Clinical implications
Our results confirmed the association between GI symptoms and mental health (e.g. anxiety/depression) in pwCF. This reinforces the importance of mental health screening and psychological care, which is already embedded in many CF centers in the Netherlands with the inclusion of a psychologist/social worker as part of the multidisciplinary team.15 In the CF mental health guidelines, annual mental health screening and treatment is recommended beginning at age 12 through adulthood.13 National implementation of these guidelines has been highly successful,43 partly because of the development of a mental health “toolbox” and additional mental health training sessions at national conferences. This study highlights the importance of investigating GI symptoms in CF in addition to anxiety and depression. The Dutch GI Symptom Tracker is now available. It can be used to facilitate collaborative patient-provider discussions to manage gastrointestinal symptoms, guide nutritional interventions, and improve adherence to pancreatic enzymes to improve outcomes in cystic fibrosis. Therefore, we recommend that the Dutch GI Symptom Tracker can be implemented into regular CF care in Dutch CF centers. GI screening can be incorporated into the International Mental Health Guidelines13 as well.
In conclusion, this is the first study investigating the association between GI symptoms -assessed by the Dutch GI Symptom Tracker-, anxiety/depression and HRQoL in Dutch pwCF. We observed a significant, positive association between more GI symptoms and elevated anxiety, depression and worse HRQoL Additional research is needed to better understand how mental and physical health are linked in CF.