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OBJECTIVES: To examine the frequencies of psychological co-morbidities among Ulcerative Colitis patients, and to also study relationship of these morbidities with aggression and self-efficacy.
METHODS: This descriptive, correlational study was conducted at outpatient department of gastroenterology of a Mayo hospital Lahore, from 2nd April to 28th August, 2019. A purposive sample of 165 UC patients was taken. Following ethical approval, structured questionnaires including Beck Depression Inventory-21, Berrenberg’s Cancer Attitude Inventory, Emet-Q, Blood-Injection Symptom Scale, Templer Death Anxiety Scale, Short form Aggression Questionnaire and SEM-CD6, to measure psychological illnesses were administered. The collected data were evaluated through SPSS V25.0.
RESULTS: Out of 165 patients, 85 (51.5%) were females & 80 (48.5%) were males, with age range 21-30 years. Sixty five (39.39%) had severe depression, 54 (32.72%) had moderate, 23 (13.93%) borderline and 14 (8.48%) mild depression. Carcinophobia was seen in 139 (84.24%) patients whereas emetophobia, trypanophobia, and death anxiety was present in 114 (69.09%), 101 (61.21%), 78 (47.27%) patients respectively. Depression and phobias were increasing the physical, verbal aggression, anger, and hostility. Additionally, the patients’ high depressive state and fears were affecting the illness management.
CONCLUSION: UC patients manifest a range of psychological co-morbidities. Especially, fear of developing cancer and death anxiety, restrict patients to control symptoms, to manage role and emotional functioning and to communicate with doctors to get adequate treatment regimens. Therefore, the commencement of psychotherapeutic programs can be helpful for maintaining the psychological health of patients.
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2. Lohan C, Diamantopoulos A, LeReun C, Wright E, Bohm N, Sawyer LM. Tofacitinib for the treatment of moderately to severely active ulcerative colitis: A systematic review, network meta-analysis and economic evaluation. BMJ Open Gastroenterol 2019; 6(1). DOI: 10.1136/bmjgast-2019-000302.
3. JairathV, Feagan BG. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: A systematic analysis for the global burden of disease study 2017. Lancet Gastroenterol Hepatol 2020;5(1):17-30. DOI: 10.1016/S2468-1253(19)30333-4.
4. King D, Reulen RC, Thomas T, Chandan JS, Thayakaran R, Subramanian A, et al. Changing patterns in the epidemiology and outcomes of inflammatory bowel disease in the United Kingdom: 2000-2018. Aliment Pharmacol Ther 2020;51(10):922-34. DOI: 10.1111/apt.15701.
5. Misra R, Limdi J, Cooney R, Sakuma S, Brookes M, Fogden E. Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study. World J Gastroenterol 2019;25(40):6145-57. DOI: 10.3748/wjg.v25.i40.6145.
6. Majeed S, Gohar F, Riaz M. Prevalence of inflammatory bowel disease and associated predisposing factors. Int J Appl Res 2018;4(2):208-11.
7. Qureshi M, Abbas Z. Clinical presentation of ulcerative colitis in Pakistani adults. Euroasian J Hepatogastroenterol 2015;5(2):127–30. DOI: 10.5005/jp-journals-10018-1151.
8. Vaizey CJ, Gibson PR, Black CM, Nicholls RJ, Weston AA, Gaya DR, et al. Disease status, patient quality of life and healthcare resource use for ulcerative colitis in the UK: An observational study. Frontline Gastroenterol 2014;5(3):183-89. DOI: 10.1136/flgastro-2013-100409.
9. Brown SD. Ulcerative Colitis from patients' viewpoint a review of two internet surveys. Gastroenterol Nurs 2012;35(1):54–63. DOI: 10.1097/SGA.0b013e 318241d981.
10. Haider SI, Rasool I, Ahmed S, Hussein S, Hussein J, Hamirani MM. Frequency of depression, anxiety and stress in patients referred for endoscopy with symptoms of dyspepsia. J Liaquat Uni Med Health Sci 2013;12(3):140-44.
11. Sajadinejad MS, Asgari K, Molavi H, Kalantari M, Adibi P. Psychological issues in inflammatory bowel disease: An overview. Gastroenterol Res Cent 2012;20(12). DOI: 10.1155/2012 /106502.
12. Olen O, Erichsen R, Sachs MC, Pedersen L, Halfvarson J, Askling J, et al. Colorectal cancer in ulcerative colitis: A Scandinavian population-based cohort study. Lancet 2020; 395(10218):123-31. DOI: 10.1016/S0140-6736(19)32545-0.
