Journal Article Annotations
2025, 2nd Quarter

GI Psychiatry

Annotations by Ashwini Nadkarni, MD
July, 2025

Psychological well-being is the major determinant of global health in the first year following a diagnosis of inflammatory bowel disease in children.
Validation of the PROMIS Global Physical and Mental Health Scale for Gastrointestinal Disorders: A Large-Scale Cross-Sectional Survey.

PUBLICATION #1 — GI Psychiatry

Psychological well-being is the major determinant of global health in the first year following a diagnosis of inflammatory bowel disease in children.

Anastasia Amelia Mekhael, A Natisha Nabbijohn, David Mack, Alain Stintzi, Janice Susan Cohen, C Meghan McMurtry.

Abstract: J Psychosom Res. 2025 Jul:194:112142. doi: 10.1016/j.jpsychores.2025.112142. Epub 2025 May 16.

Inflammatory bowel disease (IBD) represents a group of disorders with no known cure. IBD is impacted by biopsychosocial factors. The burden, psychosocial difficulties, and gene-environment interaction involved in the manifestation of IBD necessitate a fuller understanding of factors which worsen or ameliorate IBD. Case complexity (CC) captures current and historical biopsychosocial risks for individuals with IBD and holds promise for understanding variation in treatment response and individuals’ experiences with IBD. The present study aimed to understand the relative contributions of: 1) historical vs. current factors impacting CC in predicting global health; and 2) biological, psychological, social, family, and health system factors on global health. Within a longitudinal design, 8-17-year-old youth (N = 83) completed the self-report Pediatric Global Health 7 + 2 at diagnosis (baseline) and 4- and 12 months post-diagnosis. The p-IBD-INTERMED, a clinical-decision support tool, which standardizes inter-professional assessment of biopsychosocial risks contributing to CC was completed by the healthcare provider team at the same timepoints. CC was associated with global health at all time points (T1_r = -0.27; T2_r = -0.42; T3_r = -0.50). Hierarchical regression revealed that across time the relative contribution of historical CC was surpassed by current CC when predicting global health (at T1 β_HCC=-0.13_;β_CCC = -0.17; at T3 β_HCC = -0.04; β_CCC = -0.48). In this cohort, at 4- and 12-months post diagnosis, psychological factors were the only domain of current CC to significantly predict global health, accounting for 29.1 % and 24.1 % of its variance respectively. Findings suggest that the global health of patients with IBD is not fixed by early life experiences.

Background:
Inflammatory bowel disease (IBD) represents a prevalent group of disorders with no known cure. IBD is impacted by myriad biopsychosocial factors. The pervasive burden, pronounced psychosocial difficulties, and the potential gene-environment interaction involved in the manifestation of IBD necessitate a fuller understanding of factors which might worsen or ameliorate IBD. Case complexity (CC) captures current and historical biopsychosocial risks for individuals with IBD and holds promise for understanding variation in treatment response and individuals’ experiences with this chronic illness.

Aims:
We sought to understand the relative contributions of: 1) historical vs. current factors impacting CC in predicting global health (self-reported); and 2) biological, psychological, social, family, and health system factors on global health.

Methods:
Within a longitudinal design, 8-17-year-old youth (N = 83) completed the self-report Pediatric Global Health 7 + 2 at diagnosis (baseline) and 4- and 12 months post-diagnosis. The p-IBD-INTERMED, an interview-based measure of CC, was completed by the healthcare provider team at the same timepoints.

Results:
CC was associated with global health at all time points (T1_r = -0.27; T2_r = -0.42_; T3_r = -0.50). Hierarchical regression revealed that across time points the relative contribution of historical CC was surpassed by current CC when predicting global health (at T1 β_HCC= – 0.13_;β_CCC= – 0.17_; at T3 β_HCC= – 0.04_;β_CCC= – 0.48). In this cohort of newly diagnosed children that had good medical response by one-year post diagnosis, at 4- and 12-months post diagnosis, psychological factors were the only domain of current CC to significantly predict global health, accounting for 29.1 % and 24.1 % of its variance respectively.

Discussion:
Findings suggest that the global health of IBD patients is not fixed by early life experiences and shed light onto potential psychosocial treatment targets

Annotation

The finding:
This prospective cohort study sought to clarify the relative contributions of: 1) historical versus current factors impacting case complexity (CC) in predicting global health (self-reported); and 2) biological, psychological, social, family, and health system factors on global health in patients with Inflammatory Bowel Disease (IBD). The study found that case complexity was correlated with global health at baseline, 4-months, and 12-months. This is in line with existing research that indicates the health-related quality of life in youth with IBD is associated with psychosocial stressors in the youth’s environment.

