Journal Articles

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 

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: TBA

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: TBA

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

Aim: To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.

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

Abstract

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