1
|
Rosen MG, Grochowalski JH. Change Score and Subscore Precision and Reliability of the Children's Depression Inventory. Assessment 2024; 31:1124-1134. [PMID: 37902042 DOI: 10.1177/10731911231204832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
The Child Depression Inventory (CDI) is often used to assess change in depression over time, but no studies estimate the reliability of CDI change scores nor its five subscores. Our study investigated the reliability of change scores for both the total score on the CDI as well as its five subscores. We examined CDI responses from 186 maltreated children and estimated change score reliability for relative (e.g., comparison) and absolute (e.g., diagnosis) purposes. We also conducted subscore utility analysis, which determines if subscores have adequate reliability and provide information beyond the total score. We found that the total change score had acceptable reliability of .70 for our sample for both relative and absolute interpretations. In addition, the total score was a better predictor of true subscore values than the observed subscores-suggesting subscores did not add value over the total score, and that the reliability of changes in subscores was too low to be useful for any purpose. In summary, we found that the total CDI change scores were useful for assessing change in studies that examine relative or absolute change, and we advise caution when interpreting CDI subscores based on our analysis.
Collapse
|
2
|
Moore DA, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, Heyman I, Anderson R, Dickens C, Viner R, Bennett S, Logan S, Lockhart F, Thompson Coon J. Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses. Health Technol Assess 2020; 23:1-164. [PMID: 31122334 DOI: 10.3310/hta23220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2). DATA SOURCES For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. REVIEW METHODS The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen's d). When appropriate, random-effects meta-analyses produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project. RESULTS Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. LIMITATIONS Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. CONCLUSIONS There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Collapse
Affiliation(s)
- Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Erin Walker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Child Mental Health Group, University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Obi Ukoumunne
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Penny Titman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roz Shafran
- University College London Institute of Child Health, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Chris Dickens
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Russell Viner
- University College London Institute of Child Health, London, UK
| | - Sophie Bennett
- University College London Institute of Child Health, London, UK
| | - Stuart Logan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Fiona Lockhart
- Biomedical Research Centre Patient & Public Involvement Group, University College London Hospitals, London, UK
| | - Jo Thompson Coon
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| |
Collapse
|
3
|
Indah Kusumawati Noor L, Bakri A, Soejadhi R, Kesuma Y. Association Between Irritable Bowel Syndrome and Sleep Disturbance in Adolescents. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2020; 11:73-77. [PMID: 32607040 PMCID: PMC7295206 DOI: 10.2147/ahmt.s248711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Introduction Sleep disorder in adolescents is a problem that is rarely considered by both parents and healthcare professionals. Ignorance of sleep disorders is likely caused by the very rare occurrence of associated sporadic or emergency cases. Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and changes in the defecation pattern. Previous research has demonstrated IBS as one of the many causes of sleep disorders. Difficulty sleeping, frequent awakening, and difficulty returning to sleep after awakening are the symptoms often experienced by adolescents with IBS. The high incidence of IBS in adolescents and the large proportion of sleep disorders in IBS affect the quality of life and disrupt physical development, behaviour, and learning achievement. The relationship between IBS and sleep disorders in adolescents needs to be studied. This study aims to determine the relationship between sleep disorders and IBS in high school adolescents in Palembang. Methods This is a cross-sectional study conducted on 294 high school adolescents in Palembang in June 2018. Random sampling method was used and the presence of IBS and sleep disturbances were assessed using a questionnaire. Results Among all subjects, we found 113 subjects (38.4%) with IBS. Of these 113 subjects with IBS, only 60 subjects (53.1%) experienced sleep disorders. Conclusion No correlation found between sleep disorders and IBS in adolescents.
