S90 An Assessment of Mental Health Needs in Pediatric Patients With Inflammatory Bowel Disease (IBD) During the COVID-19 Pandemic

Abstract

Background: Inflammatory bowel disease (IBD) is a disorder characterized by chronic inflammation and a dysregulated response to microbiota in the gastrointestinal tract. The severity of the disease can vary and often consists of alternating periods of remission and relapse. While IBD can present at any age, approximately 25% of patients are diagnosed before 20 years of age. Additionally, many studies have indicated that adolescent and pediatric patients with IBD have a poorer quality of life and increased prevalence of psychiatric disorders requiring medications. For example, a significantly greater usage of antidepressants was noted among adolescents with IBD in a nation-wide Finnish study. The aim of this project was to assess the burden and the kind of mental health issues facing our pediatric IBD population during the COVID-19 pandemic. Methods: A retrospective chart review was conducted on pediatric IBD patients (N = 140) seen at the University of Rochester Medical Center (URMC) from 2020 to 2021. Seven individuals were excluded because they did not have an established IBD diagnosis. Patient information, including sex, IBD type, symptoms at diagnosis, and age at diagnosis, was gathered from the medical record. Patient charts 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 reviewed and recorded. Results: Of the pediatric IBD population sampled 56% were male, 44% were female, and the mean age of diagnosis was 11.2 years (SD: 3.74). Most individuals were diagnosed with Crohn’s disease (81%), and a smaller percentage were classified as having ulcerative colitis (19%). Approximately 43% of the pediatric IBD population had at least 1 mental health concern over this time period, and the most common psychiatric diagnoses were depression alone (67%), anxiety alone (3%), or both depression and anxiety (30%). About 36% of patients were prescribed a psychotropic medication and hydroxyzine (53%), sertraline (33%), and fluoxetine (25%) were the most prescribed therapeutics. 24% of patients utilized some form of mental health service but 49% of patients taking psychotropic medications did not appear to receive any formal mental health services. Patients who developed a psychiatric disorder reported more IBD-related symptoms at the time of their diagnosis compared to those without any history of psychiatric diagnoses (t(136)=1.99, P=.02). Conclusion(s): Our results suggest there are high levels of depression and/or anxiety in children with IBD seen at URMC during the time of the COVID-19 pandemic. Additionally, increased IBD symptoms at the time of diagnosis were associated with increased rates of psychopathology. Taken together, these findings suggest that more anxiety and depression screening is needed for pediatric IBD patients and that mental health services may be underutilized in the pediatric IBD population. Future directions include combining and comparing this data set with a previous pre-pandemic study performed at our institution to determine the full impact of COVID-19 on this population.