Psychologists essential to address gut-brain link in IBD treatment

Deakin Associate Professor of Psychology Antonina Mikocka-Walus said the data showed it was essential psychologists be included in routine care for those with IBD, increasingly recognised as a disorder of the gut-brain axis.

As part of her research, published recently in two sister papers in the Internal Medicine Journal and JGH Open, Associate Professor Mikocka-Walus surveyed 731 Australians with IBD.

More than half reported experiencing mental distress, but only 15 per cent were seeing a mental health practitioner.

"Inflammatory bowel disease or IBD is the collective term for Crohn's disease and ulcerative colitis," Associate Professor Mikocka-Walus said.

"It's different from the more commonly known irritable bowel syndrome (IBS), which is something that will affect up to 30 per cent of the population at one point in their lives, is very unpleasant, but does not involve inflammation of the gut or lead to surgeries.

"In comparison IBD is a chronic and largely hidden disease, which can be life-limiting, and affects about one in 250 people - more than the number of people who suffer from Multiple Sclerosis or HIV.

"There is no cure and Australia has one of the highest rates of prevalence and incidence of IBD in the world, with more and more young people diagnosed each year."

Associate Professor Mikocka-Walus said IBD was increasingly considered a disorder of the gut-brain axis where the gut's health was affected by the brain's health and vice versa.

"What we know is that when a person suffers from IBD they are at a greater risk of developing anxiety and/or depression, having a poorer quality of life than the general population, and taking their own lives," she said.

"IBD activity is associated with a nearly six-fold risk for anxiety. And the course of IBD is negatively affected by mental illness, resulting in more frequent flare ups, a more aggressive presentation, hospital readmission and increased risk of surgery."

Despite this, Associate Professor Mikocka-Walus said only 16 per cent of her survey's respondents reported being asked about mental health by their IBD specialist, and just one in 10 said they had access to a mental health practitioner at their IBD service.

"Early detection of symptoms of anxiety and depression is essential to prevent the progression of mental illness and to reduce the risk of suicide," Associate Professor Mikocka-Walus said.

"Those with IBD are crying out for an integrated model of healthcare that recognises both their physical and mental symptoms at the same time. These effects are interrelated, you can't separate them. Those with IBD need regular mental health screenings and good access to mental health professionals."

In related research published earlier this year, Associate Professor Mikocka-Walus and colleagues looked at a model to integrate mental health care into IBD services, which showed an in-service model was far more effective than outside referrals.

Nearly 500 patients were engaged in the study, offered a mental health screening and then referred for an onsite psychological intervention if required.

More than half of the patients scored highly for depression, anxiety or mental distress.

Those who were treated in-service were six times more likely to engage with the treatment than those who opted for an external referral. At 12 months, patients who accepted the intervention had decreased levels of depression and anxiety, and increased quality of life.

"These results reaffirm the advantage of integrating psychological intervention into the service itself - to increase engagement, attendance and follow-through," Associate Professor Mikocka-Walus said

Survey results were gathered from the first national report into IBD patient experience and informed the 2019 IBD Action Plan, which Associate Professor Mikocka-Walus and her collaborators presented to the Federal Government late last year, resulting in $2 million funding for IBD education, support and diagnosis.