Lesley Graff - Profile on Academia.edu (original) (raw)

Papers by Lesley Graff

Research paper thumbnail of Within-person fluctuations over three years in depression, anxiety, fatigue, and health-related quality of life in multiple sclerosis

Within-person fluctuations over three years in depression, anxiety, fatigue, and health-related quality of life in multiple sclerosis

Multiple Sclerosis Journal, Aug 3, 2023

Background: Longitudinal studies of health-related quality of life (HRQoL) in multiple sclerosis ... more Background: Longitudinal studies of health-related quality of life (HRQoL) in multiple sclerosis (MS) are limited. Most have examined average changes within the population, rather than dynamic changes within individuals. Objective: To assess the between- and within-individual association between depression, anxiety, fatigue, cognition, physical functioning, and physical comorbidities and HRQoL. Methods: Adults with MS underwent physical and cognitive assessments and reported symptoms of fatigue (Daily Fatigue Impact Scale), depression and anxiety (Hospital Anxiety and Depression Scale (HADS)), and HRQoL (RAND-36) annually ( n = 4 visits). We evaluated associations of elevated symptoms of anxiety (HADS-A) and depression (HADS-D), fatigue, physical function (timed-walk and nine-hole peg test), cognitive function and comorbidity count with physical (PCS-36) and mental (MCS-36) HRQoL using multivariable linear models—estimating between-person and within-person effects. Results: Of 255 participants with MS enrolled, 81.6% were women. After adjustment, within-person increases in depression and fatigue were associated with decreases in physical HRQoL. Increases in depression, anxiety, and comorbidity count were associated with decreases in mental HRQoL. Conclusions: Within-person increases in symptoms of depression, anxiety and fatigue, and comorbidity count are associated with HRQoL decreases among adults with MS, highlighting the potential magnitude of individual benefit of intervention for these symptoms.

Research paper thumbnail of Development of the Dietitian Integrated Evaluation Tool for Gluten-free Diets (DIET-GFD)

Nutrition, Oct 1, 2020

Objective-Celiac disease (CD) treatment involves a gluten-free diet (GFD). There is no standardiz... more Objective-Celiac disease (CD) treatment involves a gluten-free diet (GFD). There is no standardized tool for dietitians to objectively grade GFD adherence. This study aimed to develop a standardized tool for dietitians to evaluate and communicate GFD adherence. Research Methods & Procedures-Participants were recruited from the Manitoba Celiac Disease Cohort. Using a consensus process, an expert panel of gastroenterologists, dietitians, clinical health psychologists and persons with CD developed the DIET-GFD. Two dietitians then *

Research paper thumbnail of W1215 Assessing Changes in Reported Medication Adherence Over a Three Year Period: the Manitoba IBD Chort Study

Gastroenterology, May 1, 2009

BACKGROUND: P-gp, encoded by MDR-1 gene, is a transmembrane efflux pump described overexpressed i... more BACKGROUND: P-gp, encoded by MDR-1 gene, is a transmembrane efflux pump described overexpressed in cancer refractoriness by pumping treatment drugs out of cells. It is expressed in PBL, other haematopoietic cells, apical superficial epithelium of colon, ileum and other tissues with barrier function. It is an interesting and controversial candidate for UC therapeutic response and pathogenesis. Increased expression has been reported associated with steroid UC refractoriness. Conversely, deficient P-gp function has been postulated as UC susceptibility/severity factor AIM: to investigate the role of MDR1 gene in the therapeutic response of UC by studying the P-gp functionality in PBL METHODS: P-gp functional activity was evaluated in PBL of 27 patients (15 M, 12 F) median age 30 (16-71) yrs with active UC (Mayo score: severe n 9, moderate n 9, mild n 9) categorized in: S-REFR (steroid-refractory, n 16) and S-RESP (steroid-responders, n 11); healthy controls (HC, n 68): similar age/ gender. Rhodamine123 (a fluorescent P-gp substrate) efflux was studied by flow cytometry, (FACS Calibur, Becton-Dickinson) in absence and presence of P-gp modulators: Verapamil 100 μM, Valspodar 1μM reassessment. Data were expressed evaluating the behaviour of two markers (M1, M2) defined based on % of cells with different fluorescence levels. M1 (high fluorescence, low P-gp pump activity) and M2 (low fluorescence, high activity) were compared in the three groups. After inhibition, it should be expected that Rhodamine123 remain in the intracellular leading to an increase of % of cells in M1 vs. M2 RESULTS: (X±SD) Significant differences were observed in absence and presence of verapamil inhibition, showing increased P-gp functional activity in S-REFR vs. S-RESP (p<0.01) and HC (p<0.001), but not between S-RESP and HC (ANOVA and Student-Newman-Keuls post-test)(Tabla) Results were not influenced by cumulative steroids. Three out of 4 severe patients showing M2>M1 in the assay with verapamil required surgery. Clinical disease activity correlated with M2 (with inhibitor= r:0.57, p=0.000056, Spearman). Interestingly, S-REFR showed a shift (M2 to M1) in an early new assay when some newly added drug reached effectiveness (6-MP n:4, infliximab n:1) CONCLUSION: our results suggest: 1)a relevant role of P-gp in UC treatment response 2)a possible usefulness of P-gp functional assay in the early detection of individual therapeutic response.

Research paper thumbnail of Symptoms of Functional Intestinal Disorders Are Common in Patients with Celiac Disease Following Transition to a Gluten-Free Diet

Digestive Diseases and Sciences, Jul 7, 2017

Background-Celiac disease and functional intestinal disorders may overlap, yet the natural histor... more Background-Celiac disease and functional intestinal disorders may overlap, yet the natural history of functional symptoms in patients with celiac disease is unknown. Aim-To investigate the prevalence of irritable bowel syndrome (IBS), functional dyspepsia (FD) and functional bloating (FB) symptoms among patients with celiac disease at diagnosis and during the first year of a gluten-free diet. Methods-Adults with a new diagnosis of celiac disease were surveyed at baseline, 6 months and 1 year using standardized measures for intestinal symptoms [Rome III diagnostic questionnaire and Celiac Symptom Index (CSI)] and gluten-free diet adherence [Gluten-Free Eating Assessment Tool (GF-EAT) and Celiac Diet Adherence Test (CDAT)]. Results-At diagnosis, two-thirds fulfilled Rome III diagnostic questionnaire symptom criteria for IBS (52%), functional dyspepsia (27%) and/or functional bloating (9%). One year postdiagnosis, there was high adherence to a gluten-free diet as 93% reported gluten exposure less than once per month on the GF-EAT and only 8% had ongoing celiac disease symptoms (CSI score > 45). The rates of those meeting IBS (22%) and functional dyspepsia (8%) symptom criteria both decreased significantly on a gluten-free diet. The prevalence of functional symptoms (any of IBS, FD or FB) at 1 year was 47%.

