N31 Stress after an Ulcerative Colitis diagnosis: examining factors causing or alleviating stress in Ulcerative Colitis using Interpretative Phenomenological Analysis
Authors: Black J , Norton C , Sweeney L , Czuber-Dochan W 
Published: January 2025

Abstract

Background
Stress significantly affects disease flares and quality of life in people with ulcerative colitis (UC), with over 25% of individuals experiencing symptoms of anxiety or depression irrespective of disease activity.1–3 However, there is limited research on the specific stressors introduced by a UC diagnosis. This study aims to explore how stress is experienced following diagnosis and identify factors affecting it.

Methods
Ten UC patients participated in online semi-structured interviews about their experience of stress and coping during their first year post-diagnosis. The group included 7 females and 3 males, aged 16-76, with 9 being treated in England and 1 in Scotland. Nine participants were white. All had high scores on Cohen’s Perceived Stress Scale before interview and were diagnosed with UC within the last 6 years, with 7 diagnosed in the past year. The interviews were audio-recorded and analysed using Interpretative Phenomenological Analysis to capture individuals’ unique perspective on this period and synthesise these insights into Group Experiential Themes.4

Results
Initial analysis reveals a complex relationship between stress, resilience and UC, encompassing emerging themes including:
1. UC interrupts life
2. Disconnect between personal experience and clinical characterisation of UC
3. Emotion intrinsic to UC experience
4. Information is a double-edged sword
5. Healthcare’s mixed effect on stress
6. Attitude is important
7. Communication is integral to managing stress
8. Reliance on others

Conclusion
These preliminary findings provide a foundation for exploring further the stressors that UC and its treatment place on individuals. While those affected developed various strategies to cope, the support provided by others (including healthcare professionals) plays a significant role in both alleviating and exacerbating stress levels. There is a pressing need to expand and improve resources for individuals newly diagnosed with UC and those who support them to help understand and navigate the challenges the stress of the condition presents.

References
1.Black J, Sweeney L, Yuan Y, Singh H, Norton C, Czuber-Dochan W. Systematic review: the role of psychological stress in inflammatory bowel disease. Aliment Pharmacol Ther. 2022;56(8):1235-1249. doi:10.1111/apt.172022.
2.Luo H, Sun Y, Li Y, et al. Perceived stress and inappropriate coping behaviors associated with poorer quality of life and prognosis in patients with ulcerative colitis. J Psychosom Res. 2018;113:66-71. doi:10.1016/j.jpsychores.2018.07.0133.
3.Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359-370. doi:10.1016/S2468-1253(21)00014-54.
4.Smith JA, Flowers P, Larkin M. Interpretative Phenomenological Analysis: Theory, Method and Research. SAGE; 2022.
Table 1 provides illustrative quotations as examples of these themes from those interviewed.