Collapse
Affiliation(s)
- Laili Indah Kusumawati Noor
- Specialist Study Program, Department of Pediatrics, Faculty of Medicine, Universitas Sriwijaya and Moh Hoesin Hospital, Palembang, Indonesia
| | - Achirul Bakri
- Department of Pediatrics, Faculty of Medicine, Universitas Sriwijaya and Moh Hoesin Hospital, Palembang, Indonesia
| | - Rismarini Soejadhi
- Department of Pediatrics, Faculty of Medicine, Universitas Sriwijaya and Moh Hoesin Hospital, Palembang, Indonesia
| | - Yudianita Kesuma
- Department of Pediatrics, Faculty of Medicine, Universitas Sriwijaya and Moh Hoesin Hospital, Palembang, Indonesia
| |
Collapse
|
4
|
Rodeck B. [Chronic somatic disorders-The way to adulthood medicine structures]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:898-904. [PMID: 32548657 DOI: 10.1007/s00103-020-03174-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Transition is the structured crossing over of an adolescent patient from treatment by a pediatrician to that by an adult doctor. The transition falls in a difficult phase of life that includes the end of puberty, finding a job, obtaining training, gaining increasing autonomy, and "cutting off" from parents and the parents' home. In this article, problems with transition are explained with a focus on patients with chronic inflammatory bowel diseases. Structured transition programs are presented.There are different groups of patients who transfer to the adult care system: adolescents with diseases that are well known (1) or unknown (2) in adult medicine and adolescents with disabilities who are treated in social pediatric centers (SPZ) (3). For the final group there are currently no adequate treatment structures in the adult care. Medical centers for adults with intellectual and multiple disabilities (MZEB) are currently being established. In all groups transition is understood as a dynamic process in which the patient, the parents, as well as the pediatric, adolescent and adult caregivers/physicians are involved. This generally runs over a long period of time and does not rely solely on a passive handover or transfer. Cancellation of therapy with subsequent problems is very common in this phase and sometimes very harmful for the affected patient. Structured cross-sector and cross-indication transition programs with case management elements, such as the Berlin Transition Program (BTP), offer support of patients in this phase of life and can prevent the consequences of inadequate adherence to therapy. The German Society for Pediatric and Adolescent Medicine (DGKJ), the German Society for Internal Medicine (DGIM), and the German Society for Neurology (DGN) have established a transition working group that supports the BTP.
Collapse
Affiliation(s)
- Burkhard Rodeck
- Christliches Kinderhospital Osnabrück, Johannisfreiheit 1, 49074, Osnabrück, Deutschland.
| |
Collapse
|
5
|
Mental Health Service Needs in Children and Adolescents With Inflammatory Bowel Disease and Other Chronic Gastrointestinal Disorders. J Pediatr Gastroenterol Nutr 2018; 67:314-317. [PMID: 29509635 DOI: 10.1097/mpg.0000000000001947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
6
|
van den Brink G, Stapersma L, Vlug LE, Rizopolous D, Bodelier AG, van Wering H, Hurkmans PCWM, Stuyt RJL, Hendriks DM, van der Burg JAT, Utens EMWJ, Escher JC. Clinical disease activity is associated with anxiety and depressive symptoms in adolescents and young adults with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:358-369. [PMID: 29897134 DOI: 10.1111/apt.14832] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/22/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Youths with inflammatory bowel disease (IBD) are at risk for developing anxiety and depressive symptoms with a reported 20%-50% prevalence rate. AIMS This prospective study aimed to: (1) describe the prevalence and severity of anxiety and depressive symptoms in a large Dutch cohort of young IBD patients, and (2) identify demographic and clinical risk factors for anxiety and depression. METHODS IBD patients (n = 374; 10-25 years) were screened for anxiety, depression and quality of life using validated age-specific questionnaires. Patients with elevated scores for anxiety and/or depressive symptoms received a diagnostic interview assessing psychiatric disorders. Demographic and clinical characteristics were retrieved from medical charts. Multiple logistic regression analysis was performed to identify risk factors for anxiety and/or depression. RESULTS Patients (mean age 18.9 years, 44.1% male, Crohn's disease 60.4%) had disease in remission (75.4%), or mild, moderate and severe clinical disease activity in, respectively, 19.8%, 2.7% and 2.1%. Mild anxiety/depressive symptoms were present in 35.2% and severe symptoms in 12.4% of patients. Elevated symptoms of either anxiety (28.3%), depression (2.9%) or both (15.8%) were found and did not differ between adolescents (10-17 years) and young adults (18-25 years). Active disease significantly predicted depressive symptoms (odds ratio (OR): 4.6 [95% confidence interval [CI]: 2.4-8.8], P < 0.001). Female gender (OR: 1.7 [95% CI: 1.1-2.7]), active disease (OR: 1.9 [95% CI: 1.1-3.2]) and a shorter disease duration (OR: 1.3 [95% CI: 0.6-1.0) (all P < 0.025) significantly predicted anxiety and/or depressive symptoms. CONCLUSIONS Considering the high prevalence of anxiety and depressive symptoms, psychological screening is recommended in young IBD patients. Screening facilitates early recognition and psychological treatment. Female patients and patients with active disease are the most vulnerable.