Research paper thumbnail of Changes in Fatigue Over 2 Years Are Associated With Activity of Inflammatory Bowel Disease and Psychological Factors

Clinical Gastroenterology and Hepatology, Sep 1, 2013

BACKGROUND & AIMS: Cross-sectional studies have identified high levels of fatigue in patients wit... more BACKGROUND & AIMS: Cross-sectional studies have identified high levels of fatigue in patients with active or quiescent inflammatory bowel disease (IBD), but there has been little attention to the long-term effects of fatigue in these patients. We performed a longitudinal study of fatigue in patients with IBD to determine its course and contributing factors. METHODS: Data were obtained from participants in the Manitoba IBD Cohort Study (N ‫؍‬ 312; 51% with Crohn's disease), a longitudinal population-based study. Symptomatic disease activity was measured every 6 months for 2 years to characterize long-term disease patterns as active, fluctuating, or inactive, based on the validated Manitoba IBD Index. We collected data concurrently on fatigue (Multidimensional Fatigue Inventory), psychological function, and laboratory biomarkers at the point of study entry and 1 and 2 years later. Of the study participants, 26% had consistently inactive, 29% had fluctuating, and 45% had consistently active disease over the 2-year time period. Mean levels of fatigue were strongly associated with disease activity; participants with consistently inactive disease had the lowest level of fatigue at each time point. Multivariate analyses indicated fatigue levels increased over time regardless of disease pattern (P < .001). Adjusting for disease activity, disease type and age, sex (female; P < .001), and psychological variables of distress (P < .001), reduced psychological well-being (P ‫؍‬ .002) and poor sleep quality (P < .001) were associated independently with increases in fatigue over time. Fatigue can increase over time in patients with IBD, even when their disease is in remission. Psychological factors are useful targets for intervention to reduce fatigue.

Research paper thumbnail of Population-based controlled study of social support, self-perceived stress, activity and work issues, and access to health care in inflammatory bowel disease

Inflammatory Bowel Diseases, Apr 1, 2008

Background: The Manitoba IBD Cohort Study is a longitudinal, population-based study of multiple d... more Background: The Manitoba IBD Cohort Study is a longitudinal, population-based study of multiple determinants of health outcomes in persons with IBD diagnosed within 7 years at enrollment. In this cross-sectional sub-study we compared IBD participants' levels of social supports, self-perceived stress, disability, and access to health care with those of a matched community sample. Methods: IBD participants (n=388) were interviewed using the Canadian Community Health Surveys (CCHS) 1.1 and 1.2 to assess for psychosocial variables. The national CCHS data were accessed to extract a community comparison group, matched on age, sex and geographic residence. Results: Compared to the community sample, IBD participants received more tangible, affective, or emotional support in the past year and were more likely to have experienced a positive social interaction. Those with IBD were as likely to be employed as those in the community sample, although they reported greater rates of reduced activity and days missed. Work was not identified as a significant source of stress, but physical health was more likely to be identified as a main stressor by those with active IBD, compared to the non IBD sample. Individuals with IBD were twice as likely to report unmet health care needs than the community sample, however there was agreement across both groups regarding common barriers including long waits and availability. Conclusions: While the disease may contribute to greater interference with work quality and daily activities, IBD patients have similar levels of stress and appear to have enhanced social supports relative to those in the community without IBD.

Research paper thumbnail of W1284 The Manitoba IBD Cohort Study: Longitudinal use of Complementary and Alternative Medicine (CAM) in IBD Over 54 Months

Gastroenterology, May 1, 2010

with MTX,] with AZA (P = 0.003 vs MTX) and 1.1 [0-23.6] with IFX (N.S. vs MTX). Median SES-CD was... more with MTX,] with AZA (P = 0.003 vs MTX) and 1.1 [0-23.6] with IFX (N.S. vs MTX). Median SES-CD was 6.5 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] with MTX,[3][4][5][6][7][8][9][10][11][12][13][14][15][16] with AZA (P = 0.01 vs MTX) and 2 [0-27] with IFX (P = 0.035 vs MTX). Conclusion: Sustained clinical remission of CD with MTX is associated with a lower rate of MH when compared to AZA or IFX. MTX provides incomplete healing of the gut mucosa which may explain the high relapse rate of CD when given as maintenance.

Research paper thumbnail of Is Iron Deficiency in the Absence of Anemia Associated With Fatigue in IBD?

Is Iron Deficiency in the Absence of Anemia Associated With Fatigue in IBD?

Gastroenterology, May 1, 2011

We explored whether iron deficiency in the absence of anemia is associated with fatigue in inflam... more We explored whether iron deficiency in the absence of anemia is associated with fatigue in inflammatory bowel disease (IBD). We assessed iron deficiency and anemia in 280 participants from the population-based Manitoba IBD Cohort Study. Iron deficiency was identified in 20% with Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and 27% with ulcerative colitis. Anemia was identified overall in 50 (18%), with 230 who were nonanemic. In the nonanemic subgroup, there were no significant differences between iron-deficient and -sufficient groups in mean fatigue levels or proportions with problematic fatigue. There was no unique contribution of iron deficiency to problematic fatigue after adjustment for active disease and anemia. There was no evidence of an association between iron deficiency and fatigue in the absence of anemia, suggesting that iron deficiency is not a clinically relevant contributor to fatigue in IBD.

