PROTOCOL
MENTAL HEALTH OF PEOPLE WITH ABDOMINAL ELIMINATION STOMAS: SCOPE REVIEW PROTOCOL
SAÚDE MENTAL DE PESSOAS COM ESTOMIAS ABDOMINAIS DE ELIMINAÇÃO: PROTOCOLO DE REVISÃO DE ESCOPO
SALUD MENTAL DE PERSONAS CON ESTÓMAGOS DE ELIMINACIÓN ABDOMINAL: PROTOCOLO DE REVISIÓN DEL ALCANCE
https://doi.org/10.31011/reaid-2026-v.100-n.2-art.2611
1Illayanna Tátila Ferreira de Sousa
2Laura Ferraz dos Santos
3Giulhiano Xavier Rodrigues
4Luiza Chalmes Payeras
5Mariane da Silva Xavier
6Gabriella de Andrade Boska
1Hospital Regional de São Jerônimo, São Gerônimo, RS, Brazil, ORCID: https://orcid.org/0009-0009-2985-4812
2TelessaúdeRS, Porto Alegre, RS, Brazil, ORCID: https://orcid.org/0000-0002-2366-0277.
3Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil, ORCID: https://orcid.org/0009-0008-9006-3377.
4Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil, ORCID: https://orcid.org/0009-0003-9998-1450.
5Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil, ORCID: https://orcid.org/0000-0003-1176-2812.
6Departamento de Saúde Mental Álcool e outras Drogas do Ministério da Saúde, Brasília, DF, Brazil, ORCID: https://orcid.org/0000-0002-5827-6486.
Corresponding Author
Mariane da Silva Xavier
Avenida Coronel Lucas de Oliveira, nº 2367, Apto 14, bairro Petrópolis, Brazil. CEP: 90630-084, Phone: +55(55)99966-2463, E-mail: marianexavierenfa@gmail.com
Submission:
07-07-2025
Approval: 02-03-2026
ABSTRACT
Objective: to map, describe, and systematize scientific production on the mental health of people with abdominal ostomies. Methodology: scoping review guided by the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. To identify the studies, a bibliographic survey was carried out in the following databases: Web of Science, National Library of Medicine (PubMed/Medline), PsycINFO, Latin American and Caribbean Literature in Health Sciences (Lilacs), and Cumulative Index to Nursing and Allied Health Literature (Cinahl). In addition to gray literature, such as: Google Scholar and Brazilian Digital Library of Theses and Dissertations. The first 200 records were included in Google Scholar. Results: the data of interest to answer the research question were extracted from the selected articles using an instrument constructed by the researchers themselves, containing the following variables: title, author(s), year, location, method/approach, participant profile, concept of mental health, forms of assessment/identification of mental health needs, and interventions aimed at the mental health of people with elimination stomas. The protocol for this scoping review was registered on the Open Science Framework (OSF) platform at: https://doi.org/10.17605/OSF.IO/HBN9S. Conclusion: this review is expected to elucidate the mental health needs of people with elimination abdominal stomas, demonstrate gaps, and make recommendations.
Keywords: Surgical Stomas; Ostomy; Mental Health; Nursing; Enterostomal Therapy.
RESUMO
Objetivo: mapear, descrever e sistematizar as produções científicas sobre a saúde mental de pessoas com estomias abdominais de eliminação. Metodologia: revisão de escopo norteada pelo referencial do Joanna Briggs Institute e pelo checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Para identificar os estudos foi realizado um levantamento bibliográfico nas seguintes bases de dados: Web of Science, National Library of Medicine (PubMed/Medline), PsycINFO, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Cumulative Index to Nursing and Allied Health Literature (Cinahl). Além da literatura cinzenta como: Google Acadêmico e Biblioteca Digital Brasileira de Teses e Dissertações. No Google Acadêmico foram incluídos os primeiros 200 registros. Resultados: os dados de interesse para responder a questão de pesquisa foram extraídos dos artigos selecionados por instrumento construído pelos próprios pesquisadores contendo as seguintes variáveis: título, autor(es), ano, local de realização, método/abordagem, perfil dos participantes, conceito de saúde mental, formas de avaliação/identificação de necessidades de saúde mental e intervenções voltadas à saúde mental de pessoas com estomias de eliminação. O protocolo desta revisão de escopo foi registrado na plataforma Open Science Framework (OSF) em: https://doi.org/10.17605/OSF.IO/HBN9S. Conclusão: espera-se com essa revisão elucidar as necessidades de saúde mental das pessoas com estomias abdominais de eliminação, demonstrar lacunas e realizar recomendações.
