N46 Stress after an Ulcerative Colitis diagnosis: examining the role of psychological factors in Ulcerative Colitis using Interpretative Phenomenological Analysis

Abstract

Abstract Background People with ulcerative colitis (UC) report higher levels of stress, anxiety, and depression than the general population. 89% of people with IBD in the UK surveyed in 2019 said they found coping hard. However, most relevant research relies on generic stress questionnaires which ignore confounders typical in UC, such as fatigue. This study aims to provide rich, detailed accounts of how individuals encounter stress after a UC diagnosis. Methods An hour-long, semi-structured interview was conducted in January 2022 with a 76-year-old man, reporting high levels of perceived stress and diagnosed with UC three months previously. He was asked about stressors, coping and support during UC diagnosis and beyond. Interpretative Phenomenological Analysis (IPA) examines the detailed, unique interpretation of a significant experience to an individual. IPA methodology follows four stages: exploratory notes; formulating Experiential Statements (ESs) summarising the meaning of the experience to the interviewee; connecting similar ESs and developing Personal Experiential Themes (PETs), the three to five most important elements of the participant’s experience. Results Four PETs were formulated: My UC needs a positive, practical mental approach, not an emotional one Mixed experience with healthcare services affected my anxiety and disease management My UC symptoms and overall health affected my emotional well-being and coping I believe there is an absence of evidence on UC’s causes, cure, or helpful lifestyle changes The interviewee didn’t "dwell on these things" although he felt "it’s another thing and I’m going to have to deal with this long term". He "could email the nurse there if I had any problems and I did at one stage and got an instant reply" but at other times he felt "abandoned here because nobody is taking me seriously. I keep phoning these people up, they keep passing me to other people". He had developed "strategies to cope with being diagnosed" but was surprised "nobody seems to know why [UC onset] happens. There isn’t a cure for it. They don’t seem to know what causes these flare-ups etc. etc. and all we know is that it’s going to carry on." Conclusion Our interviewee described his symptoms and existing health and healthcare services as stressors, his family and clinicians’ support, his practical, unemotional approach to coping and the need to keep positive. IPA comprehensively captured the interviewee’s interpreted experiences after an UC diagnosis, charting nuanced relationships between stressors, support, and coping. Our study will analyse a further nine individuals’ experiences of stress in the year after an UC diagnosis to inform development of an intervention enhancing resilience to stress.