Joanne Sulman

Depression and inflammatory bowel disease: Findings from two nationally representative Canadian surveys

&NA; Most studies of depression and inflammatory bowel disease (IBD) have been drawn from clinical populations or from samples selected from the membership of Crohns and ulcerative colitis community organizations. This study determined the prevalence and correlates of depression in people with IBD or a similar bowel disorder from 2 nationally representative Canadian surveys. In the Canadian Community Health Survey, conducted in 2000 through 2001, there were 3076 respondents who reported that they had “a bowel disorder such as Crohns disease or colitis” that had lasted ≥6 months and had been diagnosed by a health professional. The National Population Health Survey, conducted from 1996 through 1997, had 1438 respondents who reported that they had such a condition. Within each subsample, bivariate analyses were conducted to compare the depressed and nondepressed individuals. Logistic regression analyses also were conducted using the Canadian Community Health Survey 1.1 data set. The 12‐month period prevalence of depression among individuals with IBD and similar bowel disorders was comparable in the 2 data sets (16.3% and 14.7%). Depression rates were higher among female respondents, those without partners, younger respondents, those who reported greater pain, and those who had functional limitations. Seventeen percent of depressed respondents had considered suicide in the past 12 months; an additional 30% had considered suicide at an earlier time. Only 40% of depressed individuals were using antidepressants. Individuals with IBD and similar bowel disorders experience rates of depression that are triple those of the general population. It is important for clinicians to assess depression and suicidal ideation among their patients with active IBD symptoms, particularly among those reporting moderate to severe pain.

Validation of the functional assessment of cancer therapy esophageal cancer subscale

To develop and validate a quality of life subscale for patients with esophageal cancer to be used with the Functional Assessment of Cancer Therapy—General (FACT‐G).

Health-related quality of life in esophageal cancer: effect of neoadjuvant chemoradiotherapy followed by surgical intervention.

OBJECTIVE We sought to determine the effect of neoadjuvant chemoradiotherapy followed by surgical intervention on health-related quality of life in patients with esophageal cancer. METHODS Health-related quality of life was evaluated in a prospective phase II study of neoadjuvant chemoradiotherapy followed by esophagectomy in 52 patients with carcinoma of the esophagus. Esophagectomy was performed 6 weeks after completion of induction. Functional Assessment of Cancer Therapy-Esophageal scoring was performed before treatment, 7 weeks after initiation of neoadjuvant therapy, before resection, and at 1, 3, and 6 months and 1 year after resection. RESULTS Forty-three patients completed the entire treatment protocol. Functional Assessment of Cancer Therapy-Esophageal scores decreased significantly after chemoradiation at week 7 (120 vs 127 at baseline, P = .04) but returned to baseline levels before surgical intervention (127). Similarly, scores decreased significantly after surgical intervention (115 at 1 month, P = .02) but returned to baseline levels by 3 months postoperatively (127). At 1 year postoperatively, there was a statistically significant improvement in scores compared with those at baseline (139, P = .003). Functional Assessment of Cancer Therapy-Esophageal scores continued to increase over time for patients who were alive at least 1 year after the operation with or without disease but were observed to significantly decrease in those who died within 1 year after the operation (P = .0001). An increase in quality of life was associated with a significantly lower risk of death (P = .04). CONCLUSION Neoadjuvant therapy has a significant effect on health-related quality of life, but this is transient, with recovery to baseline within 5 to 7 weeks after completion of induction therapy. Health-related quality of life decreases again after surgical intervention but returns to baseline levels within 3 months.

Robust Association Between Inflammatory Bowel Disease and Generalized Anxiety Disorder: Findings from a Nationally Representative Canadian Study.

Background:Although the link between inflammatory bowel diseases (IBD) and depression is well accepted, less is known about the relationship between IBD and anxiety disorders and factors associated with anxiety among those with IBD. Methods:Data were derived from the nationally representative 2012 Canadian Community Health Survey—Mental Health. The survey response rate was 68.9%. Two sets of analyses were undertaken. First, a series of logistic regression analyses were used to estimate the odd ratios of generalized anxiety disorder among those with IBD compared with those without (n = 22,522). The fully adjusted model controlled for sociodemographics, depression, substance abuse/dependence, pain, and adverse childhood experiences. Second, among those with IBD (n = 269), significant correlates of generalized anxiety disorder were identified using logistic regression. The presence of generalized anxiety disorder was determined using the WHO-CIDI lifetime criteria, and IBD was assessed by a self-reported health professional diagnosis. Results:Individuals with IBD had over twice the odds of anxiety compared with those without IBD, even when controlling for a range of potential explanatory factors (odds ratio = 2.18; 95% confidence interval, 1.50–3.16). Controlling for chronic pain and childhood adversities attenuate the relationship the most. Among those with IBD, a history of childhood sexual abuse, female gender, and chronic pain are the strongest correlates of anxiety. Those with Crohns and ulcerative colitis were equally vulnerable to generalized anxiety disorder. Conclusions:Our findings show that IBD is robustly related to generalized anxiety disorder. Health care professionals should be aware of the increased prevalence of generalized anxiety disorder among their patients with IBD, particularly women, those in chronic pain, and those with a history of childhood sexual abuse.

Retooling social work practice for high volume, short stay.

SUMMARY The re-engineered acute care environment that emphasizes managed care, reduced costs per case and shorter lengths of stay also demands innovative approaches to the delivery of social work service. As departments disappear and other professions compete for roles in counselling, discharge planning and community liaison, there is a real threat to the viability of the acute hospital as a setting for social work. This paper focuses on the adaptive skills needed for the restructured acute care context, including (1) the creation of key roles for social work on the multidisciplinary team, (2) pre-admission high-risk screening and discharge planning, (3) high volume recording, (4) solution-focused brief interventions, and (5) the development of community partnerships. These conceptual strategies are implemented differently in examples drawn from three distinct high-volume patient groups: reconstructive orthopaedics, high-risk fetal assessment and thoracic oncology.