Collapse
Affiliation(s)
- G van den Brink
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - L E Vlug
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - D Rizopolous
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - A G Bodelier
- Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - H van Wering
- Department of Paediatrics, Amphia Hospital, Breda, The Netherlands
| | - P C W M Hurkmans
- Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - R J L Stuyt
- Department of Gastroenterology, Haga Hospital, Den Haag, The Netherlands
| | - D M Hendriks
- Department of Paediatrics, Juliana Children's Hospital, Den Haag, The Netherlands
| | - J A T van der Burg
- Department of Paediatrics, Juliana Children's Hospital, Den Haag, The Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - J C Escher
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Scholten AM, Vermeulen E, Dhonukshe-Rutten RA, Verhagen T, Visscher A, Olivier A, Timmer L, Witteman BJ. Surplus vitamin B12 use does not reduce fatigue in patients with Irritable Bowel Syndrome or inflammatory bowel disease: A randomized double-blind placebo-controlled trial. Clin Nutr ESPEN 2018; 23:48-53. [DOI: 10.1016/j.clnesp.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 08/23/2017] [Accepted: 10/19/2017] [Indexed: 01/08/2023]
|
8
|
Brooks AJ, Smith PJ, Lindsay JO. Monitoring adolescents and young people with inflammatory bowel disease during transition to adult healthcare. Frontline Gastroenterol 2018; 9:37-44. [PMID: 29484159 PMCID: PMC5824770 DOI: 10.1136/flgastro-2016-100747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 02/04/2023] Open
Abstract
The transition of adolescents and young people (AYP) with inflammatory bowel disease (IBD) from paediatric to adult healthcare requires coordination between healthcare care providers to achieve optimum outcomes. Transition into adulthood is a time of major challenges physically, developmentally, emotionally and psychosocially for AYP living with IBD. Healthcare professionals must monitor the AYP progress proactively with attention to each of these parameters throughout the transition period to ensure that milestones are attained, and skills for self-management are formed. Thus, achieving the desired goals in both clinical and pastoral areas requires intensive monitoring from a multidisciplinary team across healthcare providers.
Collapse
Affiliation(s)
- Alenka J Brooks
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Philip J Smith
- Centre for Gastroenterology and Hepatology, Royal Free Hospital, London, UK
| | - James O Lindsay
- Bart's Health NHS Trust, The Royal London Hospital, London, UK
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| |
Collapse
|
9
|
White Paper AGA: The Impact of Mental and Psychosocial Factors on the Care of Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2017; 15:986-997. [PMID: 28300693 DOI: 10.1016/j.cgh.2017.02.037] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/09/2017] [Accepted: 02/27/2017] [Indexed: 02/07/2023]
Abstract
Patients with chronic medically complex disorders like inflammatory bowel diseases (BD) often have mental health and psychosocial comorbid conditions. There is growing recognition that factors other than disease pathophysiology impact patients' health and wellbeing. Provision of care that encompasses medical care plus psychosocial, environmental and behavioral interventions to improve health has been termed "whole person care" and may result in achieving highest health value. There now are multiple methods to survey patients and stratify their psychosocial, mental health and environmental risk. Such survey methods are applicable to all types of IBD programs including those at academic medical centers, independent health systems and those based within independent community practice. Once a practice determines that a patient has psychosocial needs, a variety of resources are available for referral or co-management as outlined in this paper. Included in this white paper are examples of psychosocial care that is integrated into IBD practices plus innovative methods that provide remote patient management.
Collapse
|
10
|
Brooks AJ, Smith PJ, Cohen R, Collins P, Douds A, Forbes V, Gaya DR, Johnston BT, McKiernan PJ, Murray CD, Sebastian S, Smith M, Whitley L, Williams L, Russell RK, McCartney SA, Lindsay JO. UK guideline on transition of adolescent and young persons with chronic digestive diseases from paediatric to adult care. Gut 2017; 66:988-1000. [PMID: 28228488 PMCID: PMC5532456 DOI: 10.1136/gutjnl-2016-313000] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/10/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022]
Abstract
The risks of poor transition include delayed and inappropriate transfer that can result in disengagement with healthcare. Structured transition care can improve control of chronic digestive diseases and long-term health-related outcomes. These are the first nationally developed guidelines on the transition of adolescent and young persons (AYP) with chronic digestive diseases from paediatric to adult care. They were commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology under the auspices of the Adolescent and Young Persons (A&YP) Section. Electronic searches for English-language articles were performed with keywords relating to digestive system diseases and transition to adult care in the Medline (via Ovid), PsycInfo (via Ovid), Web of Science and CINAHL databases for studies published from 1980 to September 2014. The quality of evidence and grading of recommendations was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The limited number of studies in gastroenterology and hepatology required the addition of relevant studies from other chronic diseases to be included.These guidelines deal specifically with the transition of AYP living with a diagnosis of chronic digestive disease and/or liver disease from paediatric to adult healthcare under the following headings;1. Patient populations involved in AYP transition2. Risks of failing transition or poor transition3. Models of AYP transition4. Patient and carer/parent perspective in AYP transition5. Surgical perspective.
