PWE-083 Distinguishing Between Possible Mental Health Disorders And Psychological Distress By Screening For Acceptance And Adjustment Issues

Abstract

Introduction A recent study indicated that 30% of IBD patients suffer from psychological distress, and that poor acceptance and adjustment is a predictor of distress (Swart et al. 2013). Psychological distress encompasses the symptoms of depression, anxiety, emotional difficulty and poor adjustment, but is not the same as mental illnesses such as Major Depressive Disorder or Generalised Anxiety Disorder. Early indications suggest IBD patients are particularly susceptible to adjustment disorders, which may be the cause of much distress. Methods As part of a service evaluation, 2400 IBD patients in the Luton and Dunstable catchment area were invited to participate in a web-based psychological and quality of life assessment. The “Acceptance and Action Questionnaire” (AAQ-II) was used for acceptance/adjustment, as well as the “Patient Health Questionnaire” (PHQ-9) for depression, and the “Generalised Anxiety Disorder Questionnaire” (GAD-7) for anxiety. Results 360 patients completed the assessment (45% male, mean age = 53; SD = 17). 31% of patients scored highly on the PHQ-9; 27% of patients scored highly on the GAD-7; and 27% of patients also scored highly on the AAQ-II. Linear regression, after taking account of relevant clinical factors, showed that poor acceptance was associated with high depression and anxiety. Cross tabulation indicated 20% of patients showed high depression and poor acceptance, and 11% of patients showed high depression and good acceptance/adjustment. Anxiety sees a similar picture with 18% high anxiety and poor acceptance/adjustment, and 8% high anxiety and good acceptance/adjustment. Conclusion The self-report prevalence rates of depression and anxiety we found are typical of chronic illness poplations, however the cross-tabulation results suggest a more complex picture. While further research is needed, theory suggests those 20% are struggling with depression which stems from their acceptance and adjustment issues. Similarly, those 11% with high depression and good acceptance are likely to have a mental health disorder like Major Depressive Disorder - 11% is a similar prevalence rate found when using diagnostic interviews. These groups of patients would likely benefit most from different treatment paths. Specifically, severe depressive symptoms stemming from acceptance/adjustment issues would likely benefit more from Acceptance and Commitment Therapy than standard procedures for treatment of depression with antidepressants and Cognitive Behavioural Therapy.