N33 Embedding Mental-Health Screening into Ulcerative Colitis Care: Real-World Outcomes from Rural Primary Care

Background Ulcerative colitis (UC) is a chronic inflammatory bowel disease associated with substantial psychosocial burden, including increased anxiety & depression. However, MH assessment is inconsistently embedded within routine primary-care, particularly in rural settings where access to specialist IBD psychology is limited. This cross-sectional review evaluates MH status using the PHQ-9 & GAD-7 among UC patients attending a structured primary-care review, noting that none had previous formal scores recorded. Methods A retrospective analysis undertaken of UC patients in a rural general practice. Demographic data and PHQ-9/GAD-7 scores submitted during a structured primary-care review were extracted. Patients who did not submit scores were recorded as missing, consistent with real-world primary-care workflows. Quantitative analysis summarised descriptive statistics, while qualitative content analysis of free-text and response patterns informed interpretation. Mixed-methods integration explored how MH symptoms co-occurred with patient characteristics. Results 63 patients were included (mean age 65.37y; SD16.97). The cohort was 100% British, with 29 women & 34 men. Prior to this, no MH measures had been documented. Quantitative findings showed that most patients recorded minimal depressive & minimal anxiety symptoms. PHQ-9 scores ranged from 0-12. Only 1 patient met the threshold for moderate depression (PHQ-9 = 12). GAD-7 scores ranged from 0-7, with 1 patient reaching moderate anxiety (GAD-7 = 7). Low-level symptoms (PHQ-9 = 3–4;GAD-7 = 3–6) were present in a small minority. Missing data were frequent, reflecting variable engagement with digital or remote questionnaire submission. Qualitatively, narrative comments (where provided) reflected concerns about disease unpredictability, social isolation in rural areas, & the emotional impact of symptom fluctuation. Integration of findings suggests that although measured symptom severity was low, patients experience psychological stress that may not be fully captured by PHQ-9/GAD-7 alone. Conclusion This review highlights a gap in routine MH recording in UC management within primary care. While quantitative scores appear low, qualitative reflections indicate unmet psychological needs consistent with broader literature demonstrating elevated anxiety & depression in IBD populations. Rurality may further exacerbate isolation and under-reporting. Embedding structured PHQ-9/GAD-7 screening into UC reviews is feasible and identifies otherwise undocumented symptoms. Despite low measured severity, integrated findings emphasise the importance of proactive MH assessment, particularly in rural primary-care settings. Future work should explore enhanced psychological support & digital-engagement strategies. References: Knowles, S.R., Graff, L. A., & Wilding, H. (2018). Quality of life in inflammatory bowel disease: A systematic review and meta-analyses—Part I. Journal of Crohn’s and Colitis, 12(2), 131–143. Neuendorf, R., Harding, A., Stello, N., Hanes, D., & Wahbeh, H. (2016). Depression and anxiety in patients with inflammatory bowel disease: A systematic review. Journal of Psychosomatic Research, 87, 70–80. Mikocka-Walus, A., & Knowles, S. (2020). Mental health in inflammatory bowel disease: A holistic, person-centred approach. The Lancet Gastroenterology & Hepatology, 5(8), 745–752.* Conflict of interest: Ellis, Victoria: Non-Promotional grant from Ferring Deaney, Carl: Non-promotional grant from Ferring Kirk, Sophie: Non-promotional grant from Ferring