Collapse
Affiliation(s)
- Alenka J Brooks
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Philip J Smith
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK,Centre for Gastroenterology and Hepatology, Royal Free Hospital, London, UK
| | | | - Paul Collins
- Royal Liverpool University Hospital, Liverpool, UK
| | - Andrew Douds
- Queen Elizabeth Hospital NHS Foundation Trust, University of East Anglia,King's Lynn, Norfolk, UK
| | - Valda Forbes
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | | | - Brian T Johnston
- Deparment of Gastroenterology, Royal Victoria Hospital, Belfast, UK
| | | | - Charles D Murray
- Centre for Gastroenterology and Hepatology, Royal Free Hospital, London, UK
| | - Shaji Sebastian
- NIHR LCRN (Y&H) Gastroenterology Speciality Co-Lead, Hull & East Yorkshire NHS Trust, Hull, UK
| | - Monica Smith
- Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lisa Whitley
- GI Services Division, University College London Hospital, London, UK
| | | | - Richard K Russell
- Department of Paediatric Gastroenterology, The Royal Hospital for Children Glasgow, Glasgow, UK
| | | | - James O Lindsay
- Bart's Health NHS Trust, The Royal London Hospital, London, UK,Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| |
Collapse
|
11
|
van Tilburg MAL, Claar RL, Romano JM, Langer SL, Drossman DA, Whitehead WE, Abdullah B, Levy RL. Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability. J Pediatr 2017; 184:94-100.e1. [PMID: 28238483 PMCID: PMC5407185 DOI: 10.1016/j.jpeds.2017.01.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/07/2016] [Accepted: 01/24/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the relative contributions of disease activity and psychological factors to self-reported symptoms and disability in children with Crohn's disease. STUDY DESIGN Participants (n = 127 children age 8-18 years) completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs and coping. Disease activity was measured by the Pediatric Crohn's Disease Activity Index. Structural equation modeling was used to test the effects of disease activity and psychological factors on symptoms and disability. RESULTS In the hypothesized model predicting symptoms, psychological factors (β = 0.58; P < .001) were significantly associated with disease symptoms but disease activity was not. The model for disability yielded significant associations for both psychological factors (β = 0.75; P < .001) and disease activity (β = 0.61, P < .05). CONCLUSION Crohn's disease symptoms in children and adolescents are not only driven by disease activity. Coping, anxiety, depression, and cognition of illness are important in the patient-reporting of symptom severity and disability. Physicians need to be aware that symptom self-reporting can be driven by psychological factors and may not always be simply an indicator of disease activity. TRIAL REGISTRATION ClinicalTrials.gov: NCT00679003.
Collapse
Affiliation(s)
- Miranda A L van Tilburg
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC; Campbell University, College of Pharmacy and Health Sciences, Buies Creek, NC.
| | - Robyn Lewis Claar
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Shelby L Langer
- School of Social Work, University of Washington, Seattle, WA
| | - Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - William E Whitehead
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | | | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA
| |
Collapse
|
12
|
Regueiro M, Greer JB, Szigethy E. Etiology and Treatment of Pain and Psychosocial Issues in Patients With Inflammatory Bowel Diseases. Gastroenterology 2017; 152:430-439.e4. [PMID: 27816599 DOI: 10.1053/j.gastro.2016.10.036] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/07/2016] [Accepted: 10/27/2016] [Indexed: 12/15/2022]
Abstract
There is increasing evidence that brain-gut interactions are altered during development of inflammatory bowel diseases (IBDs). Understanding the relationship between the neurobiology, psychological symptoms, and social ramifications of IBD can guide comprehensive care for the whole patient. The most common psychological conditions in patients with IBD are chronic abdominal pain, anxiety, and depression. We review the evidence-based data and rates of these conditions and their respective relationship to IBD and the diagnostic approaches to identify patients with these conditions. Different treatment options for pain and psychosocial conditions are discussed, and new models of team-based IBD care are introduced. Providing the health care provider with tools to diagnose and manage psychological conditions in patients with Crohn's disease or ulcerative colitis is necessary for their total care and should be part of quality-improvement initiatives.
Collapse
Affiliation(s)
- Miguel Regueiro
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julia B Greer
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eva Szigethy
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
| |
Collapse
|
13
|
Effect of Psychotherapy on Health Care Utilization in Children With Inflammatory Bowel Disease and Depression. J Pediatr Gastroenterol Nutr 2016; 63:658-664. [PMID: 27035372 PMCID: PMC5040612 DOI: 10.1097/mpg.0000000000001207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pediatric patients with inflammatory bowel disease (IBD) are at an increased risk of developing depression compared with community controls. Depression often negatively influences illness behaviors such as resource utilization. We sought to investigate the effects of treating depression on utilization of medical resources in depressed pediatric patients with IBD by comparing rates of health care utilization 1 year before and after psychotherapy. METHOD Two hundred seventeen subjects ages 9 to 17 years with IBD and depression received 3 months of psychotherapy for depression as part of a multicenter randomized controlled trial. Of these 217 subjects, 70 had utilization data available 1 year prior and 1 year after receiving 3 months of psychotherapy. Primary outcomes included frequency of hospitalizations, inpatient hospital days, outpatient gastrointestinal visits, and number of emergency room visits, radiological examinations, and endoscopies. Within subject analyses were completed comparing health care utilization 12 months before psychotherapy compared with the 12 months after the conclusion of psychotherapy. RESULTS Fifty-one and 19 patients had CD and UC, respectively. A total of 55.7% of patients had major depression and 44.3% had minor depression. Overall, all study measures of health care utilization were significantly reduced after psychotherapy (P < 0.01)-including gastrointestinal-related (mean values) hospitalization frequency, inpatient days, outpatient visit, emergency room visits, radiological examinations, and endoscopies. CONCLUSIONS Psychotherapy for comorbid depression in pediatric patients with IBD is associated with decreased GI-related health care utilization. The present study highlights the importance of screening for depression in a pediatric population with IBD, and that psychotherapy may be a reasonable adjunctive treatment for pediatric patients with IBD and comorbid depression.
