A Large Proportion of IBD Patients May Experience a Form of PTSD

Alexandra Fuss Vanderwerff, PhD

About a third of inflammatory bowel disease (IBD) patients surveyed were found to meet the clinical threshold to warrant a further diagnosis of post-traumatic stress disorder (PTSD).

Alexandra F. Vanderwerff, PhD, Counseling Psychology, University of Memphis, conducted a study examining the prevalence of PTSD symptoms among IBD patients.

She explained to HCPLive® that her initial hypothesis centered around the idea that remission would serve as a protective factor. She also wrote in the paper that little research had previously been conducted surrounding PTSD and ulcerative colitis (UC) and Crohn’s disease (CD), though previously research has demonstrated that people living with acute conditions can experience symptoms of PTSD.

A random sample of 313 adult patients who self-identified as having either ulcerative colitis (n = 140) or Crohn’s disease (n = 173) were included in the analysis, of whom about three-quarters were female. The participants were instructed to report whether or not they were currently in remission or experiencing a flare-up, as well as their expectations for experiencing a flare-up in the next 2 months.

Ultimately, about a third of participants met the threshold for PTSD symptom endorsement that would warrant a further diagnosis, Vanderwerff found.

These patients’ score was 33 or higher on the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a 20-item checklist used to help diagnose PTSD. A score of between 31-33 suggests probable PTSD, Vanderwerff explained.

The average score for the entire sample was 26, which is a relatively elevated score. Vanderwerff wrote that these patients experienced clinically significant levels of PTSD and their experience is evidence that the chronic health condition of IBD is associated with significant trauma symptoms that medical personnel should be made aware of.

As for the hypothesis that remission would serve as a protective factor against PTSD: Vanderwerff determined that this was supported for the IBD-related concern and body vigilance.

However, she learned the opposite was true for the clinical severity/PTSD symptomology relationship. When participants noted they were experiencing a flare-up, their IBD-related worries and concerns, and their levels of body vigilance was stronger than levels for individuals currently in remission, the study showed. When participants were in remission, the clinical severity and PTSD symptomology relationship was strengthened.

“My hope is that these findings increase awareness among physicians of the potential psychological needs of their patients, especially during remission when it would be natural and understandable to assume that patients would be at ease,” Vanderwerff said. “I think these findings support the importance of screening for potential distress among IBD patients, the value of integrated psychological services in gastrointestinal and colorectal settings, and to really just be aware of and vigilant for the mental health needs among patients at all stages of the disease.”

Physicians are able to facilitate wellness at all levels when they are vigilant about the mental health needs of their patients.

“By opening that gate, whether through integrated psychological services, or making appropriate referrals, they are setting their patients up for achieving best possible outcome,” Vanderwerff said.

The dissertation, "The Relationship between the Impact of Ulcerative Colitis and Crohn’s Disease on Post-traumatic Stress Disorder Symptoms Moderated by Remission Status, Remission Expectations and Post Traumatic Growth," was published online in ProQuest.