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PANCREATITIS ASSOCIATED ANXIETY, DEPRESSION, AND STRESS: INCIDENCE, RISK FACTORS, AND INTERVENTIONS FOR IMPAIRED MENTAL HEALTH DURING AND AFTER NECROTIZING PANCREATITIS
S McGuire, AM Montero, N Zyromski
Indiana University School of Medicine

Background
Necrotizing pancreatitis (NP) is characterized by a prolonged disease course requiring frequent hospitalization and intervention. NP patients are critically ill with high rates of ICU admission and organ failure. Critical illness and protracted disease course are identified as risk factors for developing anxiety, depression, and post-traumatic stress disorder (PTSD). Limited literature examines quality of life in NP patients and studies examining psychologic sequelae of NP including depression, anxiety and PTSD are virtually non-existent.

Methods
We aim to complete a prospective pilot study enrolling NP patients at a single institution (Indiana University Health). Patients will be screened for anxiety using the General Anxiety Disorder-7 (GAD7) screening questionnaire, for depression using the Patient Health Questionnaire-9 (PHQ9), and for post-traumatic stress disorder using the Post-Traumatic Symptom Scale-10 (PTSS-10). Patients who screen positive for new onset anxiety, depression, or PTSD will be considered to have Pancreatitis-associated Anxiety, Depression, and Stress (PADS). All patients with newly diagnosed PADS will be encouraged to use mindfulness-based stress reduction (MBSR) using a free app from the UCLA Mindful Awareness Research Center.

Results
We hypothesize that patients will have a high rate of PADS and that more severe disease course, longer duration of disease, longer ICU stay, and more frequent NP-based intervention are risk factors for the development of PADS. Finally, we hypothesize that a mindfulness-based stress reduction intervention will be utilized by patients and will decrease the incidence and duration and PADS.

Conclusion
Risk factors for impaired mental health during necrotizing pancreatitis disease course include critical illness, decreased quality of life, and prolonged disease course; however, mental health among the necrotizing pancreatitis patient population remains an understudied topic. Establishing the incidence of mental health disorders and implementing strategies to improve mental health outcomes is critical to holistic care of necrotizing pancreatitis patients.


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