Current Initiatives

Evaluation of psychosocial impact of Inflammatory bowel disease (IBD) in patients and caregivers in the developing world: an IBD- Emerging Nations’ Consortium (IBD-ENC) initiative

Addressing mental health in IBD

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•“Don’t Ask, Don’t tell" approach spare from longer interaction, but is inadequate care

•Major depression in nearly 30% compared to 12% controls

•Increased risk of relapse, surgery, IM use, lower adherence to therapy, and suicide

•Use of brief self-report surveys (PHQ, HADS)

•Corticosteroids - Mania and hypomania, mood changes in 50%

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Background and Aims

•No data on mental health in IBD in this part of the world

•To determine the prevalence of anxiety and depression in patients with IBD

•Predictors of Anxiety and Depression in IBD patient

•Correlation with disease activity, QOL (SIBDQ), relapse, surgery, relapse

Our Proposal

•We are aware of the looming problem of mental health in the IBD population.

•As such data on the same is scarce from this part of the world.

•We would be interested in conducting a study on the issues of mental health including depression and anxiety.

•This would be of immense benefit to assess the mental health status and optimize treatment of patients with a chronic lifelong disease.

Brief self report surveys for mental health in IBD

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Bernstein CN, Inflamm Bowel Dis. 2018 Aug

Study protocol: Questionnaire based

Patients

Sociodemographic and disease profile

Current treatment history and adherence scale (MMAS)

Disease activity (CD- HBI, UC- SCCAI)

Mental Health (PHQ-9, GAD-7)

QOL (SIBDQ)

Coping (IBD cope)

Caregiver

Socio-demographic profile

Zarit Burden Interview (ZBI)

(for care giver burden)

QOL survey (Ferrans and Powers)

Brief COPE survey (for coping mechanisms).

Phases of the study

Step 1

Step 2

Step 3

Questionnaire survey for patients and caregivers

Brief assessment and support for those above cut off

based on need and willingness to participate

Repeat questionnaire after 3-6 months

Brief assessment and support for those above cut off

based on need and willingness to participate

Repeat questionnaire after 3-6 months

Correlational and regression analysis would be performed to assess the

relationships between mental health illness or caregiver burden with QOL or coping

or disease activity.

Inclusion and exclusion criteria

Inclusion criteria:

1.Patients with known or newly diagnosed IBD and their caregivers visiting out-patient department of various centers among IBD-ENC

2. Ability to give a signed informed consent.

3. Age ≥18 years

Exclusion criteria:

1.Patients in whom IBD was ruled or in cases where diagnostic dilemma persists.

2. Not willing to participate

Sample size

• In order to achieve meaningful data, we plan to recruit 1000 patients and 1000 caregivers prospectively across all the centers with at least 5 patients from each center.

Expected outcomes

• The specific outcome that the project wants to assess is the prevalence of mental health illness in IBD patients and the caregiver burden due to IBD in nations where IBD is emerging.

• Identification of risk factors contributing to mental health illness and high care giver burden would be assessed.

• We also aim to offer psychosocial intervention in patients and caregivers who score high on questionnaire based surveys.

• On follow up we would assess the impact of such interventions in reducing the psychosocial burden of IBD.