Collapse
|
14
|
Taft TH, Keefer L. A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease. Clin Exp Gastroenterol 2016; 9:49-58. [PMID: 27022294 PMCID: PMC4789833 DOI: 10.2147/ceg.s83533] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic illness stigma is a global public health issue. Most widely studied in HIV/AIDS and mental illness, stigmatization of patients living with inflammatory bowel disease (IBD), chronic autoimmune conditions affecting the digestive tract, has garnered increasing attention in recent years. In this paper, we systematically review the scientific literature on stigma as it relates to IBD across its three domains: perception, internalization, and discrimination experiences. We aim to document the current state of research, identify gaps in our knowledge, recognize unique challenges that IBD patients may face as they relate to stigmatization, and offer suggestions for future research directions. Based on the current review, patients living with IBD may encounter stigmatization and this may, in turn, impact several patient outcomes including quality of life, psychological functioning, and treatment adherence. Significant gaps exist related to the understanding of IBD stigma, providing opportunity for future studies to address this important public health issue.
Collapse
Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurie Keefer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
15
|
van den Brink G, Stapersma L, El Marroun H, Henrichs J, Szigethy EM, Utens EM, Escher JC. Effectiveness of disease-specific cognitive-behavioural therapy on depression, anxiety, quality of life and the clinical course of disease in adolescents with inflammatory bowel disease: study protocol of a multicentre randomised controlled trial (HAPPY-IBD). BMJ Open Gastroenterol 2016; 3:e000071. [PMID: 26966551 PMCID: PMC4780038 DOI: 10.1136/bmjgast-2015-000071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/11/2015] [Accepted: 12/21/2015] [Indexed: 01/02/2023] Open
Abstract
Introduction Adolescents with inflammatory bowel disease (IBD) show a higher prevalence of depression and anxiety, compared to youth with other chronic diseases. The inflammation-depression hypothesis might explain this association, and implies that treating depression can decrease intestinal inflammation and improve disease course. The present multicentre randomised controlled trial aims to test the effectiveness of an IBD-specific cognitive–behavioural therapy (CBT) protocol in reducing symptoms of subclinical depression and anxiety, while improving quality of life and disease course in adolescents with IBD. Methods and analysis Adolescents with IBD (10–20 years) from 7 hospitals undergo screening (online questionnaires) for symptoms of depression and anxiety. Those with elevated scores of depression (Child Depression Inventory (CDI) ≥13 or Beck Depression Inventory (BDI) II ≥14) and/or anxiety (Screen for Child Anxiety Related Disorders: boys ≥26, girls ≥30) receive a psychiatric interview. Patients meeting criteria for depressive/anxiety disorders are referred for psychotherapy outside the trial. Patients with elevated (subclinical) symptoms are randomly assigned to medical care-as-usual (CAU; n=50) or CAU plus IBD-specific CBT (n=50). Main outcomes: (1) reduction in depressive and/or anxiety symptoms after 3 months and (2) sustained remission for 12 months. Secondary outcomes: quality of life, psychosocial functioning, treatment adherence. In addition, we will assess inflammatory cytokines in peripheral blood mononuclear cells and whole blood RNA expression profiles. For analysis, multilevel linear models and generalised estimating equations will be used. Ethics and dissemination The Medical Ethics Committee of the Erasmus MC approved this study. If we prove that this CBT improves emotional well-being as well as disease course, implementation is recommended. Trial registration number NCT02265588.
