Multicenter study of gastroenterologists' ability to identify anxiety and depression in a new patient encounter and its impact on diagnosis

Exploring the Patients' Perspective on Digital Tools for Psychosocial Assessment in Dentistry

BACKGROUND

Psychosocial screening is a valuable part of the assessment of patients with orofacial pain, as psychosocial factors will affect prognosis and treatment outcomes. Paper-based questionnaires are predominately used to assess the degree of psychosocial comorbidity; however, digital alternatives for screening questionnaires may be more cost-effective and resource-saving if patients are receptive to using them.

OBJECTIVE

To evaluate how patients perceive digital psychosocial screening in dentistry.

METHOD

Using a qualitative approach, individual semi-structured interviews were conducted with a purposive sample of adult patients with orofacial pain (n = 16) recruited from specialist dental clinics in Umeå and Gävle, Sweden. The interviews were transcribed verbatim and then analysed using Qualitative Content Analysis. Before the interviews, patients first completed the paper-based questionnaires and then the digital version.

RESULTS

The analysis of patients' experiences resulted in an overarching theme: Patients appreciate a holistic approach, thus valuing psychosocial screening, and they particularly favour screening in a digital format. From this theme, two categories emerged: Perceptions about health shape patients' expectations of dental care, and with deeper understanding of the value of psychosocial assessment, patients appreciate a holistic approach that includes psychosocial factors. Digital screening is perceived by patients as a reliable, meaningful and environmentally sustainable method.

CONCLUSIONS

In general, the patients appreciated a holistic approach in dentistry and understood the value of psychosocial screening as part of this. From the patients' perspective, digital psychosocial screening was both acceptable and beneficial. The findings support the introduction of digital psychosocial screening into daily dental practice.

The relationship between adverse childhood experiences and disorders of the gut-brain interaction

OBJECTIVES

Disorders of the gut-brain interaction (DGBI) arise from a complex interplay of psychosocial factors, altered physiology, and early life factors. In adults, adverse childhood experiences (ACEs) have been associated with DGBI. While both ACEs and DGBI are prevalent among children, the relationship between ACEs and DGBI in childhood is not well understood.

METHODS

Retrospective review of patients aged 3-18 years with ACE scores documented between October 1, 2019 and April 30, 2022 who were divided into three comparison groups: (1) not referred to pediatric gastroenterology (GI); (2) referred to GI and diagnosed with a DGBI; and (3) referred to GI and not diagnosed with a DGBI.

RESULTS

Of 29,490 patients with ACE scores documented during the study period, 897 completed a GI consultation. Four hundred and one (44.7%) were diagnosed with a DGBI. With each additional adverse experience, patients were 1.09 times more likely to have a DGBI diagnosis (95% confidence interval [CI] = 1.056-1.163; p ≤ 0.001). An anxiety diagnosis mediated 73% of this relationship (p = 0.012).

CONCLUSIONS

Among patients receiving pediatric GI specialty care, higher ACE scores were associated with a higher likelihood of a DGBI diagnosis. Anxiety largely mediates this relationship, suggesting potential avenues for targeted, multidisciplinary interventions in both primary and specialty care settings.

The Impact of Psychotrauma and Emotional Stress Vulnerability on Physical and Mental Functioning of Patients with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic health condition thought to be influenced by personal life experiences and emotional stress sensitivity (neuroticism). In the present study, we examined the impact of cumulative trauma experiences and trait neuroticism (as a measure for emotional stress vulnerability) on physical and mental functioning of n = 211 patients diagnosed with IBD (112 Crohn's disease, 99 ulcerative colitis). All patients were assessed for self-reported trauma histories, emotional stress vulnerability, clinical disease activity, functional gastrointestinal (GI) symptoms, and quality of life. Results showed that patients with severe IBD activity have endured significantly more interpersonal trauma and victimization than those with quiescent IBD. Moreover, cumulative trauma was found to exert an indirect (neuroticism-mediated) effect on patients' symptom complexity, with trauma and neuroticism conjointly explaining 16-21% of the variance in gastrointestinal and 35% of the variance in mental symptoms. Upon correction for condition (using a small group of available controls, n = 51), the predictive capacity of trauma and neuroticism increased further, with both predictors now explaining 31% of the somatic-and almost 50% of the mental symptom heterogeneity. In terms of trauma type, victimization (domestic violence and intimate abuse) proved the best predictor of cross-sample symptom variability and the only trauma profile with a consistent direct and indirect (neuroticism-mediated) effect on patients' mental (QoL) and physical fitness. Results are consistent with the growing body of evidence linking experiential vulnerability factors (trauma and neuroticism) and associated feelings of personal ineffectiveness, helplessness, and uncontrollability to interindividual differences in (GI) disease activity and quality of life.