Research paper thumbnail of New Insights Into the Genetic Basis for Variation in Crohn's Disease (CD) Phenotype in a Population-Based Study

New Insights Into the Genetic Basis for Variation in Crohn's Disease (CD) Phenotype in a Population-Based Study

Gastroenterology, May 1, 2011

Research paper thumbnail of A population-based study of fatigue and sleep difficulties in inflammatory bowel disease

Inflammatory Bowel Diseases, Sep 1, 2011

Research paper thumbnail of Psychometric Performance of Fatigue Scales in Inflammatory Bowel Disease

Inflammatory Bowel Diseases, Mar 14, 2023

Background: Fatigue is highly prevalent in people with inflammatory bowel disease (IBD). Fatigue ... more Background: Fatigue is highly prevalent in people with inflammatory bowel disease (IBD). Fatigue scales are important for studies testing fatigue interventions, but information about psychometric properties of many scales is insufficient in IBD. We compared the psychometric properties of multiple generic fatigue scales in participants with IBD. Methods: Individuals with IBD (N = 216) completed the Daily Fatigue Impact Scale (DFIS), the vitality subscale of the RAND-36, and the Patient Health Questionnaire-9 (PHQ-9) fatigue item twice. A subgroup (n = 84) also completed the Fatigue Impact Scale (FIS) once, from which we also scored the 21 items from the Modified Fatigue Impact Scale (MFIS-IBD). We assessed floor/ceiling effects, construct validity, and internal consistency reliability. Using relative efficiency (RE), we compared discriminating ability and comparative responsiveness of the measures regarding disease activity and employment status and changes. The FIS, MFIS, and RAND-36-vitality scales did not exhibit floor or ceiling effects. The DFIS showed mild floor effects (19.4%), and the PHQ-9 fatigue item showed floor (18.1%) and ceiling (20.8%) effects. Internal consistency reliability exceeded 0.93 for FIS, MFIS-IBD, and DFIS and was 0.81 for the RAND-36-vitality scale. In the subgroup analysis, the FIS, MFIS-IBD, and DFIS were strongly correlated with each other (r ≥ 0.90). The ability to discriminate between disease activity groups was highest for the FIS and MFIS-IBD, followed by the DFIS. The FIS, MFIS-IBD, and DFIS were responsive to changes in work impairment. The FIS, MFIS-IBDs and DFIS had adequate validity and reliability for assessing fatigue in IBD.

Research paper thumbnail of Factors associated with perceived need for mental health care in multiple sclerosis

Multiple sclerosis and related disorders, Oct 1, 2018

Background: Within the multiple sclerosis (MS) population, depression and anxiety are highly prev... more Background: Within the multiple sclerosis (MS) population, depression and anxiety are highly prevalent comorbidities that are associated with adverse outcomes such as diminished quality of life and disability progression. In the general population, many people who do not meet formal diagnostic criteria for depression or anxiety disorders still identify a need for mental health care. Limited data are available regarding the perceived need for mental health care among persons with MS. Objective: We aimed to determine factors associated with a perceived need for mental health care in the MS population. Methods: Participants with MS completed the Hospital Anxiety and Depression Scale (HADS) to assess severity of depression and anxiety symptoms, and reported whether they perceived a need for mental health care, in the context of a larger study examining the burden of psychiatric disorders in immune-mediated inflammatory disease. Participants were also evaluated using the Structured Clinical Interview for DSM-IV-TR (SCID) to diagnose depression or anxiety disorders. Participants reported their sociodemographic characteristics, and underwent physical assessments to determine their disability status. Descriptive analyses and binary logistic regression models were used to determine sociodemographic and clinical factors associated with perceived need for mental health care. Results: Of 255 participants enrolled, 251 were included in this analysis. Most participants were women, Caucasian, with post-secondary education, with a mean (SD) age at enrollment of 50.9 (12.9) years. They predominantly had a relapsing-remitting MS course. Nearly one-quarter of participants had a current SCID diagnosis of depression or anxiety (n = 57, 22.7%). Overall, 31.8% (n = 80) of participants reported a need for mental health care. These individuals were slightly younger at enrollment (p = 0.037), but otherwise did not differ with respect to sociodemographic characteristics, compared to participants not reporting this need. Those identifying need for mental health care also had an earlier age of MS symptom onset (p = 0.011). After adjusting for sociodemographic and clinical factors, elevated symptoms of depression (odds ratio [OR] 2.36; 95%CI: 1.06, 5.25) and anxiety (OR 6.08; 95%CI: 2.78, 13.3) were associated with an increased likelihood of reporting a need for mental health care. Any current SCID diagnosis of depression or anxiety was not associated with perceived need for mental health care after accounting for symptoms of depression and anxiety. Conclusions: One-third of people with MS identified a need for mental health care. Symptoms of anxiety and depression, but not current diagnosed mental health disorders, were the predominant factors associated with a perceived need for care.

Research paper thumbnail of Vascular comorbidity is associated with decreased cognitive functioning in inflammatory bowel disease

Scientific Reports

Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and card... more Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal fluency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modified Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn’s disease; mean (SD) age was 53.36 ...

Research paper thumbnail of Vascular comorbidity is associated with decreased cognitive functioning in inflammatory bowel disease

Research Square (Research Square), Oct 12, 2022

Background: Reports of cognitive impairment in in ammatory bowel disease (IBD) have been mixed. I... more Background: Reports of cognitive impairment in in ammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Methods: Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal uency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modi ed Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Results: Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn's disease; mean (SD) age was 53.36 (13.95) years, and a high proportion were females (n = 58). As the risk score (FRS) increased, participants demonstrated lower performance in information processing speed (β=-0.12; 95% CI: -0.24, -0.006) and verbal learning (β=-0.14; 95% CI: -0.28, -0.01) at the 50 th percentile. After adjusting for IBD type, higher FRS remained associated with lower information processing speed (β=-0.13; 95% CI: -0.24, -0.03). Conclusion: Vascular comorbidity is associated with lower cognitive functioning in persons with IBD, particularly in the areas of information processing speed and verbal learning. These ndings suggest that prevention, identi cation, and treatment of vascular comorbidity in IBD may play a critical role for improving functional outcomes in IBD.

Research paper thumbnail of The comorbidity and cognition in multiple sclerosis (CCOMS) neuroimaging protocol: Study rationale, MRI acquisition, and minimal image processing pipelines

Frontiers in Neuroimaging

The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort... more The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort by a team of clinicians, neuropsychologists, and neuroimaging experts to investigate the neural basis of cognitive changes and their association with comorbidities among persons with multiple sclerosis (MS). The objectives are to determine the relationships among psychiatric (e.g., depression or anxiety) and vascular (e.g., diabetes, hypertension, etc.) comorbidities, cognitive performance, and MRI measures of brain structure and function, including changes over time. Because neuroimaging forms the basis for several investigations of specific neural correlates that will be reported in future publications, the goal of the current manuscript is to briefly review the CCOMS study design and baseline characteristics for participants enrolled in the three study cohorts (MS, psychiatric control, and healthy control), and provide a detailed description of the MRI hardware, neuroimaging acquisit...