Collapse
Affiliation(s)
- Gertrude van den Brink
- Department of Pediatric Gastroenterology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Luuk Stapersma
- Department of Child and Adolescent Psychiatry/Psychology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry/Psychology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Jens Henrichs
- Department of Midwifery Science , AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , The Netherlands
| | - Eva M Szigethy
- Department of Psychiatry , University of Pittsburgh , Pittsburgh, Pennsylvania , USA
| | - Elisabeth Mwj Utens
- Department of Child and Adolescent Psychiatry/Psychology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Johanna C Escher
- Department of Pediatric Gastroenterology , Erasmus MC-Sophia Children's Hospital , Rotterdam , The Netherlands
| |
Collapse
|
16
|
Mueller R, Ziade F, Pittet V, Fournier N, Ezri J, Schoepfer A, Schibli S, Spalinger J, Braegger C, Nydegger A. Quality of Life in Swiss Paediatric Inflammatory Bowel Disease Patients: Do Patients and Their Parents Experience Disease in the Same Way? J Crohns Colitis 2016; 10:269-76. [PMID: 26519462 PMCID: PMC4957466 DOI: 10.1093/ecco-jcc/jjv199] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/21/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases (IBDs) may impair quality of life (QoL) in paediatric patients. We aimed to evaluate in a nationwide cohort whether patients experience QoL in a different way when compared with their parents. METHODS Sociodemographic and psychosocial characteristics were prospectively acquired from paediatric patients and their parents included in the Swiss IBD Cohort Study. Disease activity was evaluated by the Paediatric Crohn's Disease Activity Index (PCDAI) and the Paediatric Ulcerative Colitis Activity Index (PUCAI). We assessed QoL using the KIDSCREEN questionnaire. The QoL domains were analysed and compared between children and parents according to type of disease, parents' age, origin, education and marital status. RESULTS We included 110 children and parents (59 Crohn's disease [CD], 45 ulcerative colitis [UC], 6 IBD unclassified [IBDU]). There was no significant difference in QoL between CD and UC/IBDU, whether the disease was active or in remission. Parents perceived overall QoL, as well as 'mood', 'family' and 'friends' domains, lower than the children themselves, independently of their place of birth and education. However, better concordance was found on 'school performance' and 'physical activity' domains. Marital status and age of parents significantly influenced the evaluation of QoL. Mothers and fathers being married or cohabiting perceived significantly lower mood, family and friends domains than their children, whereas mothers living alone had a lower perception of the friends domain; fathers living alone had a lower perception of family and mood subscores. CONCLUSION Parents of Swiss paediatric IBD patients significantly underestimate overall QoL and domains of QoL of their children independently of origin and education.
Collapse
Affiliation(s)
- Rebekka Mueller
- Division of Pediatric Gastroenterology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Farah Ziade
- Division of Pediatric Gastroenterology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Valérie Pittet
- Institute of Social and Preventive Medicine, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Fournier
- Institute of Social and Preventive Medicine, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Jessica Ezri
- Division of Pediatric Gastroenterology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Susanne Schibli
- Division of Gastroenterology, University Children’s Hospital of Bern, Bern, Switzerland
| | - Johannes Spalinger
- Division of Gastroenterology, University Children’s Hospital of Bern, Bern, Switzerland,Division of Gastroenterology, Children’s Hospital of Lucerne, Lucerne, Switzerland
| | - Christian Braegger
- Division of Gastroenterology and Nutrition, University Children’s Hospital of Zurich, Zurich, Switzerland
| | - Andreas Nydegger
- Division of Pediatric Gastroenterology, University Hospital of Lausanne, Lausanne, Switzerland
| | | |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Depression in pediatric inflammatory bowel disease is increasingly recognized to be a heterogeneous condition with diverse underlying predisposing and precipitating factors. Although there is a growing awareness regarding the benefits of integrating behavioral health into medical care, the way psychiatric treatments can best target different aspects of depression and related dysfunction has not been systematically explored. RECENT FINDINGS This review discusses neurobiological risk factors for depression in inflammatory bowel disease including inflammation, associated anti-inflammatory treatment with corticosteroids, pain, and sleep disturbance, as well as psychosocial factors including reactions to illness, illness perception, and disease and environmental stressors with an emphasis on how these factors can influence treatment decisions. Empirically supported psychosocial and psychopharmacological interventions are discussed within this context. SUMMARY Understanding the diverse pathways that can lead to depression in youths with inflammatory bowel disease can lead to the development of more targeted interventions and better integration of psychosocial care into the medical treatment of inflammatory bowel disease.
