Journal Article Annotations
2024, 3rd Quarter

GI Psychiatry

Annotations by Ashwini Nadkarni, MD
October, 2024

Adverse childhood experiences and psychiatric comorbidity in multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis in the Canadian longitudinal study on aging.
Comparing the effectiveness of online individualized transdiagnostic treatment with acceptance and commitment therapy on medication adherence, gastrointestinal symptoms and perceived stress of patients with irritable bowel syndrome.

PUBLICATION #1 — GI Psychiatry

Adverse childhood experiences and psychiatric comorbidity in multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis in the Canadian longitudinal study on aging.

Julia O’Mahony, Charles N Bernstein, Ruth Ann Marrie.

Abstract: J Psychosom Res. 2024 Sep 13:187:111893. doi: 10.1016/j.jpsychores.2024.111893. Online ahead of print.

Objectives:
Adverse childhood experiences (ACE) are associated with immune-mediated inflammatory diseases (IMID). We evaluated whether: (i) ACE associate with psychiatric comorbidity among individuals with IMID, including rheumatoid arthritis (RA), multiple sclerosis (MS), and inflammatory bowel disease (IBD); (ii) whether psychiatric disorders mediate the relationship between ACE and IMID; and (iii) whether these findings differ from those in individuals with other chronic physical disorders.

Methods:
Using data from the Canadian Longitudinal Study on Aging (CLSA) we performed a retrospective case-control study of participants aged 45-85 years recruited between 2010 and 2015. ACE were queried using questions derived from the Childhood Experiences of Violence Questionnaire-Short Form and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire. We used multivariable logistic regression and causal mediation analysis to address our objectives.

Results:
We included 13,977 CLSA participants. Among the 31 % of IMID participants who reported a comorbid psychiatric disorder, 79 % reported a history of ACE. ACE associated with increased odds (OR [95 % CI]) of a psychiatric disorder (2.55 [1.02-6.35]) among participants with IMID; this did not differ across IMID. The total effect (OR [95 % CI]) of ACE on IMID was 1.11 (1.07-1.16), of which 10.60 % (8.04-17.47) was mediated by psychiatric disorders. We found similar associations among participants with other chronic physical disorders.

Conclusion:
Our findings suggest that psychiatric disorders partially mediate the association between ACE and IMID. Most participants with IMID and comorbid psychiatric disorders report a history of ACE and may benefit from trauma-informed mental health care.

Annotation

The finding:
Studies suggest that adverse childhood experiences (ACE) are associated with increased risk of immune-mediated inflammatory disease (IMID) but the mechanisms that underly this relationship are unknown. This retrospective case-control study used data from the Canadian Longitudinal Study on Aging (CLSA) evaluated whether ACE is associated with psychiatric comorbidity among individuals with IMID, including rheumatoid arthritis (RA), multiple sclerosis (MS), and inflammatory bowel disease (IBD); and whether psychiatric disorders mediate the relationship between ACE and IMID.

Strength and weaknesses:
The study used a large sample representative of Canada’s population, multiple comparator cohorts, and adjustment for multiple potential confounders. However, ACE were self-reported retrospectively, which could lead to recall bias. Age at diagnosis of chronic diseases was inconsistently collected or reported and the authors were therefore unable to confirm whether mental health diagnoses were conferred prior to physical health diagnoses. The study design also precludes from performing causal inference analyses, thereby limiting evaluating mechanisms responsible for the associations found. Additionally, the study utilized an observational single-center retrospective study design and a limited sample size with just 10% of our population having the primary outcome. This resulted in wide confidence intervals and a risk of overfitting.

Relevance:
This study highlights the prevalence of ACE among patients with IMID and comorbid psychiatric disorders and thus the need for more trauma-informed mental health care for this population.

PUBLICATION #2 — GI Psychiatry

Comparing the effectiveness of online individualized transdiagnostic treatment with acceptance and commitment therapy on medication adherence, gastrointestinal symptoms and perceived stress of patients with irritable bowel syndrome.

Homa Shahkaram, Amir Sadeghi, Abbas Masjedi Arani, Maryam Bakhtiari, Amir Sam Kianimoghadam.

Abstract: Gastroenterol Hepatol Bed Bench. 2024;17(3):288-296. doi: 10.22037/ghfbb.v17i3.2920.

Abstract

Aim:
This study aimed to investigate whether transdiagnostic treatment as well as acceptance and commitment therapy (ACT) could improve treatment adherence and alleviate gastrointestinal symptoms plus perceived stress in patients suffering from irritable bowel syndrome.

Background:
Research has shown that people with chronic diseases often have negative attitudes toward medications, especially when they also have psychiatric disorders. This, along with the complex dosing requirements and inadequate knowledge about medication adherence among irritable bowel syndrome patients, can affect the treatment efficacy.

Methods:
A randomized clinical trial was conducted using a pre-test-post-test design. The statistical population included patients with irritable bowel syndrome referring to Taleghani Hospital in Tehran between winter 2021 and spring 2022. Convenience sampling was used to select 30 individuals, with 15 people assigned to each group. Two types of psychotherapy were provided online and individually to the participants. The desired treatments were given to the transdiagnostic treatment and ACT groups in eight weekly sessions of 45-60 minutes.

Results:
There was no significant difference between the transdiagnostic treatment pre-test and ACT regarding perceived stress, medication adherence, and gastrointestinal symptoms (P>0.05). There was no significant difference either between the transdiagnostic treatment and ACT post-test. However, there was a significant difference between the pre-test and post-test phases of ACT regarding adherence, gastrointestinal symptoms, plus perceived stress (P<0.05) and transdiagnostic treatment regarding gastrointestinal symptoms (P<0.05).

Conclusion:
Specialists may use transdiagnostic treatment and ACT as effective psychological treatments to alleviate gastrointestinal symptoms and perceived stress, thereby increasing treatment adherence in patients with irritable bowel syndrome.

Annotation

The finding:
Psychological factors play a crucial role in the course, control, prognosis, and clinical outcomes of IBS, which has become increasingly prevalent in recent decades. This randomized clinical trial study aimed to examine whether Unified Protocol or UP (derived from CBT) and Acceptance and Commitment Therapy (ACT) can enhance treatment adherence and alleviate gastrointestinal symptoms and perceived stress in patients with irritable bowel syndrome. The results indicated no significant difference in baseline between the clinical scores of the two groups. However, the UP group showed a significant improvement in gastrointestinal symptoms, while the ACT group saw a reduction in both gastrointestinal symptoms and perceived stress, as well as an increase in medication adherence. Thus, ACT was an effective therapy for reducing perceived stress. Stress is a major contributor to gastrointestinal problems, such as IBS, which is one of the most prevalent disorders in clinical practice.

Strength and weaknesses:
This study benefits from randomization of patients but due to a lack of access to the participants and the online implementation of the research, there was no follow-up stage. Secondly, the sampling was not carried out randomly, and self-report tools were used. Thirdly, there was no control group.

Relevance:
This study reveals the value of ACT in reducing perceived stress in IBS patients as well as improving medication adherence. CL psychiatrists caring for patients with IBS should consider referral to ACT as an opportunity to improve medical and psychiatric outcomes.