Research paper thumbnail of Performance of Regression-Based Norms for Cognitive Functioning of Persons With Multiple Sclerosis in an Independent Sample

Frontiers in Neurology, 2021

Background: Cognitive impairment is common in multiple sclerosis (MS). Interpretation of neuropsy... more Background: Cognitive impairment is common in multiple sclerosis (MS). Interpretation of neuropsychological tests requires the use of normative data. Traditionally, normative data have been reported for discrete categories such as age. More recently continuous norms have been developed using multivariable regression equations that account for multiple demographic factors. Regression-based norms have been developed for use in the Canadian population for tests included in the MACFIMS and BICAMS test batteries. Establishing the generalizability of these norms is essential for application in clinical and research settings.Objectives: We aimed to (i) test the performance of previously published Canadian regression-based norms in an independently collected sample of Canadian healthy controls; (ii) compare the ability of Canadian and non-Canadian regression-based norms to discriminate between healthy controls and persons with MS; and (iii) develop regression-based norms for several cogniti...

Research paper thumbnail of Anxiety and depression affect performance on the symbol digit modalities test over time in MS and other immune disorders

Multiple Sclerosis Journal, 2020

Background: Longitudinal studies assessing depression and anxiety effects on cognition in multipl... more Background: Longitudinal studies assessing depression and anxiety effects on cognition in multiple sclerosis (MS) are limited. Objective: We tested whether within-person fluctuations in symptoms of depression or anxiety over time affect cognition in persons with MS, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and a lifetime history of depression/anxiety disorders (DEP/ANX) but without an immune-mediated inflammatory diseases (IMID). Methods: We followed participants (MS: 255, IBD: 247, RA: 154, and DEP/ANX: 306) for 3 years. Annually, they completed the hospital anxiety and depression scale (HADS) and cognitive tests including the symbol digit modalities test (SDMT). We evaluated associations of elevated symptoms (scores ⩾ 11) of anxiety (HADS-A) and depression (HADS-D) with SDMT z-scores using multivariable linear models—estimating between-person and within-person effects. Results: Participants with MS performed worse on the SDMT than participants in the DEP/ANX co...

Research paper thumbnail of The impact of the coronavirus (COVID-19) pandemic on individuals with gastrointestinal disorders: A protocol of an international collaborative study

The impact of the coronavirus (COVID-19) pandemic on individuals with gastrointestinal disorders: A protocol of an international collaborative study

Journal of Psychosomatic Research, 2021

Objective The COVID-19 pandemic has had a significant impact on mental health across the globe. P... more Objective The COVID-19 pandemic has had a significant impact on mental health across the globe. People living with a chronic gastrointestinal (GI) disorder might be particularly at risk of mental health complications given higher rates of comorbid anxiety and depression compared to the healthy population. As GI disorders affect up to 40% of the population worldwide, this international collaborative study seeks to evaluate the extent of the impact of the COVID-19 pandemic on GI symptoms specifically and more generally on the well-being of those living with chronic GI conditions. Methods A longitudinal survey with three time points (baseline, 6-month, and 12-month) will be conducted online. Adult participants with GI disorders from multiple countries will be recruited via patient associations, social media advertising, utilizing snowball sampling. Participants will be invited to complete a battery of questionnaires including demographic and health parameters, and measures of gastrointestinal symptoms, fear of COVID-19, perceived impact of COVID-19, illness perceptions, coping, depression, anxiety, stress, catastrophizing, and quality of life, using validated measures where available. Statistical analyses will include univariate descriptive models, multivariate models utilizing regression, mediation, and moderation, and latent growth models. Conclusions This project may present novel information to the field of psychogastroenterology and may provide crucial information regarding the areas of impact for individuals with GI disorders during and following the pandemic. Further, this information can guide healthcare providers and patient associations on how to target support related to the pandemic mental health sequelae for these patients.

Research paper thumbnail of Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 & Inflammatory Bowel Disease in Canada: A Knowledge Translation Strategy

Journal of the Canadian Association of Gastroenterology, 2021

The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in C... more The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in Canada, is over 0.75% in 2021. Many individuals with IBD are immunocompromised. Consequently, the World Health Organization’s declaration of a global pandemic uniquely impacted those with IBD. Crohn’s and Colitis Canada (CCC) formed the COVID-19 and IBD Taskforce to provide evidence-based guidance during the pandemic to individuals with IBD and their families. The Taskforce met regularly through the course of the pandemic, synthesizing available information on the impact of COVID-19 on IBD. At first, the information was extrapolated from expert consensus guidelines, but eventually, recommendations were adapted for an international registry of worldwide cases of COVID-19 in people with IBD. The task force launched a knowledge translation initiative consisting of a webinar series and online resources to communicate information directly to the IBD community. Taskforce recommendations were po...

Research paper thumbnail of Incidence of Adverse Psychiatric Events During Treatment of Inflammatory Bowel Disease With Biologic Therapies: A Systematic Review

Crohn's & Colitis 360, 2019

We conducted a systematic review and a fixed-effects meta-analysis to determine whether incident ... more We conducted a systematic review and a fixed-effects meta-analysis to determine whether incident adverse psychiatric events (APE) including depression, anxiety, psychosis, or suicide were associated with biologic therapy in IBD. Six randomized controlled trials and a cohort study met criteria, reporting an incidence of APE in 4,882 patients. The risk difference per 100 person-months of any APE with a biologic medication was 0.01 (95% confidence interval = 0.00–0.02). There was insufficient evidence available in randomized controlled trials to conclude that biologic therapy in IBD is associated with an increased incidence of APE.