Palavras-chave: Estomas Cirúrgicos; Estomia; Saúde Mental; Enfermagem; Estomaterapia.
RESUMEN
Objetivo: mapear, describir y sistematizar la producción científica sobre la salud mental de las personas con ostomías abdominales. Metodología: revisión exploratoria guiada por el marco del Instituto Joanna Briggs y la lista de verificación "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". Para identificar los estudios, se realizó una revisión bibliográfica en las siguientes bases de datos: Web of Science, Biblioteca Nacional de Medicina (PubMed/Medline), PsycINFO, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs) y Cumulative Index to Nursing and Allied Health Literature (Cinahl). Además de literatura gris, como Google Académico y la Biblioteca Digital Brasileña de Tesis y Disertaciones. Los primeros 200 registros se incluyeron en Google Académico. Resultados: Los datos de interés para responder a la pregunta de investigación se extrajeron de los artículos seleccionados mediante un instrumento elaborado por los propios investigadores, que contiene las siguientes variables: título, autor(es), año, ubicación, método/enfoque, perfil del participante, concepto de salud mental, formas de evaluación/identificación de necesidades de salud mental e intervenciones dirigidas a la salud mental de las personas con estomas de eliminación. El protocolo para esta revisión exploratoria se registró en la plataforma Open Science Framework (OSF) en: https://doi.org/10.17605/OSF.IO/HBN9S. Conclusión: Se espera que esta revisión dilucide las necesidades de salud mental de las personas con estomas abdominales de eliminación, identifique las deficiencias y formule recomendaciones.
Palabras clave: Estomas Quirúrgicos; Estomía; Salud Mental; Enfermería; Estomaterapia.
INTRODUCTION
A stoma is defined as an opening from hollow organs or viscera to the external environment. This procedure is performed surgically(1) and, depending on the body part involved, is given a specific name. Thus, a tracheostomy is a respiratory stoma; a gastrostomy and jejunostomy are for feeding; and a urostomy, ileostomy, and colostomy are for elimination(2).
It is estimated that there is one person with a stoma for every thousand inhabitants in countries with good healthcare, and this number may be higher in less developed countries(2). In Brazil, the Ministry of Health estimates that there are 400,000 people with stomas, though this data may be outdated(3) . In addition to the lack of a system to identify these individuals, the difficulty in obtaining accurate figures also stems from the fact that the condition is often a consequence of the progression of other diseases or traumas.
A survey of 80,000 ostomates conducted in the United Kingdom found that output ostomies are the most common among ostomates(4), corroborating similar data found in recent studies in Brazil, which indicate that output ostomies are the most prevalent in various regions of the
country(5). The most common causes stem from neoplasms of the colon and rectum(5), being more prevalent in women over 60 years of age(2).
Although it is a necessary intervention, the elimination stoma has various implications for life on both an individual and collective level, both physically and emotionally(6). Negative body image resulting from the stoma and the use of a collection pouch 24 hours a day; adaptation to a new lifestyle leading to decreased self-esteem; compromised sexuality due to insecurity or fear of rejection(7); loss of bowel control and public embarrassment lead to feelings of distress and fear of discrimination(6). All of these situations can trigger mental health problems(8).
In this sense, it can be stated that the quality of life of ostomates is not limited to the use of the stoma; rather, it encompasses aspects related to health, cultural values, and psychological and economic issues(9). Quality of life can be understood as people’s perception of the places they occupy in life, within the cultural contexts and value systems in which they live, and in relation to their goals, expectations, standards, concerns, and desires(10).
The ways in which concepts are defined and articulated influence public policies and care. Thus, quality of life and mental health are distinct yet complementary concepts. Considering the mental health of ostomates means not separating individuals from their contexts nor the illness from its process of development. In other words, it is necessary to consider the individual factors that influence the psychosocial sphere, such as social, economic, ethnic/racial, and gender factors, as well as living environments, diet, income, employment, and education, among others.
Mental health problems result from the interaction between vulnerabilities and stress caused by life circumstances(11). Following the surgical procedure to create a stoma, a person’s overall well-being may be disrupted due to changes in their self-image, leading to fear of social interaction and, consequently, withdrawal from social life(5). A lack of information also exacerbates fear, leading to misconceptions about the stoma, as well as increasing the difficulty in managing it(12), resulting in incidents such as leakage from the collection bag or odor(13).