Strength and weaknesses:
This is the first study to longitudinally explore several biopsychosocial aspects of pediatric IBD to examine relations with each youth’s own sense of global health. By examining the relative influence of past complexity on global health and how this shifts post-diagnosis, the study also gained a developmental understanding of the course of the condition. However, the study’s cohort lacked ethnic and geographic diversity, potentially limiting generalizability and the exploration of cultural and sociopolitical differences within the sample. In addition, given that participants were drawn from a single IBD centre, it is possible that the analyses did not capture patterns that result from systemically different care.

Relevance:
This study highlights the need for routine monitoring of healthcare needs beyond biomedical/physical assessments, including psychological factors, and reinforces the role of consultation-liaison psychiatrists and improving outcomes for patients with IBD.

PUBLICATION #2 — GI Psychiatry

Validation of the PROMIS Global Physical and Mental Health Scale for Gastrointestinal Disorders: A Large-Scale Cross-Sectional Survey.

Pragalathan Apputhurai, Olafur S Palsson, Shrikant I Bangdiwala, Ami D Sperber, Antonina Mikocka-Walus, Simon R Knowles.

Abstract: Neurogastroenterol Motil. 2025 Apr 24:e70059. doi: 10.1111/nmo.70059. Online ahead of print.

Background:
While the Patient-Reported Outcomes Measurement Information System (PROMIS) global health scales are frequently used to assess individual quality of life, it has yet to be validated in gastrointestinal cohorts. Based on the Rome Foundation Global Epidemiology Survey, the aim of this study was to conduct the most comprehensive psychometric evaluation of the PROMIS health scales (8-item and revised 4-item) across gastrointestinal and non-gastrointestinal condition cohorts.

Methods:
A cross-sectional survey was conducted in 26 countries. A series of confirmatory factor and reliability analyses were undertaken across gastrointestinal condition groups, that is, Disorders of Gut-Brain Interaction (DGBI) [any DGBI, individual DGBI, and DGBI anatomic region], gastroesophageal reflux disease, chronic constipation, chronic diarrhea, coeliac disease, diverticulitis, inflammatory bowel disease, cancer anywhere in the gastrointestinal tract, and peptic ulcer and a non-gastrointestinal condition group. Convergent validity was also assessed via a series of Pearson’s correlation coefficients with PHQ-4 (anxiety and depression) and PHQ-12 (somatization).

Results:
Based on 54,040 participants (50.9% male; mean age 44.33 years) confirmatory factor analysis indicated a poor fit for the original Hays et al. 4-item version of the PROMIS global health scale. The briefer version 2-factor 2-item model (the Rome alternate model) yielded acceptable fit across all groups. The Hays 2-factor 2-item model subscales also demonstrated strong convergent, content, and construct validity with original PROMIS global health scale subscales across all groups and DGBI regions and across anxiety, depression, and somatization.

Conclusions & inferences:
The 4-item revised version of the Hays model of the PROMIS global health scale demonstrates stronger psychometric properties compared to the original Hays model. This ultra-brief assessment instrument is a viable tool for assessing quality of life in gastrointestinal and non-gastrointestinal cohorts.

Annotation

The finding:
This cross-sectional study aimed to validate the original 8-item and revised 4-item versions of the PROMIS (Patient-Reported Outcomes Measurement Information System) global health scale, using confirmatory factor analysis in those with a gastrointestinal condition (i.e., disorders of gut brain interaction or DGBI), gastroesophageal reflux disease (GERD), chronic constipation, chronic diarrhea, celiac disease, diverticulitis, inflammatory bowel disease (IBD), cancer anywhere in the gastrointestinal tract, and peptic ulcer, and a non-gastrointestinal cohort. A secondary aim was to identify and validate a brief version of the PROMIS global health scales across both gastrointestinal and non-gastrointestinal condition cohorts. The study found that the original PROMIS demonstrated poor factor structures, indicating problematic construct validity but that the 4-item revised version of the Hays model of the PROMIS global health scale demonstrates stronger psychometric properties compared to the original Hays model.

Strength and weaknesses:
Strengths of this analysis include its efforts to validate short PROMIS global health scale measures in populations with specific health conditions such as gastrointestinal disorders. The study also marks the most comprehensive evaluation of the PROMIS scales to date. However, given the cross-sectional study design, evaluation of test–retest reliability or change in quality of life (QoL) could not be conducted.

Relevance:
This study represents the most comprehensive evaluation of the PROMIS scales using the largest and demographically representative sample, including both gastrointestinal and non-gastrointestinal cohorts. The findings indicate that the original 8-item PROMIS global health scales are psychometrically problematic. However, the ultra-brief 4-item PROMIS Hays model was found to have strong construct reliability, and based on this large normative data, it is a viable measure of quality of life in future research. For consultation-liaison psychiatrists treating patients with co-morbid psychiatric and gastrointestinal disorders, this study provides a valuable reference on consideration of the most useful patient reported outcome measure tools.