Support like a walking stick: parent-buddy matching for language and culture in the NICU.

Abstract Purpose: (1) To explore the experience of non-English-speaking mothers with preterm, very low birth weight (VLBW) infants (<1,500 g); and (2) to examine mothers’ assessment of a peer support program matching them with linguistically and culturally similar parent-buddies. Design: An exploratory, qualitative analysis based on grounded theory. Sample: A convenience sample of eight mothers from four of the most prevalent non-English-speaking cultures (Spanish, Portuguese, Chinese, and Tamil) in an urban Canadian-teaching hospital. Main Outcome Variable: Non-Anglophone mothers’ experience and support in the NICU. Results: Study mothers experienced intense role disequilibrium during the unanticipated crisis of preterm birth of a VLBW infant; situational crises owing to the high-tech NICU environment and their infant’s condition; and developmental crises with feelings of loss, guilt, helplessness, and anxiety. Language barriers compounded the difficulties. Parent-buddies helped non-English-speaking mothers mobilize their strengths. Culture and language are important determinants of service satisfaction for non-English-speaking mothers. Linguistically congruent parent-to-parent matching increases access to service.

Do culturally sensitive services for Chinese in-patients make a difference?.

Abstract Hospitals in large cities provide services to an increasingly diverse linguistic and cultural clientele. Some strategies adopted to improve services to non-English speaking populations include the use of bilingual social workers, interpreters and printed translation tools. In order to identify gaps in culturally sensitive care in a Canadian teaching hospital, this study surveyed a consecutive sample of 279 Chinese in-patients to determine satisfaction with hospital experience, levels of information about hospital routines and awareness of on-site Chinese cultural services. Results were generally positive. However, satisfaction and information levels were significantly higher among those patients who were aware of culturally appropriate Chinese resources such as social workers, cultural interpreters, and culturally specific reference tools. Of particular interest are the 121 patients (44%) who were less comfortable with English, since awareness of culturally specific resources tended to make a greater difference to this sub-group. These results can potentially help health care providers improve services to patients and families from diverse cultural and linguistic groups.

Childhood maltreatment is associated with ulcerative colitis but not Crohn's disease: findings from a population-based study

Background:Previous research suggests a link between childhood adversities and inflammatory bowel disease (IBD); however, study limitations prevent generalization of findings. To address this, the current study uses a Canadian population–based sample to investigate the relationship between 3 childhood adversities and 2 types of IBD while controlling for a range of factors. Methods:Secondary data analysis of a subsample of the nationally representative 2012 Canadian Community Health Survey—Mental Health consisted of those with no missing data on any of the variables of interest (n = 21,852). The survey response rate was 68.9%. This study used logistic regression to estimate odds ratios of 3 types of childhood adversities (physical abuse, sexual abuse, and witnessing parental domestic violence) separately for ulcerative colitis and Crohns disease, each compared with those without IBD. The final model controls for sociodemographics, health behaviors, and mental health. The exposure was assessed by retrospective self-report, and the outcome was by self-report of a health professional diagnosis. Results:In a fully adjusted model, those who are physically (odds ratio = 2.28; confidence interval, 1.39–3.75) or sexually abused (odds ratio = 2.64; confidence interval, 1.61–4.33) during childhood had significantly higher odds of ulcerative colitis than their non-maltreated peers. No relationship is found between witnessing parental domestic violence and ulcerative colitis. None of the early adversities are significantly related to Crohns disease. Conclusions:Childhood physical and sexual abuse are related to ulcerative colitis, but not Crohns disease. Future research that can address epigenetic and neuroendocrine factors should investigate pathways through which early adversities may translate into one type of IBD but not another.

Functional Somatic Syndromes and Childhood Physical Abuse in Women: Data From a Representative Community-Based Sample

This study investigated whether childhood physical abuse was associated with functional somatic syndromes (FSS) in women while controlling for age, race, and four clusters of potentially confounding factors: (a) Other childhood adversities, (b) adult health behaviors, (c) socioeconomic status and stressors, and (d) mental health. A regional subsample of the 2005 Canadian Community Health Survey of 7,342 women was used. Women reported whether they had been diagnosed with chronic fatigue syndrome (CFS), fibromyalgia (Fm), irritable bowel syndrome (IBS), or multiple chemical sensitivities (MCS). Fully 749 reported having been physically abused by someone close to them during their youth. When controlling for potentially confounding factors, childhood physical abuse was significantly associated with CFS (OR = 2.11; 95% CI = 1.22, 3.65), Fm (OR = 1.65; 95% CI = 1.08, 2.52), and MCS (OR = 2.82; 95% = CI 1.90, 4.17). Clinicians using reattribution and stepped care approaches in the management of FSS should assess for a history of abuse.

Does difference matter? Diversity and human rights in a hospital workplace.

Abstract The urban hospital workplace is a dynamic environment that mirrors the cultural and social diversity of the modern city. This paper explores the literature relating to diversity in the workplace and then describes an urban Canadian teaching hospitals comprehensive approach to the promotion of an equitable and inclusive diverse environment. With this goal, four years ago the hospital established an office of Diversity and Human Rights staffed by a social worker. The office provides education, training, policy development and complaints management. The administration also convened a hospital-wide committee to advise on the outcomes, and to plan a process for diversity and human rights organizational change. The committee worked with a social work research consultant to design a qualitative focus group study, currently ongoing, to explore the perspectives of hospital staff. The lessons learned from the process have the potential to increase overall cultural competency of staff that can translate into more sensitive work with patients.