13. Choi K, Chun J, Han K, Park S, Soh H, Kim J, et al. Risk of anxiety and depression in patients with inflammatory bowel disease: a nationwide, population-based study. J Clin Med 2019; 8(5):654. DOI:10.3390/jcm8050654.
14. Bannaga AS, Selinger CP. Inflammatory bowel disease and anxiety: links, risks, and challenges faced. Clin Exp Gastroenterol 2015;8:111–17. DOI:10.2147/CEG.S57982.
15. Khaliq SA, Gul A. Validity and reliability of Urdu version of beck's depression inventory among students of madaris (Islamic Institutes). Isra Med J 2018;10(3):175-6.
16. Berrenberg JL. The cancer attitude inventory: Development and validation. J Psychosoc Oncol 1991;9(2):35-44. DOI: 10.1300/J077v09n02_03.
17. Boschen MJ, Veale D, Ellison N, Redell T. The emetophobia questionnaire (EmetQ-13): Psychometric validation of a measure of specific phobia of vomiting (emetophobia). J Anx Dis 2013; 27(7): 670-77. DOI: 10.1016/j.janxdis.2013.08.004.
18. Page AC, Bennett KS, Carter O, Smith J, Woodmore K. The blood-injection symptom scale (BISS): Assessing a structure of phobic symptoms elicited by blood and injections. Behav Res Ther1997;35(5):457-64. DOI: 10.1016/s0005-7967(96)00120-9.
19. Saleem T, Gul S, Saleem S. Death anxiety scale; translation and validation in patients with cardiovascular disease. Professional Med J 2015;22(6):723-32.
20. Gallagher JM, & Ashford J. Buss-Perry aggression questionnaire: Testing alternative measurement models with assaultive misdemeanor offenders. Crim Justice Beh 2016; 43(11):1-30. DOI:10.1177/0093854816643986.
21. Riaz S, Haq N, Ahmed F, Nasim A, Tahir M, Khan MK, et al. Reliability and validity of Urdu version of the self-efficacy for managing chronic disease 6-item scale for patients with hypertension in Quetta, Pakistan. Asian J Res Med Pharm Sci 2017; 2(1):1-8. DOI: 10.9734/AJRIMPS/2017/37210.
22. Graff LA, Walker JR, Bernstein CN. Depression and anxiety in inflammatory bowel disease: A review of comorbidity and management, inflammatory bowel diseases. Inflamm Bowel Dis 2009;15(7):1105–18. DOI: 10.1002/ibd.20873.
23. Kochar B, Barnes EL, Long MD, Cushing KC, Galanko J, Martin CF, et al. Depression is associated with more aggressive inflammatory bowel disease. Am J Gastroenterol 2018;113(1):80-85. DOI:10.1038/ajg.2017.423.
24. Yanartas O, Kani HT, Bicakci E, Kilic I, Banzragch M, Acikel C, et al. The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease. Neuropsychiatr Dis Treat 2016;12:673–83. DOI: 10.2147/NDT.S106039.
25. Connelly TM, Koltun WA. The cancer "fear" in IBD patients: Is it still REAL? J Gastrointest Surg 2014; 18(1):213-8. DOI: 10.1007/s11605-013-2317-z.
26. Wani AL, Ara A, Bhat SA. Blood injury and injection phobia: The neglected one. Behav Neurol 2014;2014. DOI:10.1155/2014/471340.
27. McLenon J, Rogers AM. The fear of needles: A systematic review and meta‐analysis. J Advanc Nurs 2018;75(1):30–42. DOI: 10.1111/jan.13818.
28. Falvey J, Greenwood R, Creed TJ, Smithson J, Sylvester P, Fraser A, et al. Mortality in ulcerative colitis—what should we tell our patients? Three-year mortality following admission for the treatment of ulcerative colitis: A 6-year retrospective case review. Frontline Gastroenterol 2010;1(1):35–41. DOI: 10.1136/fg.2009.000216.
29. Nuvvula S. Learned helplessness. Contemp Clin Dent 2016;7(4):426-27. DOI: 10.4103/0976-237X.194124.
30. Cooper JM, Collier J, James V, Hawkey CJ. Beliefs about personal control and self-management in 30–40year olds living with inflammatory bowel disease: A qualitative study. Inter J Nur Stud 2010;47(12):1500–9. DOI: 10.1016/j.ijnurstu.2010.05.008.