Page 87 - JCTR-9-4

Ali et al. | Journal of Clinical and Translational Research 2023; 9(4): 297-307 303
that Black patients had an increased prevalence of depression the observed disparities in psychiatric comorbidities among IBD
with low screening rates [44]. Several studies have demonstrated patients. This strategy may assist in lowering barriers to receiving
racial disparities in outcomes in patients hospitalized with IBD, care for mental health and enhancing the general standard of care
with Blacks having higher readmission rates, a longer length for IBD patients with psychiatric comorbidities. The complex
of stay, and increased morbidity and mortality compared to and potentially bidirectional relationship between IBD and
White patients [45,46]. This may be due to several sociocultural psychiatric disorders should be the subject of further investigation,
factors and barriers to healthcare utilization. One study revealed considering elements such as cultural background, gender, and
that Whites were more likely to be seen by gastroenterologists social determinants of health [54]. A deeper understanding of
annually than Black IBD patients [47]. These disparities have been these relationships will facilitate the development of focused
attributed to the underutilization of specialist care as a result of interventions to address these disparities. It will improve the
difficulties in obtaining specialist referrals and financial concerns overall clinical care and outcomes for IBD patients with comorbid
among Black patients [47]. Similar reasons may contribute to psychiatric conditions. In light of the trends observed over a
decreasing healthcare utilization for psychiatric disorders in non- decade-long span in our study, we speculate that increased disease
White patients, leading to poor prognoses and worse outcomes. awareness, advancements in diagnostic methodologies, societal
Contrarily, schizophrenia and schizoaffective disorder were less attitudes toward mental health, and potential changes in lifestyle
likely to be seen in Whites than in Blacks and Hispanics. This trend and environmental factors may have influenced the prevalence
may be attributed to the disproportionate number of schizophrenia and recognition of IBD and associated psychiatric illnesses. This
diagnoses among African Americans and Latino Americans [48]. further emphasizes the importance of ongoing research to better
The prognosis of IBD can be negatively impacted by understand and address these evolving trends.
psychiatric disorders, often due to medication non-adherence,
resulting in worsened clinical outcomes, functional disability, and 5. Limitations
reduced quality of life [18-21,49,50]. The previous investigations We acknowledge several limitations to our study, primarily
have examined the impact of psychiatric disorders on the IBD grounded in the inherent restrictions of using the NIS. While it
patient population [11,49,50]. However, the clinical evidence presents a large database for generalized interpretation, hospital
on race and gender disparities in IBD patients remains sparse. data in NIS do not evaluate non-hospitalized individuals. Therefore,
Our study represents one of the largest analyses exploring this dataset could lead to an underrepresentation of psychiatric
racial and gender-based disparities in psychiatric comorbidities disorders within the broader IBD population. The database also
in IBD patients, identifying females and Whites as particularly lacks supplementary data on treatments such as antidepressants
susceptible. It is essential to consider how social and structural and antipsychotic usage. It could provide a more holistic view of
norms may influence the diagnosis of IBD and psychiatric the prevalence of psychiatric disorders in IBD patients. Another
illnesses. For instance, it is known that women are more likely limitation is the reliance on ICD codes as the primary indicator
to access health services, particularly mental health support. This
observation could possibly be overrepresented in our findings. of psychiatric disorders. Despite being systematic in their disease
Similarly, the barriers faced by racial and ethnic minorities in classification, these codes may not fully capture the complexity of
accessing healthcare could lead to delayed or missed diagnoses. mental health diagnoses [55]. The exclusive reliance on ICD codes
As the prevalence of psychiatric comorbidities increases in could also lead to the misclassification or underrepresentation
chronic medical conditions, it is important for clinicians and of certain mental health conditions. The study does not account
policymakers to consider the racial and gender-based disparities for changes in mental health reporting patterns due to increasing
in these psychiatric illnesses [51,52]. Our results highlight the societal awareness. The increased awareness may lead to improved
need for further research to develop effective screening and identification and reporting of mental health disorders, causing
treatment guidelines for IBD patients with psychiatric disorders. an apparent rise in prevalence. Simultaneously, heightened
This could improve the prognosis, enhance the quality of life, and awareness might also encourage individuals to report milder
reduce healthcare costs. Beyond medical treatment, addressing distress as mental health issues, potentially overestimating the
psychosocial concerns in IBD is critical. Mussell et al. described prevalence rates. The study does highlight ethnic disparities in the
the efficacy of outpatient psychological group therapy in the prevalence of psychiatric disorders, observing higher rates among
short- and long-term reduction of psychological distress in IBD White IBD patients compared to other ethnic groups. However,
patients, but they simultaneously emphasized gender-specific these findings should be interpreted cautiously due to potential
interventions [53]. Further studies examining the correlation confounding factors. Sociocultural influences, healthcare access
between IBD and psychiatric comorbidities across different disparities, and systemic biases could potentially contribute to
genders and races are warranted. It would be helpful to shed underdiagnosis or underreporting in minority populations.
light on the interplay of psychiatric disorders, IBD, and potential 6. Conclusions
genetic, environmental, and social factors affecting outcomes.
It is critical to consider implementing culturally sensitive This study revealed that females had a higher frequency of
mental health screening and treatment protocols. It can help to IBD hospitalizations compared to males. Most patients were
cater to the specific needs of diverse patient populations to address in the younger age group of 18–33 years. The most frequent
DOI: http://dx.doi.org/10.18053/jctres.09.202304.22-00231