Access to inflammatory bowel disease nurses and education is associated with less stress, anxiety, and depression: Australian national inflammatory bowel disease survey

Background and Aim: The coronavirus disease 2019 (COVID-19) global pandemic has had an impact on the mental health of people around the world Patients with inflammatory bowel disease (IBD) have increased rates of anxiety and depression compared with the general population This cross-sectional study aimed to quantify stress, anxiety, and depression in people with IBD in Australia during the pandemic Methods: An electronic survey was made available to patients with IBD across Australia from June 17 to July 12, 2020, using the social media platforms of Crohn's & Colitis Australia and Western Sydney Local Health District website People over the age of 18 years and with a diagnosis of IBD were invited to participate IP address restrictions meant each participant could fill out the survey only once The validated Depression Anxiety Stress Scales-Short Form (DASS-21) questionnaire was used to assess depression, anxiety, and stress in respondents Significant depression, anxiety, or stress was defined as at least moderate DASS-21 subscores for depression, anxiety, or stress Results: There were 352 respondents (mean age, 40 years [SD, 14];78 9% female) to the survey Most participants were from New South Wales (54%) and Victoria (23%) Sixty percent reported having a diagnosis of Crohn's disease, with 40% of these reporting perianal involvement Private gastroenterologists managed 50% of patients, while 26 3% had access to dedicated IBD clinics IBD nurses were reported to be accessible to 46% of respondents Current systemic steroid use was reported by 10 9%, while 44 7% reported using immunomodulators, and 55 3% were taking biological agents Of all participants, 60 5% fulfilled DASS-21 criteria for at least moderate depression, anxiety, or stress A pre-existing diagnosis of depression and/or anxiety was reported by 45% of respondents More than two-thirds of these patients reported worsening of their diagnosis due to the psychological impact of the pandemic Of those without a pre-existing diagnosis of anxiety or depression, 34 9% met criteria for at least moderate depression, 32 0% met criteria for at least moderate anxiety, and 29 7% met criteria for at least moderate stress Univariate and multivariate analysis was performed to assess predictors of depression, anxiety, or stress using baseline characteristics Predictors for significant depression, anxiety, and stress included age (odds ratio [OR], 0 96;95% confidence interval [CI], 0 95-0 98;P = 0 02), symptom status (mild symptoms ORindex no symptoms, 1 9;95% CI, 1 0-3 7;P = 0 04;moderate symptoms ORindex no symptoms, 3 6;95% CI, 1 6-8 1, P = 0 002;severe symptoms ORindex no sytmptoms, 3 7;95% CI, 1 5-9 4;P = 0 006), lack of access to an IBD nurse (OR, 1 7;95% CI, 1 0-2 9;P = 0 04), lack of advice from a medical practitioner regarding reducing COVID-19 infection risk (OR, 1 9;95% CI, 1 1-3 2;P = 0 02), and perceived increased susceptibility to COVID-19 compared with the general population (agree OR index strongly agree, 0 7;95% CI, 0 4-1 3;P = 0 3;neither agree nor disagree ORindex strongly agree, 0 3;95% CI, 0 1-0 5;P = 0 0003;disagree ORindex strongly agree, 0 2;95% CI, 0 05-0 6;P = 0 004) There was no significant association with sex, education level, employment status, IBD subtype, current treatment with steroids, immunomodulators, biological agents, IBD medication knowledge, IBD medication compliance, gastroenterology phone-based review access, and exposure to COVID-19 information on news and social media Conclusion: An alarmingly high prevalence of depression, anxiety, and stress was found among the participants Access to IBD nurse support and greater attention to education were associated with a lower likelihood of having a diagnosis of depression, anxiety, or stress Further research and attention to the mental health concerns of patients with IBD should be a priority