Posttraumatic Stress in Patients With Inflammatory Bowel Disease: Prevalence and Relationships to Patient-Reported Outcomes

Abstract

Background Patients with chronic illness are at increased risk for traumatic stress because of medical trauma. Initial studies of posttraumatic stress (PTS) in patients with inflammatory bowel disease (IBD) have found that approximately one-third of patients may experience significant PTS symptoms including flashbacks, nightmares, hypervigilance, disrupted sleep, and low mood. We aim to better characterize PTS in IBD and its relationship with patient outcomes in a large cohort of patients with IBD. Methods Adult patients registered with the Crohn’s & Colitis Foundation/University of North Carolina IBD Partners database were invited to complete a supplementary survey between February and July 2020. The Post Traumatic Stress Disorder Checklist-5th edition was administered as a supplemental survey. Additional data from IBD Partners included disease severity, surgery and hospital history, demographics, and health care utilization. Results A total of 797 patients participated (452 with Crohn disease, 345 with ulcerative colitis). No impacts on response patterns because of the COVID-19 pandemic were found. Although 5.6% of the sample reported an existing PTS diagnosis because of IBD experiences, 9.6% of participants met the full IBD-related PTS diagnostic criteria per the Post Traumatic Stress Disorder Checklist-5th edition. Female patients, younger patients, those with less educational attainment, non-White patients, and Hispanic patients reported higher levels of PTS symptoms. Patients with higher PTS symptoms were more likely to have been hospitalized, have had surgery, have more severe symptoms, and not be in remission. Increased PTS was also associated with increased anxiety, depression, pain interference, fatigue, and health care utilization. Conclusions The present findings support prior research that approximately one-quarter to one-third of patients with IBD report significant symptoms of PTS directly from their disease experiences, and certain demographic groups are at higher risk. In addition, PTS is associated with several IBD outcomes. Patients with higher PTS symptoms are less likely to be in remission and may utilize more outpatient gastrointestinal services. Intervention trials to mitigate PTS symptoms in patients with IBD are warranted.

Signs of Dissociation and Symptoms of Post-Traumatic Stress Disorder in Inflammatory Bowel Disease: A Case-Control Study

“…This is the first study investigating the prevalence of both IBD-related PTSD and dissociative symptoms in a cohort of patients compared to healthy controls. According to recent studies, IBD patients are more susceptible to PTSD symptoms compared to patients with irritable bowel syndrome [18], and this psychological comorbidity could play a negative impact on IBD outcomes [19]. Our results, from an Italian IBD outpatients setting, confirm the high prevalence of IBD-related PTSD, as recently shown by a US study [19], and expand this observation by adding information on the high prevalence of IBD-related dissociative symptoms.…”

“…The rationale for this association could be represented by bidirectional gut-brain interactions and systemic inflammation [17] and supported by the association between PTSD and CD activity [16], as well as by the higher prevalence of PTSD among IBD compared to IBS patients [18]. In addition, PTSD seems to be associated with several IBD outcomes [19].…”

Effect of closed and permanent stoma on disease course, psychological well-being and working capacity in Swiss IBD cohort study patients

“…This indicates that IBD patients with an underlying robust indication for stoma surgery, either persistence of stoma or stoma closure surgery, do not appear to have a sustainably impact future psychological wellbeing. This contradicts previous studies indicating surgery to be a trigger for PTSD [22] and showing that patients with higher PTSD symptoms have more likely had surgery [46]. This correlates with the finding that patients in the SIBDCS with ostomy scored higher in the PDS total score, showed a higher avoidance of stimuli associated with ostomy and a higher re-experiencing score in the SIBDCS.…”

“…This correlates with the finding that patients in the SIBDCS with ostomy scored higher in the PDS total score, showed a higher avoidance of stimuli associated with ostomy and a higher re-experiencing score in the SIBDCS. This could however also be due to a relatively more severe course of disease (stoma as a surrogate for a more debilitating disease course, imperfect matching; as mentioned above) which has also been shown to impact severity of PTSD symptoms [46]. It has also to be stressed that none of the studies focused specifically on ostomy and that we were able to show a decrease in PDS avoidance score in patients with permanent ostomy and an increase in closed ostomy, suggesting a possible impact of stoma type (permanent/closed).…”

Exploring the Impact of Trauma and Psychosocial Processes on the Quality of Life in Individuals Living with Inflammatory Bowel Disease

“…Reflecting the bi-directional nature of the brain-gut axis, stress, including post-traumatic stress (PTS) have been identified as a key process influencing digestive processes [7][8][9]. Further, living with a medical condition (such as IBD) is linked to the development of PTS [10][11][12][13], and subsequently, posttraumatic stress disorder (PTSD). In a recent systematic review, Glynn et al [14] identified that the prevalence of PTSD across gastrointestinal cohorts was high, with 31% of individuals with inflammatory conditions (e.g., ulcerative colitis, Crohn's disease, gastro-oesophageal reflux disease, peptic disease) having PTSD.…”