In the nursing context, health guidance is limited to stoma care and the use of collection equipment(14); thus, it is important to consider that the numerous challenges that arise after the creation of a diversion stoma can generate feelings of helplessness and sadness. This negative burden adds to symptoms of anxiety and distress, directly affecting this population’s self-esteem. Thus, a mental health approach becomes essential for coping with this condition(8).
Therefore, given the lack of studies on this topic, and since the few existing studies provide no further information about ostomates beyond the stoma itself, the objective of this scoping review protocol is to map, describe, and systematize the scientific literature on the mental health of people with abdominal elimination stomas.
Study Type
This is a scoping review guided by the Joanna Briggs Institute (JBI) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist(15-16).
The purpose of the scoping review is to map the fundamental concepts within a specific research area, clarifying the definitions and theoretical boundaries of a given topic or field(17).
This review aims to identify what has been studied regarding the mental health of people with abdominal stomas by analyzing concepts, approaches, and interventions.
The protocol for this scoping review was registered on the Open Science Framework (OSF) platform at: https://doi.org/10.17605/OSF.IO/HBN9S.
Research Question
The research question was constructed based on the PCC mnemonic (Population, Concept, and Context). The structure is as follows: P, people with abdominal ostomies; C, global scientific literature; C, mental health.
Thus, the guiding question formulated for the review was: What has been studied regarding the mental health of people with abdominal ostomies in global scientific literature?
Identification of Studies
To identify the studies, a literature search was conducted in the following databases: Web of Science, National Library of Medicine (PubMed/Medline), PsycINFO, Latin American and Caribbean Health Sciences Literature (Lilacs), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition to gray literature such as: Google Scholar and the Brazilian Digital Library of Theses and Dissertations (BDTD). In Google Scholar, the first 200 records were included.
The search strategy for each of the databases to be searched was developed based on the Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH), namely: “Stomas; Ostomies; Stoma care; Elimination stomas; Urostomy; Ileostomy; Colostomy; Mental health, Mental disorders; Depression; Anxiety.”
The search strategy was adapted for each database according to the language and was combined using the Boolean operators “AND” and “OR” (Chart 1). All identified documents were exported to the Mendeley reference manager.
Chart 1 – Search strategy performed in each database, RS, 2025
|
Database |
Search strategy |
|
LILACS |
(Estomias) OR (Ostomias) AND (Saúde mental) OR (Transtornos mentais) |
|
PubMed |
stoma OR ostomy AND mental health |
|
PsycINFO |
stoma OR ostomy AND mental health |
|
Google Scholar |
(Estomias) OR (Ostomias) AND (Saúde mental) AND (enfermagem) |
|
BDTD |
Estomias) OR (Ostomias) AND (Saúde mental) |
Source: Prepared by the authors, 2025.
Study Selection
The studies were collected from databases between November 2024 and January 2025 by two independent reviewers using a double-blind format, with the support of Rayyan software; a third reviewer was called upon to resolve conflicts between the reviewers at any stage of the review when they could not reach a consensus. No time or location restrictions were established. Studies in Portuguese, English, and Spanish were included, encompassing both quantitative and qualitative approaches, regardless of study design, experience reports, and case studies; full-text articles; and those addressing the topic of mental health in individuals with abdominal elimination ostomies. Exclusion criteria included studies that were not made available in full even after attempts to contact the authors, studies on types of ostomies other than elimination ostomies, studies that did not address the topic of mental health, and literature reviews. Initially, the titles and abstracts were reviewed, and those studies that met the inclusion criteria were selected for full-text reading, in accordance with the JBI protocol. After full-text reading, the final sample of articles included in the review was determined. The references of the articles included in the review were also checked for the possible inclusion of documents not identified by the search strategy. The process of selecting and defining the final sample was presented in the PRISMA flowchart.
Analysis of the Studies
Data relevant to answering the research question were extracted from the selected articles using a tool developed by the researchers themselves, which included the following variables: title, author(s), year, location, method/approach, participant profile, concept of mental health, methods of assessment/identification of mental health needs, and interventions focused on the mental health of people with ostomies.
Ethical Considerations
As this is a scoping review, this protocol does not require approval from the Research Ethics Committee.
RESULTS
Summary and Presentation of Results
The results were presented to identify and describe how the mental health of people with ostomies has been addressed in scientific research and what possible interventions exist. To present the findings, a narrative summary was accompanied by charts, figures, and tables. It is hoped that this review will shed light on the mental health needs of people with abdominal ostomies, highlight gaps, and provide recommendations.
