The impact of post-traumatic stress disorder on screening and surveillance colonoscopy

Despite the widespread prevalence of post-traumatic stress disorder (PTSD), there are few data on its effects on utilization of colonoscopy, an invasive procedure involving heightened vulnerability. The aim of this study was to describe factors, including PTSD, associated with screening and surveillance colonoscopy utilization.

We designed a retrospective cohort study examining colonoscopy patterns from 2009 to 2019 among patients aged 50 to 74 years. Primary outcomes were factors associated with screening and surveillance colonoscopy, assessed with multivariable logistic regression. A stratified analysis of screening sedation modality was also performed.

A total of 65,062 patients were included, with PTSD reported among 267 (.41%). Most patients with a history of PTSD underwent screening colonoscopy (58.4%) compared with those without a history of PTSD (10.9%). The adjusted odds ratio (OR) for undergoing screening colonoscopy if patients had a history of PTSD was 3.15 (95% confidence interval [CI], 2.37-4.21). Similarly, the adjusted OR for undergoing surveillance colonoscopy if patients had a history of PTSD was 2.05 (95% CI, 1.46-2.85). When stratifying according to procedural sedation versus monitored anesthesia care (MAC), patients without PTSD were more likely to undergo surveillance if screening was with MAC (adjusted OR, 3.90; 95% CI, 2.77-5.45). However, this did not have a similarly positive effect among patients with PTSD (adjusted OR, 1.60; 95% CI, .40-5.41).

This study validates known characteristics associated with colonoscopy utilization and identifies PTSD as an unexpectedly important protective factor in both screening and surveillance, which has not previously been reported. The lack of positive impact of MAC on surveillance colonoscopy in this population underscores the need for an individualized decision on anesthesia to shape best practices in endoscopic trauma-informed care.