Research paper thumbnail of Within-person fluctuations over three years in depression, anxiety, fatigue, and health-related quality of life in multiple sclerosis

Within-person fluctuations over three years in depression, anxiety, fatigue, and health-related quality of life in multiple sclerosis

Multiple Sclerosis Journal, Aug 3, 2023

Background: Longitudinal studies of health-related quality of life (HRQoL) in multiple sclerosis ... more Background: Longitudinal studies of health-related quality of life (HRQoL) in multiple sclerosis (MS) are limited. Most have examined average changes within the population, rather than dynamic changes within individuals. Objective: To assess the between- and within-individual association between depression, anxiety, fatigue, cognition, physical functioning, and physical comorbidities and HRQoL. Methods: Adults with MS underwent physical and cognitive assessments and reported symptoms of fatigue (Daily Fatigue Impact Scale), depression and anxiety (Hospital Anxiety and Depression Scale (HADS)), and HRQoL (RAND-36) annually ( n = 4 visits). We evaluated associations of elevated symptoms of anxiety (HADS-A) and depression (HADS-D), fatigue, physical function (timed-walk and nine-hole peg test), cognitive function and comorbidity count with physical (PCS-36) and mental (MCS-36) HRQoL using multivariable linear models—estimating between-person and within-person effects. Results: Of 255 participants with MS enrolled, 81.6% were women. After adjustment, within-person increases in depression and fatigue were associated with decreases in physical HRQoL. Increases in depression, anxiety, and comorbidity count were associated with decreases in mental HRQoL. Conclusions: Within-person increases in symptoms of depression, anxiety and fatigue, and comorbidity count are associated with HRQoL decreases among adults with MS, highlighting the potential magnitude of individual benefit of intervention for these symptoms.

Research paper thumbnail of Development of the Dietitian Integrated Evaluation Tool for Gluten-free Diets (DIET-GFD)

Nutrition, Oct 1, 2020

Objective-Celiac disease (CD) treatment involves a gluten-free diet (GFD). There is no standardiz... more Objective-Celiac disease (CD) treatment involves a gluten-free diet (GFD). There is no standardized tool for dietitians to objectively grade GFD adherence. This study aimed to develop a standardized tool for dietitians to evaluate and communicate GFD adherence. Research Methods & Procedures-Participants were recruited from the Manitoba Celiac Disease Cohort. Using a consensus process, an expert panel of gastroenterologists, dietitians, clinical health psychologists and persons with CD developed the DIET-GFD. Two dietitians then *

Research paper thumbnail of W1215 Assessing Changes in Reported Medication Adherence Over a Three Year Period: the Manitoba IBD Chort Study

Gastroenterology, May 1, 2009

BACKGROUND: P-gp, encoded by MDR-1 gene, is a transmembrane efflux pump described overexpressed i... more BACKGROUND: P-gp, encoded by MDR-1 gene, is a transmembrane efflux pump described overexpressed in cancer refractoriness by pumping treatment drugs out of cells. It is expressed in PBL, other haematopoietic cells, apical superficial epithelium of colon, ileum and other tissues with barrier function. It is an interesting and controversial candidate for UC therapeutic response and pathogenesis. Increased expression has been reported associated with steroid UC refractoriness. Conversely, deficient P-gp function has been postulated as UC susceptibility/severity factor AIM: to investigate the role of MDR1 gene in the therapeutic response of UC by studying the P-gp functionality in PBL METHODS: P-gp functional activity was evaluated in PBL of 27 patients (15 M, 12 F) median age 30 (16-71) yrs with active UC (Mayo score: severe n 9, moderate n 9, mild n 9) categorized in: S-REFR (steroid-refractory, n 16) and S-RESP (steroid-responders, n 11); healthy controls (HC, n 68): similar age/ gender. Rhodamine123 (a fluorescent P-gp substrate) efflux was studied by flow cytometry, (FACS Calibur, Becton-Dickinson) in absence and presence of P-gp modulators: Verapamil 100 μM, Valspodar 1μM reassessment. Data were expressed evaluating the behaviour of two markers (M1, M2) defined based on % of cells with different fluorescence levels. M1 (high fluorescence, low P-gp pump activity) and M2 (low fluorescence, high activity) were compared in the three groups. After inhibition, it should be expected that Rhodamine123 remain in the intracellular leading to an increase of % of cells in M1 vs. M2 RESULTS: (X±SD) Significant differences were observed in absence and presence of verapamil inhibition, showing increased P-gp functional activity in S-REFR vs. S-RESP (p<0.01) and HC (p<0.001), but not between S-RESP and HC (ANOVA and Student-Newman-Keuls post-test)(Tabla) Results were not influenced by cumulative steroids. Three out of 4 severe patients showing M2>M1 in the assay with verapamil required surgery. Clinical disease activity correlated with M2 (with inhibitor= r:0.57, p=0.000056, Spearman). Interestingly, S-REFR showed a shift (M2 to M1) in an early new assay when some newly added drug reached effectiveness (6-MP n:4, infliximab n:1) CONCLUSION: our results suggest: 1)a relevant role of P-gp in UC treatment response 2)a possible usefulness of P-gp functional assay in the early detection of individual therapeutic response.

Research paper thumbnail of Symptoms of Functional Intestinal Disorders Are Common in Patients with Celiac Disease Following Transition to a Gluten-Free Diet

Digestive Diseases and Sciences, Jul 7, 2017

Background-Celiac disease and functional intestinal disorders may overlap, yet the natural histor... more Background-Celiac disease and functional intestinal disorders may overlap, yet the natural history of functional symptoms in patients with celiac disease is unknown. Aim-To investigate the prevalence of irritable bowel syndrome (IBS), functional dyspepsia (FD) and functional bloating (FB) symptoms among patients with celiac disease at diagnosis and during the first year of a gluten-free diet. Methods-Adults with a new diagnosis of celiac disease were surveyed at baseline, 6 months and 1 year using standardized measures for intestinal symptoms [Rome III diagnostic questionnaire and Celiac Symptom Index (CSI)] and gluten-free diet adherence [Gluten-Free Eating Assessment Tool (GF-EAT) and Celiac Diet Adherence Test (CDAT)]. Results-At diagnosis, two-thirds fulfilled Rome III diagnostic questionnaire symptom criteria for IBS (52%), functional dyspepsia (27%) and/or functional bloating (9%). One year postdiagnosis, there was high adherence to a gluten-free diet as 93% reported gluten exposure less than once per month on the GF-EAT and only 8% had ongoing celiac disease symptoms (CSI score > 45). The rates of those meeting IBS (22%) and functional dyspepsia (8%) symptom criteria both decreased significantly on a gluten-free diet. The prevalence of functional symptoms (any of IBS, FD or FB) at 1 year was 47%.