REFERENCES
1. Associação Brasileira de Estomaterapia. Sobest: estomias, feridas e incontinências. Estomias. SOBEST; 2020.
2. Ministério da Saúde (BR). Secretaria Especializada de Atenção à Saúde. Departamento de Atenção Especializada e Temática. Guia de atenção à saúde da pessoa com estomia. Brasília: Ministério da Saúde; 2021.
3. Biblioteca Virtual em Saúde Ministério da Saúde. Dia Nacional dos Ostomizados. Disponível em: https://bvsms.saude.gov.br/16-11-dia-nacional-dos-ostomizados/
4. Paula MA, Moraes JT. Consenso brasileiro para os cuidados às pessoas adultas com estomias de eliminação. Estima (Online). 2020.
5. Diniz IV, Barra IP, Silva MA, Oliveira SHS, Mendonça AEO, Soares MJGO. Perfil epidemiológico de pessoas com estomias intestinais de um centro de referência. Estima (Online). 2020;18:e2620. doi:10.30886/estima.v18.929_PT
6. Rosa JD. Acesso a um serviço especializado de cuidados em estomias: análise a partir do olhar do usuário estomizado [monografia]. Porto Alegre: Universidade Estadual do Rio Grande do Sul; 2020.
7. Nascimento CMS, Trindade GLB, Luz MHBA, Santiago RF. Vivência do paciente estomizado: uma contribuição para a assistência de enfermagem. Texto Contexto Enferm. 2011;20:557–64.
8. Silva NM, Santos MAD, Rosado SR, Galvão CM, Sonobe HM. Psychological aspects of patients with intestinal stoma: integrative review. Rev Lat Am Enfermagem. 2017;25:e2950. doi:10.1590/1518-8345.2231.2950
9. Diniz IV, Costa IKF, Nascimento JA, Silva IP, Mendonça AEO, Soares MJGO. Factors associated to quality of life in people with intestinal stomas. Rev Esc Enferm USP. 2021;55:e20200377. doi:10.1590/1980-220X-REEUSP-2020-0377
10. World Health Organization. Division of Mental Health and Prevention of Substance Abuse. Programme on Mental Health. WHOQOL user manual. Genève: WHO; 2012.
11. Organização Mundial da Saúde. Informe mundial sobre la salud mental: transformar la salud mental para todos. Genebra: OMS; 2022.
12. Machado LG, Silva RM, Siqueira FD, Nunes da Silva ME, Vasconcellos RO, Girardon‑Perlini MO. Desafios do usuário frente à estomia: entre o real e o almejado. Nursing (São Paulo). 2019;22(253):2962–6.
13. Richbourg L, Thorpe JM, Rapp CG. Difficulties experienced by the ostomate after hospital discharge. J Wound Ostomy Continence Nurs. 2007;34(1):70–9. doi:10.1097/00152192‑200701000‑00011
14. Silva AL. Importância da educação em enfermagem no contexto da estomaterapia. 2023.
15. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. Adelaide: JBI; 2024. doi:10.46658/JBIMES‑24‑09
16. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA‑ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. doi:10.7326/M18‑0850
17. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). JBI Manual for Evidence Synthesis. JBI; 2020. https://doi.org/10.46658/JBIMES-20-12
Funding and Acknowledgments: This research received no funding.
Conflict of Interest Statement Nothing to declare.
Data Availability Statement
No databases were generated in this study. The information presented is described in the body of the article.
Authorship Criteria (Author Contributions)
Authorship designation should be based on ICMJE guidelines, which consider an author to be someone who: 1. contributes substantially to the conception and/or planning of the study; 2. to the acquisition, analysis, and/or interpretation of the data; 3. as well as to the drafting and/or critical review and final approval of the published version.
Illayanna Tátila Ferreira de Sousa: 1, 2 and 3.
Laura Ferraz dos Santos: 2 and 3.
Luiza Chalmes Payeras: 2 and 3.
Giulhiano Xavier Rodrigues: 2 and 3.
Mariane da Silva Xavier: 2 and 3.
Gabriella de Andrade Boska: 2 and 3.
Scientific Editor: Ítalo Arão Pereira Ribeiro. Orcid: https://orcid.org/0000-0003-0778-1447
Rev Enferm Atual In Derme 2026;100(2): e026057
