Psychogastroenterology: Why can’t gastrointestinal problems be treated effectively without addressing mental health co-morbidities

Abstract:

Background: Gastrointestinal conditions such as inflammatory bowel disease and irritable bowel syndrome are common in the general population. They are also frequently associated with anxiety and depression, which has been found to negatively impact disease course and compliance with treatment. Yet, current models of care rarely include mental health assessment and management into standard gastroenterology care. The present paper discusses studies conducted in South Australia contributing to establishing an integrated service for patients with gastrointestinal conditions which addresses their disease holistically.

Methods: Three different approaches were used while developing the new service: 1) collecting baseline epidemiological data on mental health comorbidities; 2) targeting mental health problems; 3) examining the effects of the model implementation. Studies with a variety of designs have been conducted, including systematic reviews, randomised controlled trials, cohort and cross-sectional studies, as well as qualitative exploratory studies.

Results: The data collected demonstrate high rates of mental health co-morbidities which are maintained over time. Patients with documented psychological comorbidities were more likely to be hospitalized than those without (odds ratio [OR] = 4.13, 95% confidence interval [CI]: 1.25, 13.61). A drop in the use of opiates (p = 0.037) and hospitalization rates (from 48% to 30%) has been noted as a result of introduction of the new service.

Conclusion: The data to date suggest that the new service may yield superior long-term outcomes in terms of medication use and hospitalization rates and potentially reduce healthcare costs. The model is going to be further developed to continue improving patient outcomes.