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Anxiety, Depression, and Catecholamine Levels After Self-Management Intervention in Irritable Bowel Syndrome

Deechakawan, Wimon PhD, RN; Heitkemper, Margaret M. PhD, RN, FAAN; Cain, Kevin C. PhD; Burr, Robert L. MSEE, PhD; Jarrett, Monica E. PhD, RN

doi: 10.1097/SGA.0000000000000017
Features

Patients with irritable bowel syndrome (IBS) often report higher levels of psychological distress, specifically anxiety, and depression than non-IBS patients. The management of gastrointestinal symptoms and psychological distress is demonstrably amenable to cognitive–behavioral therapies in a significant number of patients with IBS. The present secondary analysis evaluates the impact of nurse-delivered self-management interventions on anxiety, depression, and urine catecholamine levels in adult IBS patients. Participants in the study were randomized to 2 intervention groups of either comprehensive self-management (CSM) intervention or usual care control. Daily diary ratings of gastrointestinal symptoms, anxiety, and depression were recorded every evening for 28 days during the baseline period and subsequently at 3, 6, and 12 months postrandomization. Catecholamine levels of epinephrine and norepinephrine were measured from 4 weekly 1st morning urine samples at baseline as well as at each follow-up time. The CSM group reported significantly lower levels of anxiety and depression at follow-up than the usual care group (p = .018 and .021, respectively). In contrast, urine catecholamine levels displayed no appreciable change. Thus, although nurse-delivered CSM interventions showed no impact on urinary catecholamine levels, daily psychological distress was measurably reduced.

Wimon Deechakawan, PhD, RN, is Research Nurse, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.

Margaret M. Heitkemper, PhD, RN, FAAN, is Professor, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.

Kevin C. Cain, PhD, is Research Scientist, Department of Biostatistics and Office for Nursing Research, University of Washington, Seattle, Washington.

Robert L. Burr, MSEE, PhD, is Research Professor, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.

Monica E. Jarrett, PhD, RN, is Professor, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.

Correspondence to: Wimon Deechakawan, PhD, RN, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 98195 (wimond@uw.edu).

This writing of article was supported by grants from the NINR, NIH (R01 NR004142), and the Center for Women's Health and Gender Research (P30 NR 004001).

The authors thank Pam Barney and Pam Weisman, psychiatric nurse practitioners, who conducted the intervention sessions; Ernie Tolentino and Joyce Tsuji, research scientists, who completed the laboratory assays; and participants, who volunteered for the study.

The authors declare no conflict of interest.

Received March 19, 2012

Accepted September 15, 2012

© 2014 by the Society of Gastroenterology Nurses and Associates, Inc.