Simon R. Knowles

Investigating the role of perceived stress on bacterial flora activity and salivary cortisol secretion: a possible mechanism underlying susceptibility to illness

This study examined the impact of academic stress on salivary cortisol concentrations and lactic acid bacteria activity. Whole, unstimulated saliva samples and faecal samples were collected from 23 healthy undergraduate students (23.0+/-6.8 years; range 18-44) over two 1-week periods: during the beginning of semester (low-stress baseline condition) and during the first week of exams (high-stress condition). Students also completed a series of questionnaires measuring perceived levels of stress, gastrointestinal symptoms, and nutritional intake. Significant findings indicated that faecal lactic acid bacterial levels were lower during the high-stress condition. Paralleling this, students rated perceived levels of stress as being greater during the exam period compared to the baseline condition. The findings from this study have provided further insight into the link between stress and gastrointestinal flora activity in humans.

Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases.

Background:Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies. Methods:Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research. Results:(1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohns disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset. Conclusions:The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatment.

Molecular Characterisation of Gastrointestinal Microbiota of Children With Autism (With and Without Gastrointestinal Dysfunction) and Their Neurotypical Siblings

Many children with autism spectrum disorders (ASDs) suffer from gastrointestinal problems such as diarrhoea, constipation and abdominal pain. This has stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. Therefore, we designed this study to identify differences (and/or similarities) in the microbiota of children with autism (without gastrointestinal dysfunction: n = 23; with gastrointestinal dysfunction: n = 28) and their neurotypical siblings (n = 53) who share a similar environment using bacterial tag‐encoded FLX amplicon pyrosequencing. Regardless of the diagnosis and sociodemographic characteristics, overall, Firmicutes (70%), Bacteroidetes (20%) and Proteobacteria (4%) were the most dominant phyla in samples. Results did not indicate clinically meaningful differences between groups. The data do not support the hypothesis that the gastrointestinal microbiota of children with ASD plays a role in the symptomatology of ASD. Other explanations for the gastrointestinal dysfunction in this population should be considered including elevated anxiety and self‐restricted diets. Autism Res 2012, 5: 419–427.

Preliminary examination of the relations between disease activity, illness perceptions, coping strategies, and psychological morbidity in Crohn's disease guided by the common sense model of illness

Background: An individuals psychological adjustment to illness is influenced by disease severity, illness perceptions, and coping strategies. A more precise understanding of the contribution of each of these factors to a patients well‐being may influence the kind of psychological support required by patients. This study therefore aimed to characterize the contributors to psychological well‐being in patients with Crohns disease (CD). The design was a cross‐sectional questionnaire‐based study. Methods: Ninety‐six CD patients (34 males, 62 females, mean age 38 years) attending a tertiary hospital inflammatory bowel disease outpatient clinic were studied. Disease severity was evaluated according to the Crohns Disease Activity Index (CDAI), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). Results: Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ2 (7) = 10.42, P = 0.17, χ2/N = 1.49, root mean square error of approximation (RMSEA) < 0.07, comparative fit index (CFI) > 0.97, Goodness‐of‐fit index (GFI) > 0.97). Disease activity had a significant direct influence on illness perceptions (&bgr; = 51, P < 0.001). In turn, illness perceptions had a significant direct influence on depression and anxiety (&bgr; = 41, P < 0.001, &bgr; = 0.40, P < 0.001, respectively). Use of emotional coping strategies was associated significantly (P < 0.001) with the presence of anxiety and depression. Conclusions: There is an interrelationship between disease activity, illness perceptions, coping strategies, and depression and anxiety. These aspects of psychological processing provide a framework and direction for the psychological support that patients with CD require.

The efficacy and methodological challenges of psychotherapy for adults with inflammatory bowel disease: a review.

Abstract:Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD.

Review of studies that have used the Standard Shiftwork Index: Evidence for the underlying model of shiftwork and health

The Standard Shiftwork Index (SSI) provides shiftwork researchers with a standardised battery for assessing the impact of shiftwork on psychological and physiological well-being. We review the published SSI literature and evaluate the extent to which the results of these publications support the model underpinning the SSI. A total of 70 SSI publications were identified, of which 41 were selected. The 41 studies were published between 1993 and 2006 and had a combined total of 21,420 respondents. The analysis indicated support for parts of the SSI model, particularly in relation to the impact of shift systems design on individual well-being, as well as the role of individual factors (e.g., personality, coping style). However, evidential support for the model as a whole is incomplete. The findings of the reviewed studies are summarised and methodological limitations are discussed.

Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: A preliminary exploration using Structural Equation Modeling

BACKGROUND AND AIMS This study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD. METHODS Seventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale. RESULTS Exploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ(2) (25)=27.84, p=.32, χ(2)/N=1.11, CFI>0.99, RMSEA<0.04, SRMR<0.07, GFI>0.93). Illness perceptions had a significant direct influence on depression (β=0.49, p<0.001), anxiety (β=0.55, p<0.001), and family functioning (β=-0.17, p<0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction. CONCLUSIONS The findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.

A Confirmatory Factor Analysis of the GHQ12 Using a Large Australian Sample

The GHQ12 has become a popular screening instrument used by both clinicians and researchers. To date there have been a number of studies investigating the factor structure of the GHQ12. Most have identified a factorial structure to the instrument but there has been little consistency in the factors identified. One reason for this may be that different investigators are using different scoring methods and this could impact the structure identified. This study used structured equation modeling (LISREL 8.7) to carry out a confirmatory factor analysis, with a large sample of 8,732 university staff, on four 3-factor and one unitary model solutions using the three most common scoring methods (Classical, Corrected, and Likert). It was found that the method of scoring substantially affects model estimation and suggestions were made as to the best scoring method for future use.

EHealth Technologies in Inflammatory Bowel Disease: A Systematic Review

BACKGROUND AND AIMS Electronic-health technologies (eHealth) such as Web-based interventions, virtual clinics, smart-phone applications, and telemedicine are being used to manage patients with inflammatory bowel disease (IBD). We aimed to: (1) Evaluate the impact of eHealth technologies on conventional clinical indices and patient-reported outcome measures (PROs) in IBD; (2) assess the effectiveness, cost-effectiveness and feasibility of using eHealth technologies to facilitate the self-management of individuals with IBD, and; (3) provide recommendations for their design and optimal use for patient care. METHODS Relevant publications were identified via a literature search, and 17 publications were selected based on predefined quality parameters. RESULTS Six randomized controlled trials and nine observational studies utilizing eHealth technologies in IBD were identified. Compared with standard outpatient-led care, eHealth technologies have led to improvements in: Relapse duration [(n = 1) 18 days vs 77 days, p < 0.001]; disease activity (n = 2); short-term medication adherence (n = 3); quality of life (n = 4); IBD knowledge (n = 2); healthcare costs (n = 4); the number of acute visits to the outpatient clinic due to IBD symptoms (n = 1), and; facilitating the remote management of up to 20% of an IBD cohort (n = 2). Methodological shortcomings of eHealth studies include heterogeneity of outcome measures, lack of clinician/patient input, lack of validation against conventional clinical indices and PROs, and limited cost-benefit analyses. CONCLUSIONS EHealth technologies have the potential for promoting self-management and reducing the impact of the growing burden of IBD on health care resource utilization. A theoretical framework should be applied to the development, implementation, and evaluation of eHealth interventions.

Utilization and efficacy of internet-based eHealth technology in gastroenterology: a systematic review.

Abstract Objective. While there have been several reviews exploring the outcomes of various eHealth studies, none have been gastroenterology-specific. This paper aims to evaluate the research conducted within gastroenterology which utilizes internet-based eHealth technology to promote physical and psychological well-being. Material and methods. A systematic literature review of internet-based eHealth interventions involving gastroenterological cohorts was conducted. Searched databases included: EbSCOhost Medline, CINAHL, and PsycINFO. Inclusion criteria were studies reporting on eHealth interventions (both to manage mental health problems and somatic symptoms) in gastroenterology, with no time restrictions. Exclusion criteria were non-experimental studies, or studies using only email as primary eHealth method, and studies in language other than English. Results. A total of 17 papers were identified; seven studies evaluated the efficacy of a psychologically oriented intervention (additional two provided follow-up analyses exploring the original published data) and eight studies evaluated disease management programs for patients with either irritable bowel syndrome, inflammatory bowel disease (IBD) or celiac disease. Overall, psychological eHealth interventions were associated with significant reductions in bowel symptoms and improvement in quality of life (QoL) that tended to continue up to 12 months follow up. The eHealth disease management was shown to generally improve QoL, adherence, knowledge about the disease, and reduce healthcare costs in IBD, although the studies were associated with various methodological problems, and thus, this observation should be confirmed in well-designed interventional studies. Conclusions. Based on the evidence to date, eHealth internet-based technology is a promising tool that can be utilized to both promote and enhance gastrointestinal disease management and mental health.