Psychological Considerations and Interventions in Inflammatory Bowel Disease Patient Care

The presence of psychological comorbidities, specifically anxiety and depression, is well documented in inflammatory bowel disease (IBD). The drivers of these conditions typically reflect 4 areas of concern: disease impact, treatment concerns, intimacy, and stigma. Various demographic and disease characteristics increase risk for psychological distress. However, the risk for anxiety and depression is consistent throughout IBD course and is independent of disease activity. Early intervention before psychological distress becomes uncontrolled is ideal, but mental health often is unaddressed during patient visits. Understanding available psychological treatments and establishing referral resources is an important part of the evolution of IBD patient care.

Psychological Considerations and Interventions in Inflammatory Bowel Disease Patient Care

The presence of psychological comorbidities, specifically anxiety and depression, is well documented in inflammatory bowel disease (IBD). The drivers of these conditions typically reflect 4 areas of concern: disease impact, treatment concerns, intimacy, and stigma. Various demographic and disease characteristics increase risk for psychological distress. However, the risk for anxiety and depression is consistent throughout IBD course and is independent of disease activity. Early intervention before psychological distress becomes uncontrolled is ideal, but mental health often is unaddressed during patient visits. Understanding available psychological treatments and establishing referral resources is an important part of the evolution of IBD patient care.

The role of incongruence between the perceived functioning by patients and clinicians in the detection of psychological distress among functional and motor digestive disorders

OBJECTIVES

Previous research on gastrointestinal and other medical conditions has shown the presence of incongruence between self- and clinician-reported functioning and its relation with psychopathology. The main objective of this study was to test whether inconsistencies between clinician- and self-assessed functionality can be used to detect psychopathology among patients diagnosed of motor or functional gastrointestinal disorders.

METHODS

One hundred and three patients from a gastroenterology inpatient unit were included in this study. All patients underwent clinical assessment, including intestinal manometry, Rome III criteria for functional gastrointestinal disorders, and psychological and psychiatric evaluation. Patients with suspected gastroparesis underwent a scintigraphic gastric emptying test. Definitive diagnoses were made at discharge.

RESULTS

Patients with higher levels of incongruence differed in various sociodemographic (age, educational level, work activity and having children) and psychopathological (all SCL-90-R subscales except anxiety and hostility) characteristics. Using general lineal models, incongruence was found to be the variable with stronger relations with psychopathology even when controlling for diagnosis. Interactions were found between incongruence and diagnosis reflecting a pattern in which patients with functional disorders whose subjective evaluation of functioning is not congruent with that of the clinician, have higher levels of psychopathology than patients with motor disorders.

CONCLUSIONS

Incongruence between clinician and self-reported functionality seems to be related to higher levels of psychopathology in patients with functional disorders. These findings underscore the need for routine psychosocial assessment among these patients. Gastroenterologists could use the concept of incongruence and its clinical implications, as a screening tool for psychopathology, facilitating consultation-liaison processes.

Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study

AIM

To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.

METHODS

A total of 1736 patients with chronic digestive system diseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A self-designed General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient’s general information, which included demographic data (including age, sex, marital status, and education) and disease characteristics (including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).

RESULTS

The overall detection rate was 31.11% (540/1736) for depression symptoms alone, 27.02% (469/1736) for anxiety symptoms alone, 20.68% (359/1736) for both depression and anxiety symptoms, and 37.44% (650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression (44.06%) and anxiety symptoms (33.33%). χ² trend test showed: the higher the body mass index (BMI), the lower the detection rate of depression and anxiety symptoms (χ²_trend = 13.697, P < 0.001; χ²_trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms (χ²_trend = 130.455, P < 0.001, χ²_trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms (χ²_trend = 85.759, P < 0.001; χ²_trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression (57.55%) and anxiety (55.19%), followed by patients with liver cirrhosis (41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease.

CONCLUSION

Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.

Hypnotherapy for Esophageal Disorders

Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms--visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome.

Anxiety and Depression Increase in a Stepwise Manner in Parallel With Multiple FGIDs and Symptom Severity and Frequency

OBJECTIVES

Anxiety and depression occur frequently in patients with functional gastrointestinal disorders (FGIDs), but their precise prevalence is unknown. We addressed this issue in a large cohort of adult patients and determined the underlying factors.

METHODS

In total, 4,217 new outpatients attending 2 hospitals in Hamilton, Ontario, Canada completed questionnaires evaluating FGIDs and anxiety and depression (Hospital Anxiety and Depression scale). Chart review was performed in a random sample of 2,400 patients.

