P086 Increased Need for Psychotropic Medication and Mental Health Service Usage in Pediatric Patients With Inflammatory Bowel Disease (IBD)

Abstract

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic immune disorder characterized by a dysregulated response to microbiota in the gastrointestinal tract. Many IBD patients are diagnosed as children, and childhood disease is often more aggressive with increased need for surgery, nutritional supplementation, and steroid use, all of which can increase psychological stress. Previous studies have found that pediatric IBD patients have increased rates of depression, anxiety disorders, and suicide risk compared to other children (1, 2). While 2.8% of all adolescents take antidepressants (3), it is likely that pediatric IBD patients are taking these medications at an increased rate given their greater risk for psychological stress. The aim of this project was to assess the actual frequency of psychotropic medication and mental health service usage in our pediatric IBD population. METHODS: A retrospective chart review was conducted on pediatric IBD patients (N = 400) seen at the University of Rochester Medical Center (URMC) from 2016 to 2019. Patient information, including sex (57% male), IBD type (78% Crohn’s disease), and age at diagnosis (Mean = 11.5 years), was gathered from the medical record. Patients were excluded if clinical notes could not confirm their IBD diagnosis or if they only visited URMC once. Patient medication lists were reviewed for psychotropic medications. Medications used to treat ADHD, ADD, and chronic migraines were excluded. Mental health visits within the psychiatry, behavioral health, pediatric psychology, adolescent medicine, and social work departments were briefly reviewed and recorded. Frequencies and descriptive statistics were calculated using SPSS. RESULTS: Anxiety and depression are the most common disorders (23% and 14%, respectively) in this population and are most frequently treated with SSRIs (22%). URMC’s pediatric IBD patients take antidepressants and other psychotropic drugs at a higher rate (28.5%) than other children their age. 75% of mental health service and psychotropic medication use in this population began after being diagnosed with IBD, suggesting that IBD may contribute to the development of psychopathology. Additionally, 43% of patients taking psychotropic medications did not appear to receive any formal mental health services based on their clinical records. CONCLUSION(S): As demonstrated by these results, there are higher levels of anxiety and depression in children with IBD, and resulting mental health treatment often starts after initial IBD diagnosis. Antidepressants, primarily SSRIs, are used most often to treat these disorders, and a large portion of these patients are not seeking the help of a mental health provider. Taken together, these findings suggest that more anxiety and depression screening is needed for pediatric IBD patients and that mental health services are being underutilized in the pediatric IBD population. Future directions include developing mental health screening measures specifically for pediatric IBD patients and evaluating whether preemptive mental health interventions lessen the risk of developing psychopathology.