Research paper thumbnail of Changes in Fatigue Over 2 Years Are Associated With Activity of Inflammatory Bowel Disease and Psychological Factors

Clinical Gastroenterology and Hepatology, Sep 1, 2013

BACKGROUND & AIMS: Cross-sectional studies have identified high levels of fatigue in patients wit... more BACKGROUND & AIMS: Cross-sectional studies have identified high levels of fatigue in patients with active or quiescent inflammatory bowel disease (IBD), but there has been little attention to the long-term effects of fatigue in these patients. We performed a longitudinal study of fatigue in patients with IBD to determine its course and contributing factors. METHODS: Data were obtained from participants in the Manitoba IBD Cohort Study (N ‫؍‬ 312; 51% with Crohn's disease), a longitudinal population-based study. Symptomatic disease activity was measured every 6 months for 2 years to characterize long-term disease patterns as active, fluctuating, or inactive, based on the validated Manitoba IBD Index. We collected data concurrently on fatigue (Multidimensional Fatigue Inventory), psychological function, and laboratory biomarkers at the point of study entry and 1 and 2 years later. Of the study participants, 26% had consistently inactive, 29% had fluctuating, and 45% had consistently active disease over the 2-year time period. Mean levels of fatigue were strongly associated with disease activity; participants with consistently inactive disease had the lowest level of fatigue at each time point. Multivariate analyses indicated fatigue levels increased over time regardless of disease pattern (P < .001). Adjusting for disease activity, disease type and age, sex (female; P < .001), and psychological variables of distress (P < .001), reduced psychological well-being (P ‫؍‬ .002) and poor sleep quality (P < .001) were associated independently with increases in fatigue over time. Fatigue can increase over time in patients with IBD, even when their disease is in remission. Psychological factors are useful targets for intervention to reduce fatigue.

Research paper thumbnail of Population-based controlled study of social support, self-perceived stress, activity and work issues, and access to health care in inflammatory bowel disease

Inflammatory Bowel Diseases, Apr 1, 2008

Background: The Manitoba IBD Cohort Study is a longitudinal, population-based study of multiple d... more Background: The Manitoba IBD Cohort Study is a longitudinal, population-based study of multiple determinants of health outcomes in persons with IBD diagnosed within 7 years at enrollment. In this cross-sectional sub-study we compared IBD participants' levels of social supports, self-perceived stress, disability, and access to health care with those of a matched community sample. Methods: IBD participants (n=388) were interviewed using the Canadian Community Health Surveys (CCHS) 1.1 and 1.2 to assess for psychosocial variables. The national CCHS data were accessed to extract a community comparison group, matched on age, sex and geographic residence. Results: Compared to the community sample, IBD participants received more tangible, affective, or emotional support in the past year and were more likely to have experienced a positive social interaction. Those with IBD were as likely to be employed as those in the community sample, although they reported greater rates of reduced activity and days missed. Work was not identified as a significant source of stress, but physical health was more likely to be identified as a main stressor by those with active IBD, compared to the non IBD sample. Individuals with IBD were twice as likely to report unmet health care needs than the community sample, however there was agreement across both groups regarding common barriers including long waits and availability. Conclusions: While the disease may contribute to greater interference with work quality and daily activities, IBD patients have similar levels of stress and appear to have enhanced social supports relative to those in the community without IBD.

Research paper thumbnail of W1284 The Manitoba IBD Cohort Study: Longitudinal use of Complementary and Alternative Medicine (CAM) in IBD Over 54 Months

Gastroenterology, May 1, 2010

with MTX,] with AZA (P = 0.003 vs MTX) and 1.1 [0-23.6] with IFX (N.S. vs MTX). Median SES-CD was... more with MTX,] with AZA (P = 0.003 vs MTX) and 1.1 [0-23.6] with IFX (N.S. vs MTX). Median SES-CD was 6.5 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] with MTX,[3][4][5][6][7][8][9][10][11][12][13][14][15][16] with AZA (P = 0.01 vs MTX) and 2 [0-27] with IFX (P = 0.035 vs MTX). Conclusion: Sustained clinical remission of CD with MTX is associated with a lower rate of MH when compared to AZA or IFX. MTX provides incomplete healing of the gut mucosa which may explain the high relapse rate of CD when given as maintenance.

Research paper thumbnail of Is Iron Deficiency in the Absence of Anemia Associated With Fatigue in IBD?

Is Iron Deficiency in the Absence of Anemia Associated With Fatigue in IBD?

Gastroenterology, May 1, 2011

We explored whether iron deficiency in the absence of anemia is associated with fatigue in inflam... more We explored whether iron deficiency in the absence of anemia is associated with fatigue in inflammatory bowel disease (IBD). We assessed iron deficiency and anemia in 280 participants from the population-based Manitoba IBD Cohort Study. Iron deficiency was identified in 20% with Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease and 27% with ulcerative colitis. Anemia was identified overall in 50 (18%), with 230 who were nonanemic. In the nonanemic subgroup, there were no significant differences between iron-deficient and -sufficient groups in mean fatigue levels or proportions with problematic fatigue. There was no unique contribution of iron deficiency to problematic fatigue after adjustment for active disease and anemia. There was no evidence of an association between iron deficiency and fatigue in the absence of anemia, suggesting that iron deficiency is not a clinically relevant contributor to fatigue in IBD.

Research paper thumbnail of New Insights Into the Genetic Basis for Variation in Crohn's Disease (CD) Phenotype in a Population-Based Study

New Insights Into the Genetic Basis for Variation in Crohn's Disease (CD) Phenotype in a Population-Based Study

Gastroenterology, May 1, 2011

Research paper thumbnail of A population-based study of fatigue and sleep difficulties in inflammatory bowel disease

Inflammatory Bowel Diseases, Sep 1, 2011

Research paper thumbnail of Psychometric Performance of Fatigue Scales in Inflammatory Bowel Disease