Collapse
Affiliation(s)
| | | | - Eva Szigethy
- University of Pittsburgh, Department of Psychiatry
| |
Collapse
|
18
|
Abstract
OBJECTIVE The association between inflammatory bowel disease (IBD) and depression provides a unique opportunity to understand the relation between systemic inflammation and depressive symptom profiles. METHODS Youth (n = 226) ages 9 to 17 years with comorbid IBD and depression underwent psychiatric assessment and evaluation of IBD activity. Latent profile analysis (LPA) identified depressive subgroups based on similar responses to the Children's Depression Rating Scale-Revised. Demographic factors, depression severity, anxiety, IBD activity, inflammatory markers, IBD-related medications, and illness perception were evaluated as predictors of profile membership. RESULTS Mean age was 14.3 years; 75% had Crohn disease; 31% were taking systemic corticosteroids. Mean depressive severity was moderate, whereas IBD activity, which reflects inflammation, was mild. LPA identified 3 subgroups: Profile-1 (mild, 75%) had diverse low-grade depressive symptoms and highest quality of life; Profile-2 (somatic, 19%) had severe fatigue, appetite change, anhedonia, decreased motor activity, and depressed mood with concurrent high-dose steroid therapy and the highest IBD activity; and Profile-3 (cognitive, 6%) had the highest rates of self-reported depressive symptoms, ostomy placements, and anxiety with IBD symptoms in the relative absence of inflammation. CONCLUSIONS Evidence was found for 3 depression profiles in youth with IBD and depression. Our analyses determined that patients with predominantly somatic or cognitive symptoms of depression comprised 25% of our cohort. These findings may be used to design subgroup-specific interventions for depression in adolescents with IBD and other physical illnesses associated with systemic inflammation.
Collapse
|
19
|
Rogler D, Fournier N, Pittet V, Bühr P, Heyland K, Friedt M, Koller R, Rueger V, Herzog D, Nydegger A, Schäppi M, Schibli S, Spalinger J, Rogler G, Braegger CP. Coping is excellent in Swiss Children with inflammatory bowel disease: results from the Swiss IBD cohort study. J Crohns Colitis 2014; 8:409-20. [PMID: 24230970 DOI: 10.1016/j.crohns.2013.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/24/2013] [Accepted: 10/15/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) starting during childhood has been assumed to impair quality of life (QoL) of affected children. As this aspect is crucial for further personality development, the health-related quality of life (HRQOL) was assessed in a Swiss nationwide cohort to obtain detailed information on the fields of impairment. METHODS Data were prospectively acquired from pediatric patients included in the Swiss IBD Cohort Study. IBD activity was evaluated by PCDAI and PUCAI. The age adapted KIDSCREEN questionnaire was evaluated for 110 children with IBD (64 with Crohn's disease 46 with ulcerative colitis). Data were analyzed with respect to established reference values of healthy controls. RESULTS In the KIDSCREEN index a moderate impairment was only found for physical wellbeing due to disease activity. In contrast, mental well-being and social support were even better as compared to control values. A subgroup analysis revealed that this observation was restricted to the children in the German speaking part of Switzerland, whereas there was no difference compared to controls in the French part of Switzerland. Furthermore, autonomy and school variables were significantly higher in the IBD patients as compared to controls. CONCLUSIONS The social support for children with IBD is excellent in this cohort. Only physical well-being was impaired due to disease activity, whereas all other KIDSCREEN parameters were better as compared to controls. This indicates that effective coping and support strategies may be able to compensate the burden of disease in pediatric IBD patients.
Collapse
Affiliation(s)
- Daniela Rogler
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland; Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nicolas Fournier
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Valérie Pittet
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Patrick Bühr
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Klaas Heyland
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Michael Friedt
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Rebekka Koller
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Vanessa Rueger
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland
| | - Denise Herzog
- Division of Paediatric Gastroenterology, Cantons Hospital Fribourg, Fribourg, Switzerland
| | - Andreas Nydegger
- Division of Gastroenterology, University Children's Hospital of Lausanne, Lausanne, Switzerland
| | - Michela Schäppi
- Division of Gastroenterology, University Children's Hospital Geneva, Geneva, Switzerland
| | - Susanne Schibli
- Division of Gastroenterology, University Children's Hospital Bern, Bern, Switzerland
| | - Johannes Spalinger
- Division of Gastroenterology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Christian P Braegger
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zurich, Switzerland; Children's Research Centre, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
20
|
Abstract
BACKGROUND Previous investigations have produced mixed findings on whether youth with inflammatory bowel disease (IBD) experience elevated rates of depressive symptoms. Our first aim was to compare self-report of depressive symptoms by youth with IBD with a community sample. The second aim was to examine the relationship between symptoms of depression and measures of disease activity. METHODS Item-level responses on the Children's Depression Inventory among a sample of 78 youth diagnosed with IBD were compared with responses from a community sample using 1-sample t-tests. Particular attention was given to items assessing somatic symptoms of depression given the potential overlap with IBD disease symptoms. The relationship between depressive symptoms and IBD disease activity was evaluated using Spearman's rank correlation coefficients and linear regression. RESULTS Youth with IBD reported lower levels of depressive symptoms compared with the community sample on the Children's Depression Inventory Total Score, and similar or lower levels of difficulty on items assessing somatic symptoms. Most of the sample had inactive or mild disease activity at the time of participation, with 14% experiencing moderate/severe disease activity. Higher ratings of disease activity were related to greater depressive symptoms. Responses on somatic items from the Children's Depression Inventory were not differentially related to disease activity. CONCLUSIONS As a group, pediatric patients with IBD did not experience the clinical levels of depressive symptoms or elevations in depressive symptoms when compared with a community sample. Somatic symptoms of depression do not differentiate youth with IBD experiencing elevations in disease activity from youth experiencing nonsomatic symptoms of depression.
