma, (younger) age, knowledge of a sufferer and knowledge of the disease. Perceived stigma, negative attitudes and incorrect beliefs are likely to impinge on the psychosocial well-being of those living with the disease, particularly those with early onset. The data from this study was collected from 200 householders and suggest that more public information about positive lifestyle possibilities for those living with Parkinson’s would be of value to disease sufferers and their carers.

URL: http://pandora.nla.gov.au/pan/51365/20070816-0000/ojs.lib.swin.edu.au/index.php/ejap/article/view/32.html

The aim of this study was to assess the relationships between age and various personality variables (i.e., morningness, languidity, flexibility, neuroticism, and extroversion) on a variety of well-being scores, including: (1) physiological (i.e., chronic fatigue, cardiovascular symptoms, and digestive symptoms), (2) psychological (i.e., cognitive and somatic anxiety), and (3) total sleep disturbance. It was hypothesized that morningness, flexibility, and extroversion scores would have a significant beneficial relationship with subjective well-being. In contrast, age, languidity, and neuroticism scores would have a significant adverse relationship with subjective well-being. One hundred and twenty-nine Police Officers completed a modified version of the Standard Shiftwork Index (SSI). The results of the Pearson’s product coefficients indicated that higher morningness, flexibility, and extroversion personality scores were related to increased subjective well-being, while age, languidity, and neuroticism were correlated with reduced subjective well-being. The results of this current study provide additional empirical support for the premise that an individual’s psychological and physiological well-being is influenced by personality. In addition, the impact of the outlined personality measures may either exacerbate or attenuate the ability to adapt successfully to a shift-working lifestyle.

URL: https://www.questia.com/library/journal/1G1-147390791/assessing-the-relationship-between-age-and-personality

There is an extensive amount of literature utilising the emotional Stroop task (EST) to investigate attentional processes underlying a range of psychological conditions. Relatively fewer studies have specifically examined the impact of different Stroop stimuli presentation methods (i.e., blocked or mixed presentation of words). The aim of this study was to directly investigate this issue using an online version of the task. After an initial practice trial, 117 Psychology students (19 Male, 98 Female) were randomly allocated to either a random or counterbalanced blocked condition. Demographic information and level of psychological distress (K10) were also collected. Results indicated that there were no significant differences between blocked and random conditions on attentional interference. Further analysis indicated that random presentation produced significantly higher levels of response latencies to emotional words in participants with high levels of psychological distress. These data add to the methodological debate surrounding the use of blocked vs. random presentation of Stroop stimuli. Implications of these results for assessing control and clinical groups using the EST are discussed.

URL: http://pandora.nla.gov.au/pan/51365/20070816-0000/ojs.lib.swin.edu.au/index.php/ejap/article/view/20.html

The aim of this study was to investigate the possible mediating role of various cognitive and behavioural coping strategies on the relationship between age and psychological (i.e., cognitive and somatic anxiety) and physiological (i.e., chronic fatigue, digestive and cardiovascular symptoms) well-being. Fourteen specific individual coping strategies (four disengagement, four engagement, and six behavioural) were assessed in this study. The four disengagement and four engagement coping styles were taken from the Coping Strategies Inventory (CSI) included in the Standard Shiftwork Index (SSI), while the six behavioural coping strategies were based on recommendations published within the shiftwork literature (e.g., exercising, altering family or social life commitments to fit in with working shifts, advising friends and family about shift patterns, etc). Three open-ended questions were also included in the questionnaire allowing shiftworkers to provide further contextual detail about the specific coping strategies utilised. One hundred and eight Police Officers with at least 12 months shiftworking experience completed a modified version of the SSI and an active coping questionnaire. A series of exploratory stepwise regressions provided evidence that shiftworkers utilise a constellation of different coping strategies, and that each of these coping strategies may mediate specific aspects of the relationship between age and psychological and/or physiological well-being. Comments from shiftworkers provided further evidence for the variety of coping strategies utilised to help adapt to shiftwork.

URL: https://www.questia.com/library/journal/1G1-140303715/exploring-the-mediating-roles-of-cognitive-and-behavioural

The aim of this study was to utilize a subset population initially reported in Knowles and Bull (2003) to investigate the impact of perceived stress on individual psychological and physiological well-being. Of the original 129 participants participating in the 2003 study, 64 also completed the modified version of the Standard Shift-work Index (SSI) and two other questionnaires: the Perceived Stress Scale (PSS) and the General Health Questionnaire (GHQ). It was hypothesized that an analysis of the responses to these scales would indicate that age, disengagement, and perceived stress would be adversely related to well-being. Furthermore, it was also hypothesized that perceived stress would be a more influential covariate of well-being when compared to the covariates of age and disengagement coping. Analysis of the data provided partial support for the hypotheses that age, disengagement coping, and perceived stress were adversely related to a variety of psychological and physiological symptoms. In addition, results also indicate that the covariate of perceived stress accounted for a majority of the significant findings. Overall these findings provide evidence that, while age and disengagement coping moderate well-being, levels of perceived stress may play a more influential role.

URL: https://www.questia.com/library/journal/1G1-140242542/investigating-the-affect-of-stress-on-police-officer

The primary aim of this article is to assess the impact of a high stress shift work occupation (i.e., police work) on psychological (i.e., cognitive and somatic anxiety) and physiological (i.e., chronic fatigue, digestive and cardiovascular symptoms) wellbeing. Specifically, this study seeks to assess the impact of age on psychological and physiological wellbeing as well as to assess the mediating impact of adverse (disengagement) and beneficial (engagement) coping strategies on psychological and physiological wellbeing. One hundred and twenty-nine subjects from two Police Local Area Commands in Eastern Australia completed a modified version of the Standard Shiftwork Index (SSI). It was hypothesized that age and disengagement coping would be adversely related to psychological and physiological symptoms and that, conversely, engagement coping would be beneficially related to psychological and physiological wellbeing. Although analysis of the data supported the hypothesis that age and disengagement coping were adversely related to a variety of psychological and physiological symptoms, the results did not support the hypothesis that engagement coping was beneficially related to either psychological or physiological wellbeing. These findings are discussed within the context their implications for police officer psychological and physiological wellbeing.

URL: https://www.questia.com/library/journal/1G1-140242549/assessing-the-impact-of-shift-work-and-stress-on-the