Inflammatory Bowel Diseases, Mar 14, 2023

Background: Fatigue is highly prevalent in people with inflammatory bowel disease (IBD). Fatigue ... more Background: Fatigue is highly prevalent in people with inflammatory bowel disease (IBD). Fatigue scales are important for studies testing fatigue interventions, but information about psychometric properties of many scales is insufficient in IBD. We compared the psychometric properties of multiple generic fatigue scales in participants with IBD. Methods: Individuals with IBD (N = 216) completed the Daily Fatigue Impact Scale (DFIS), the vitality subscale of the RAND-36, and the Patient Health Questionnaire-9 (PHQ-9) fatigue item twice. A subgroup (n = 84) also completed the Fatigue Impact Scale (FIS) once, from which we also scored the 21 items from the Modified Fatigue Impact Scale (MFIS-IBD). We assessed floor/ceiling effects, construct validity, and internal consistency reliability. Using relative efficiency (RE), we compared discriminating ability and comparative responsiveness of the measures regarding disease activity and employment status and changes. The FIS, MFIS, and RAND-36-vitality scales did not exhibit floor or ceiling effects. The DFIS showed mild floor effects (19.4%), and the PHQ-9 fatigue item showed floor (18.1%) and ceiling (20.8%) effects. Internal consistency reliability exceeded 0.93 for FIS, MFIS-IBD, and DFIS and was 0.81 for the RAND-36-vitality scale. In the subgroup analysis, the FIS, MFIS-IBD, and DFIS were strongly correlated with each other (r ≥ 0.90). The ability to discriminate between disease activity groups was highest for the FIS and MFIS-IBD, followed by the DFIS. The FIS, MFIS-IBD, and DFIS were responsive to changes in work impairment. The FIS, MFIS-IBDs and DFIS had adequate validity and reliability for assessing fatigue in IBD.

Research paper thumbnail of Factors associated with perceived need for mental health care in multiple sclerosis

Multiple sclerosis and related disorders, Oct 1, 2018

Background: Within the multiple sclerosis (MS) population, depression and anxiety are highly prev... more Background: Within the multiple sclerosis (MS) population, depression and anxiety are highly prevalent comorbidities that are associated with adverse outcomes such as diminished quality of life and disability progression. In the general population, many people who do not meet formal diagnostic criteria for depression or anxiety disorders still identify a need for mental health care. Limited data are available regarding the perceived need for mental health care among persons with MS. Objective: We aimed to determine factors associated with a perceived need for mental health care in the MS population. Methods: Participants with MS completed the Hospital Anxiety and Depression Scale (HADS) to assess severity of depression and anxiety symptoms, and reported whether they perceived a need for mental health care, in the context of a larger study examining the burden of psychiatric disorders in immune-mediated inflammatory disease. Participants were also evaluated using the Structured Clinical Interview for DSM-IV-TR (SCID) to diagnose depression or anxiety disorders. Participants reported their sociodemographic characteristics, and underwent physical assessments to determine their disability status. Descriptive analyses and binary logistic regression models were used to determine sociodemographic and clinical factors associated with perceived need for mental health care. Results: Of 255 participants enrolled, 251 were included in this analysis. Most participants were women, Caucasian, with post-secondary education, with a mean (SD) age at enrollment of 50.9 (12.9) years. They predominantly had a relapsing-remitting MS course. Nearly one-quarter of participants had a current SCID diagnosis of depression or anxiety (n = 57, 22.7%). Overall, 31.8% (n = 80) of participants reported a need for mental health care. These individuals were slightly younger at enrollment (p = 0.037), but otherwise did not differ with respect to sociodemographic characteristics, compared to participants not reporting this need. Those identifying need for mental health care also had an earlier age of MS symptom onset (p = 0.011). After adjusting for sociodemographic and clinical factors, elevated symptoms of depression (odds ratio [OR] 2.36; 95%CI: 1.06, 5.25) and anxiety (OR 6.08; 95%CI: 2.78, 13.3) were associated with an increased likelihood of reporting a need for mental health care. Any current SCID diagnosis of depression or anxiety was not associated with perceived need for mental health care after accounting for symptoms of depression and anxiety. Conclusions: One-third of people with MS identified a need for mental health care. Symptoms of anxiety and depression, but not current diagnosed mental health disorders, were the predominant factors associated with a perceived need for care.

Research paper thumbnail of Vascular comorbidity is associated with decreased cognitive functioning in inflammatory bowel disease

Scientific Reports

Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and card... more Reports of cognitive impairment in inflammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal fluency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modified Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn’s disease; mean (SD) age was 53.36 ...

Research paper thumbnail of Vascular comorbidity is associated with decreased cognitive functioning in inflammatory bowel disease

Research Square (Research Square), Oct 12, 2022

Background: Reports of cognitive impairment in in ammatory bowel disease (IBD) have been mixed. I... more Background: Reports of cognitive impairment in in ammatory bowel disease (IBD) have been mixed. IBD and cardiovascular disease are often co-morbid, yet it remains unknown whether vascular comorbidity confers a risk for decreased cognitive functioning, as observed in other populations. Methods: Participants with IBD were recruited from a longitudinal study of immune-mediated disease. Participants were administered a standardized neuropsychological test protocol, evaluating information processing speed, verbal learning and memory, visual learning and memory, and verbal uency/executive function. Cognitive test scores were standardized using local regression-based norms, adjusting for age, sex, and education. Vascular risk was calculated using a modi ed Framingham Risk Score (FRS). We tested the association between FRS and cognitive test scores using a quantile regression model, adjusting for IBD type. Results: Of 84 IBD participants, 54 had ulcerative colitis and 30 had Crohn's disease; mean (SD) age was 53.36 (13.95) years, and a high proportion were females (n = 58). As the risk score (FRS) increased, participants demonstrated lower performance in information processing speed (β=-0.12; 95% CI: -0.24, -0.006) and verbal learning (β=-0.14; 95% CI: -0.28, -0.01) at the 50 th percentile. After adjusting for IBD type, higher FRS remained associated with lower information processing speed (β=-0.13; 95% CI: -0.24, -0.03). Conclusion: Vascular comorbidity is associated with lower cognitive functioning in persons with IBD, particularly in the areas of information processing speed and verbal learning. These ndings suggest that prevention, identi cation, and treatment of vascular comorbidity in IBD may play a critical role for improving functional outcomes in IBD.

