PREVALENCE AND IMPACTS OF POST-TRAUMATIC STRESS SYMPTOMS IN IBD PATIENTS FROM UNDER-REPRESENTED MINORY GROUPS

Abstract

Abstract INTRODUCTION Post Traumatic Stress (PTS) is a chronic psychological condition that occurs in response to a traumatic event, and includes symptoms of re-experiencing, avoidance behaviors, changes in mood, and hyperarousal. Left untreated, PTS is associated with poor outcomes and significant impairments in quality of life (HRQoL). Recent studies find 20-30% of IBD patients report significant PTS symptoms due to IBD experiences. The majority of participants in these studies are white, non-Hispanic making results difficult to generalize to other populations. As such, we aim to characterize IBD related PTS in under-represented minority (URM) patients. METHODS Adult patients 18+ who identify as a URM (Latino/a, African American, Asian, Middle Eastern, Native American or Native Pacific Islander) recruited via social media and researchmatch.org website completed an anonymous online survey: demographics, disease information, Harvey Bradshaw Index (HBI) or simple clinical colitis activity index (SCCAI) with >4 = active IBD, NIH-PROMIS QoL module (fatigue, sleep disturbance, social isolation, pain interreference), and PTSD Checklist-5 (PCL5) with >30 = suggested IBD-PTS, with subscale scores. Independent samples t-Test, Pearson’s correlation, and hierarchical linear regression statistics were used. RESULTS 67 participants: 46% UC, 79% female, 73% South/Southeast Asian, 6% Hispanic, Age (Mean±SD) = 35.42±9.79 years. 55% had active IBD (HBI/SCCAI > 4; 5.57±4.51). 43% scored >30 on PCL5. Specifically, 55.2% reported re-experiencing trauma, 59.7% avoiding trauma triggers, 62.7% mood changes/irritability, and 67.2% autonomic hyperarousal. Patients with active IBD reported higher IBD-PTS (p=.001) as well as more fatigue, sleep disturbance, pain interference, and social isolation (all p<.001); no differences by IBD diagnosis, gender, or age. When controlling for HBI/SCCAI score, IBD-PTS severity was a significant predictor, but smaller than disease severity, of fatigue (β=.223, p=.025) and pain interference (β=.254, p=.006), and a larger predictor of sleep disturbance (β=.424, p<.001) and social isolation (β= -.417, p<.001). Only the PTS symptoms of hyperarousal and mood contributed to these relationships. CONCLUSION 43% of URM met criteria for PTS, and scored above 50% in each symptom category of the PCL-5, suggesting URM patients are at even higher risk for IBD-related PTS. Despite disease severity, IBD-PTS severity predicted fatigue, pain interference, sleep disturbance, and social isolation domains of HRQoL; mood changes or hyperarousal presence appear to be the most important symptoms to address. IBD-PTS could have a greater influence on HRQoL than disease activity and should be assessed in patients with both active and inactive disease. More research is necessary to evaluate this relationship and the prevalence of IBD-PTS in URM.