A Real-World Longitudinal Case-Study Implementing Digital Screening and Treatment for Distress in Inflammatory Bowel Disease: The COMPASS-IBD Patient Journey

Abstract

Background: Comorbid psychological distress (anxiety and depression) in inflammatory bowel disease (IBD) is common and associated with poorer outcomes and increased healthcare burden. Scalable and accessible integrated care is needed. This study examined the feasibility of implementing routine digital mental health screening and digital cognitive-behavioral therapy (COMPASS-IBD) for psychological distress in a large IBD service. Methods: During implementation, distress was identified by screening or IBD clinician referral. Further triage determined eligibility to receive COMPASS-IBD with trainee therapist support (12 weeks). Pre- and post-intervention outcomes examined reach, acceptability, implementation, and potential effectiveness of the new pathway. Results: Screening was completed by 827 patients (from November 2022 to September 2023), with 196 patients meeting clinical cutoffs and referred for IBD psychology triage. An additional 82 patients were directly referred via IBD clinicians. Of 91 eligible patients, 65 (71.4%) were enrolled into COMPASS-IBD. Distress significantly reduced post-intervention (Patient Health Questionnaire Anxiety and Depression Scale = −6.203; 95% confidence interval, −8.76 to −3.64; P < .001; Cohen’s d = −0.553). Symptoms of anxiety, depression, and IBD-related quality of life significantly improved, but IBD symptomatology did not. Full adherence (≥5 online and ≥3 therapist sessions) to COMPASS-IBD was completed by 32.3% of patients. After initially increasing, the IBD psychology waitlist decreased in wait time (30.8%) and number (63.4%) by the end of study implementation. Patients were accepting of the new treatment pathway. Conclusions: Routine mental health screening and COMPASS-IBD were successfully implemented in an outpatient IBD service, but support from trainee psychologists and the research team was required. This new integrated pathway can identify and treat psychological distress in IBD with minimal service resource.