Research paper thumbnail of The comorbidity and cognition in multiple sclerosis (CCOMS) neuroimaging protocol: Study rationale, MRI acquisition, and minimal image processing pipelines

Frontiers in Neuroimaging

The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort... more The Comorbidity and Cognition in Multiple Sclerosis (CCOMS) study represents a coordinated effort by a team of clinicians, neuropsychologists, and neuroimaging experts to investigate the neural basis of cognitive changes and their association with comorbidities among persons with multiple sclerosis (MS). The objectives are to determine the relationships among psychiatric (e.g., depression or anxiety) and vascular (e.g., diabetes, hypertension, etc.) comorbidities, cognitive performance, and MRI measures of brain structure and function, including changes over time. Because neuroimaging forms the basis for several investigations of specific neural correlates that will be reported in future publications, the goal of the current manuscript is to briefly review the CCOMS study design and baseline characteristics for participants enrolled in the three study cohorts (MS, psychiatric control, and healthy control), and provide a detailed description of the MRI hardware, neuroimaging acquisit...

Research paper thumbnail of Performance of Regression-Based Norms for Cognitive Functioning of Persons With Multiple Sclerosis in an Independent Sample

Frontiers in Neurology, 2021

Background: Cognitive impairment is common in multiple sclerosis (MS). Interpretation of neuropsy... more Background: Cognitive impairment is common in multiple sclerosis (MS). Interpretation of neuropsychological tests requires the use of normative data. Traditionally, normative data have been reported for discrete categories such as age. More recently continuous norms have been developed using multivariable regression equations that account for multiple demographic factors. Regression-based norms have been developed for use in the Canadian population for tests included in the MACFIMS and BICAMS test batteries. Establishing the generalizability of these norms is essential for application in clinical and research settings.Objectives: We aimed to (i) test the performance of previously published Canadian regression-based norms in an independently collected sample of Canadian healthy controls; (ii) compare the ability of Canadian and non-Canadian regression-based norms to discriminate between healthy controls and persons with MS; and (iii) develop regression-based norms for several cogniti...

Research paper thumbnail of Anxiety and depression affect performance on the symbol digit modalities test over time in MS and other immune disorders

Multiple Sclerosis Journal, 2020

Background: Longitudinal studies assessing depression and anxiety effects on cognition in multipl... more Background: Longitudinal studies assessing depression and anxiety effects on cognition in multiple sclerosis (MS) are limited. Objective: We tested whether within-person fluctuations in symptoms of depression or anxiety over time affect cognition in persons with MS, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and a lifetime history of depression/anxiety disorders (DEP/ANX) but without an immune-mediated inflammatory diseases (IMID). Methods: We followed participants (MS: 255, IBD: 247, RA: 154, and DEP/ANX: 306) for 3 years. Annually, they completed the hospital anxiety and depression scale (HADS) and cognitive tests including the symbol digit modalities test (SDMT). We evaluated associations of elevated symptoms (scores ⩾ 11) of anxiety (HADS-A) and depression (HADS-D) with SDMT z-scores using multivariable linear models—estimating between-person and within-person effects. Results: Participants with MS performed worse on the SDMT than participants in the DEP/ANX co...

Research paper thumbnail of The impact of the coronavirus (COVID-19) pandemic on individuals with gastrointestinal disorders: A protocol of an international collaborative study

The impact of the coronavirus (COVID-19) pandemic on individuals with gastrointestinal disorders: A protocol of an international collaborative study

Journal of Psychosomatic Research, 2021

Objective The COVID-19 pandemic has had a significant impact on mental health across the globe. P... more Objective The COVID-19 pandemic has had a significant impact on mental health across the globe. People living with a chronic gastrointestinal (GI) disorder might be particularly at risk of mental health complications given higher rates of comorbid anxiety and depression compared to the healthy population. As GI disorders affect up to 40% of the population worldwide, this international collaborative study seeks to evaluate the extent of the impact of the COVID-19 pandemic on GI symptoms specifically and more generally on the well-being of those living with chronic GI conditions. Methods A longitudinal survey with three time points (baseline, 6-month, and 12-month) will be conducted online. Adult participants with GI disorders from multiple countries will be recruited via patient associations, social media advertising, utilizing snowball sampling. Participants will be invited to complete a battery of questionnaires including demographic and health parameters, and measures of gastrointestinal symptoms, fear of COVID-19, perceived impact of COVID-19, illness perceptions, coping, depression, anxiety, stress, catastrophizing, and quality of life, using validated measures where available. Statistical analyses will include univariate descriptive models, multivariate models utilizing regression, mediation, and moderation, and latent growth models. Conclusions This project may present novel information to the field of psychogastroenterology and may provide crucial information regarding the areas of impact for individuals with GI disorders during and following the pandemic. Further, this information can guide healthcare providers and patient associations on how to target support related to the pandemic mental health sequelae for these patients.

Research paper thumbnail of Crohn’s and Colitis Canada’s 2021 Impact of COVID-19 & Inflammatory Bowel Disease in Canada: A Knowledge Translation Strategy

Journal of the Canadian Association of Gastroenterology, 2021

The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in C... more The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in Canada, is over 0.75% in 2021. Many individuals with IBD are immunocompromised. Consequently, the World Health Organization’s declaration of a global pandemic uniquely impacted those with IBD. Crohn’s and Colitis Canada (CCC) formed the COVID-19 and IBD Taskforce to provide evidence-based guidance during the pandemic to individuals with IBD and their families. The Taskforce met regularly through the course of the pandemic, synthesizing available information on the impact of COVID-19 on IBD. At first, the information was extrapolated from expert consensus guidelines, but eventually, recommendations were adapted for an international registry of worldwide cases of COVID-19 in people with IBD. The task force launched a knowledge translation initiative consisting of a webinar series and online resources to communicate information directly to the IBD community. Taskforce recommendations were po...

Research paper thumbnail of Incidence of Adverse Psychiatric Events During Treatment of Inflammatory Bowel Disease With Biologic Therapies: A Systematic Review

Crohn's & Colitis 360, 2019

We conducted a systematic review and a fixed-effects meta-analysis to determine whether incident ... more We conducted a systematic review and a fixed-effects meta-analysis to determine whether incident adverse psychiatric events (APE) including depression, anxiety, psychosis, or suicide were associated with biologic therapy in IBD. Six randomized controlled trials and a cohort study met criteria, reporting an incidence of APE in 4,882 patients. The risk difference per 100 person-months of any APE with a biologic medication was 0.01 (95% confidence interval = 0.00–0.02). There was insufficient evidence available in randomized controlled trials to conclude that biologic therapy in IBD is associated with an increased incidence of APE.