RESULTS

Seventy-six percent of patients fulfilled Rome III criteria for FGIDs, but only 57% were diagnosed with FGIDs after excluding organic diseases, and the latter group was considered for the analysis. Compared with patients not meeting the criteria, prevalence of anxiety (odds ratio (OR) 2.66, 95% confidence interval (CI): 1.62-4.37) or depression (OR 2.04, 95% CI: 1.03-4.02) was increased in patients with FGIDs. The risk was comparable to patients with organic disease (anxiety: OR 2.12, 95% CI: 1.24-3.61; depression: OR 2.48, 95% CI: 1.21-5.09). The lowest prevalence was observed in asymptomatic patients (OR 1.37; 95% CI 0.58-3.23 and 0.51; 95% CI 0.10-2.48; for both conditions, respectively). The prevalence of anxiety and depression increased in a stepwise manner with the number of co-existing FGIDs and frequency and/or severity of gastrointestinal (GI) symptoms. Psychiatric comorbidity was more common in females with FGIDs compared with males (anxiety OR 1.73; 95% CI 1.35-2.28; depression OR 1.52; 95% CI 1.04-2.21). Anxiety and depression were formally diagnosed by the consulting physician in only 22% and 9% of patients, respectively.

CONCLUSIONS

Psychiatric comorbidity is common in patients referred to a secondary care center but is often unrecognized. The prevalence of both anxiety and depression is influenced by gender, presence of organic diseases, and FGIDs, and it increases with the number of coexistent FGIDs and frequency and severity of GI symptoms.

Role of anxiety in the comfort of nonsedated average-risk screening sigmoidoscopy

OBJECTIVES

The aim of this prospective study was to assess the role of generalized anxiety disorder in the comfort of nonsedated, average-risk screening sigmoidoscopy.

METHODS

Patients were asked to complete a screening questionnaire before undergoing average-risk colon cancer screening with nonsedated sigmoidoscopy. The questionnaire included demographic information and a series of Likert-based and visual analog scales designed to assess patient comfort, procedural symptom severity, and satisfaction. The Primary Care Evaluation of Mental Disorders questionnaire was used to assess for generalized anxiety disorder. Comfort levels and postprocedural symptom severity were recorded immediately after the procedure and 1 week postprocedure. χ and t tests were used to analyze the data.

RESULTS

Eighty-one patients were enrolled in the study. Twenty-seven patients tested positive for anxiety (high anxiety), whereas 54 tested negative (low anxiety). There were no differences in anxiety according to sex (P = 0.53), or age (P = 0.32). There was no difference in reaching the splenic flexure between high- and low-anxiety patients (P = 0.15); however, pairwise comparisons revealed patients with high anxiety reported significantly higher levels of abdominal pain after the procedure (P < 0.01) and still recalled higher pain from the procedure 1 week later (P < 0.01) than those patients with low anxiety scores. Furthermore, those patients with high anxiety reported significantly more procedure-related cramping and bloating both immediately after the procedure and again 1 week later (P < 0.01). Finally, patients with high anxiety reported the procedure as being more uncomfortable 1 week later, when compared with low-anxiety patients (P = 0.01).

CONCLUSIONS

The level of anxiety correlated directly to pain and discomfort postprocedure and related inversely to the level of satisfaction. Better management of anxiety may lead to better procedural comfort in nonsedated procedures.

Prevalence of depressive and anxiety disorders in Chinese gastroenterological outpatients

AIM: To investigate the prevalence and physicians’ detection rate of depressive and anxiety disorders in gastrointestinal (GI) outpatients across China.

METHODS: A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13 general hospitals. A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale (HADS). The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results. Subjects with HADS scores ≥ 8 were subsequently interviewed by psychiatrists using the Mini International Neuropsychiatric Interview (MINI) to make further diagnoses.

RESULTS: There were 1059 patients with HADS score ≥ 8 and 674 (63.64%) of them undertook the MINI interview by psychiatrists. Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition), the adjusted current prevalence for depressive disorders, anxiety disorders, and comorbidity of both disorders in the GI outpatients was 14.39%, 9.42% and 4.66%, respectively. Prevalence of depressive disorders with suicidal problems [suicide attempt or suicide-related ideation prior or current; module C (suicide) of MINI score ≥ 1] was 5.84% in women and 1.64% in men. The GI physicians’ detection rate of depressive and anxiety disorders accounted for 4.14%.

CONCLUSION: While the prevalence of depressive and anxiety disorders is high in Chinese GI outpatients, the detection rate of depressive and anxiety disorders by physicians is low.