Analysis of patient activation and its influencing factors among Chinese rural older adults with chronic multimorbidity.

The rapid growth in inflammatory bowel disease (IBD) prevalence and management complexity continues to expand year over year. In this decade, it is projected that an estimated 470,000 Canadians will be diagnosed with IBD. Canada has the highest observed prevalence rates of IBD in the world. IBD-related psychological distress (IBD-PD) refers to the emotional reactions to a chronic disease like IBD, which can be associated with increased stress, comorbid mental health disorders, and symptoms of active disease. Mental health conditions in IBD are also associated with increased primary care and ER visits. The COVID-19 pandemic brought awareness to the growing mental health crisis in the general population and in those with IBD. Among the IBD population alone, many IBD patients experience some form of IBD-PD at some point during their IBD journey, and patients feel there is inadequate access to mental health supports for this distress. Patients feel their mental and emotional health needs are not currently being met in their routine IBD care. Routine screening and referral for mental health problems are clinical needs that are not being met and more implementation studies on routine mental health assessments in IBD clinics are needed. Despite this care gap, IBD patients indicate high levels of comfort with discussing psychological distress with their IBD care team compared to receiving support from formalized mental health professionals. In the United States, only one-third of patients with IBD-PD are able to access mental health care. In fact, a predictive factor of psychological distress is being ‘not able to find a healthcare provider’. A recent meta-analysis suggests there is a high prevalence of anxiety and depressive symptoms in IBD patients, and the prevalence of these symptoms (anxiety and depression) is higher in those with active IBD. From a gut-brain behaviour outcomes framework, psychological distress contributes to IBD disease activity over time and exacerbates symptoms. Psychological distress in IBD has been linked to stressful life events and lack of social support, with social support having a protective effect on the degree of distress. IBD patients have higher levels of anxiety, stress, and depression compared to non-IBD controls and levels of distress correlate with proinflammatory gene expression in ileal tissue.