A systematic review of anxiety, depression and medication adherence in Inflammatory Bowel Disease, and An empirical study of factors predicting psychological, behavioural and medical outcomes in home parenteral nutrition

Rea, Sara 2022. A systematic review of anxiety, depression and medication adherence in Inflammatory Bowel Disease, and An empirical study of factors predicting psychological, behavioural and medical outcomes in home parenteral nutrition. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

This research is presented in two parts: a systematic literature review and an empirical paper. The systematic literature review examined the relationship between anxiety, depression and medication nonadherence in inflammatory bowel disease (IBD). IBD encompasses one of the conditions (Crohn’s disease) that is a common underlying reason for intestinal failure requiring home parenteral nutrition (HPN)—the topic of the empirical paper. The empirical study explored the role of psychological flexibility and self-compassion in predicting psychological, behavioural and medical outcomes in people on HPN. IBD encompasses a variety of autoimmune non-infectious conditions involving chronic inflammation of the gastrointestinal tract, with the two most common forms being ulcerative colitis and Crohn’s disease. At present there is no cure and therefore treatment focuses on helping people live well with the disease and is often managed with medication. Medication adherence, the extent to which medication taking corresponds with agreed recommendations by a health care provider, is associated with improved outcomes in IBD. Therefore, understanding factors associated with nonadherence is important to support patients. Anxiety and depression are common in IBD, and previous research suggests they may be associated with medication nonadherence. The systematic review examined whether anxiety and depression were associated with medication nonadherence in adults diagnosed with IBD. Searches on relevant databases found 18 studies that met inclusion criteria. Methodological quality of the included studies was assessed, and results pertaining to anxiety and depression, and medication adherence were summarised through narrative synthesis. Results were mixed across studies, however a number of studies found a significant association between depression and medication nonadherence, with effect sizes ranging from very small to large. Studies that utilised objective measures of adherence consistently found significant associations with depression compared to self-report. The current evidence does not support an association between anxiety and medication nonadherence. Study quality was found to vary across studies, impacting on the validity of findings. Potential explanations for the relationship between depression and nonadherence, and the challenges around measuring adherence are discussed. Suggestions for future research are provided, with a focus on increasing methodological rigour. The review highlights the importance of health professionals working with individuals with IBD to be alert to symptoms of depression, both to support their patients’ mental wellbeing, and to facilitate conversations in relation to their treatment. The empirical paper reports on the role of two psychological processes in predicting outcomes in home parenteral nutrition (HPN) from a cross-sectional, observational study. HPN is a type of nutrition feed provided directly to the bloodstream when a person is unable to absorb sufficient nutrients through their intestines. It poses significant challenges to daily activities, can impact a person’s quality of life and psychological wellbeing, and requires meticulous adherence to line care procedures to prevent potentially life-threatening infection. Current understanding about psychological processes that affect outcomes in HPN is limited. Psychological flexibility and self-compassion have been identified as important processes in other health populations. Psychological flexibility is the ability to be in the present moment with awareness and openness to one’s experience, and to take action guided by one’s values. Self-compassion is the ability to connect to one’s suffering, with feelings of kindness and caring, along with an understanding and non-judgemental attitude towards oneself, whilst acknowledging suffering as part of humanity. Sixty-six adults on HPN completed an online survey assessing psychological flexibility, self-compassion, psychological distress (depression, anxiety and stress), wellbeing, QOL, line care adherence and line infections. Results indicated that higher psychological flexibility and self-compassion were significantly correlated with all outcomes in the predicted directions, except for line infections. Psychological flexibility uniquely predicted lower total distress, lower anxiety, better wellbeing and higher QOL. Self-compassion uniquely predicted lower total distress, depression and stress. Despite some limitations, this study contributes to a gap in the literature around understanding psychological processes that contribute to outcomes in HPN. Interventions aimed at improving psychological flexibility and self-compassion may be beneficial to support the emotional wellbeing and quality of life of individuals on HPN. Further research would benefit from prospective designs and consideration of objective measures of infection. Additionally, a measure of line care adherence was developed for the study and future validation of this measure would help determine its usefulness for screening for line care adherence. Overall, the systematic review contributes to the literature considering risk factors for medication nonadherence in IBD and emphasises the importance of a holistic, integrated care approach to caring for people with IBD. The empirical study highlights the role of two psychological processes in predicting psychological, behavioural and medical outcomes in HPN, and provides a rationale for further research examining psychological interventions that may help better support the wellbeing of people on HPN.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	8 September 2022
Last Modified:	05 Jan 2024 08:26
URI:	https://orca.cardiff.ac.uk/id/eprint/152404

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