Collapse
|
21
|
Reed-Knight B, Lobato D, Hagin S, McQuaid EL, Seifer R, Kopel SJ, Boergers J, Nassau JH, Suorsa K, Bancroft B, LeLeiko NS. Stability of Emotional and Behavioral Functioning in Youth with Inflammatory Bowel Disease. CHILDRENS HEALTH CARE 2014; 43:151-168. [PMID: 29497228 DOI: 10.1080/02739615.2013.837824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study prospectively examined stability of psychological and behavioral functioning in two matched cohorts of youth with inflammatory bowel disease (IBD): (1) newly-diagnosed and (2) previously-diagnosed patients. Youth and their parents completed measures of emotional and behavioral functioning at Time 1 and 6-months later. Mean-level analyses indicated that scores at Time 1 and Time 2 were within the nonclinical range. A significant decrease occurred in Internalizing symptoms for previously-diagnosed patients. Both groups demonstrated high levels of profile stability, with no significant differences across groups. Results suggest that emotional and behavioral functioning is generally stable without targeted intervention.
Collapse
Affiliation(s)
- Bonney Reed-Knight
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children's Hospital/The Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Debra Lobato
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children's Hospital/The Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Bradley Hasbro Children's Research Center, Providence, Rhode Island
| | - Sarah Hagin
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children's Hospital/The Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Bradley Hasbro Children's Research Center, Providence, Rhode Island
| | - Elizabeth L McQuaid
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children's Hospital/The Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Bradley Hasbro Children's Research Center, Providence, Rhode Island
| | - Ronald Seifer
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Bradley Hasbro Children's Research Center, Providence, Rhode Island
| | - Sheryl J Kopel
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children's Hospital/The Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Julie Boergers
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children's Hospital/The Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Bradley Hasbro Children's Research Center, Providence, Rhode Island
| | - Jack H Nassau
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children's Hospital/The Rhode Island Hospital, Providence, Rhode Island.,The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Bradley Hasbro Children's Research Center, Providence, Rhode Island
| | - Kristina Suorsa
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children's Hospital/The Rhode Island Hospital, Providence Rhode Island
| | - Barbara Bancroft
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children's Hospital/The Rhode Island Hospital, Providence Rhode Island
| | - Neal S LeLeiko
- The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children's Hospital/The Rhode Island Hospital, Providence Rhode Island
| |
Collapse
|
22
|
Reigada LC, Benkov KJ, Bruzzese JM, Hoogendoorn C, Szigethy E, Briggie A, Walder DJ, Warner CM. Integrating illness concerns into cognitive behavioral therapy for children and adolescents with inflammatory bowel disease and co-occurring anxiety. J SPEC PEDIATR NURS 2013; 18:133-43. [PMID: 23560585 DOI: 10.1111/jspn.12019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/05/2012] [Accepted: 01/10/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE To examine the feasibility and preliminary benefits of an integrative cognitive behavioral therapy (CBT) with adolescents with inflammatory bowel disease and anxiety. DESIGN AND METHODS Nine adolescents participated in a CBT program at their gastroenterologist's office. Structured diagnostic interviews, self-report measures of anxiety and pain, and physician-rated disease severity were collected pretreatment and post-treatment. RESULTS Postintervention, 88% of adolescents were treatment responders, and 50% no longer met criteria for their principal anxiety disorder. Decreases were demonstrated in anxiety, pain, and disease severity. PRACTICE IMPLICATIONS Anxiety screening and a mental health referral to professionals familiar with medical management issues is important.
Collapse
Affiliation(s)
- Laura C Reigada
- Brooklyn College of the City University of New York, Brooklyn, NY, USA.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
BACKGROUND Children with Crohn's disease (CD) may report abdominal pain despite clinical remission, suggesting that functional abdominal pain (FAP) may be playing a role. The aim of this study was to explore the presence and impact of FAP in children with CD in remission. METHODS Children, aged 9 to 17 years, with CD were enrolled. Demographic information, the Pediatric Crohn's Disease Activity Index, and the Children's Depression Inventory were obtained. Disease remission was defined by physician global assessment, normal laboratories findings, absence of 3 or more stools a day, nocturnal stooling, bloody diarrhea, concurrent steroid therapy, strictures, or disease flare within 6 months. FAP was defined as patients with abdominal pain and CD remission. Rates of depression (Children's Depression Inventory >9) were compared. RESULTS Of 307 children, 139 reported abdominal pain. Of this group, 18 of 139 (13%) children met the criteria for FAP. Despite clinical remission, 8 of 18 patients with CD having FAP were classified with active disease by Pediatric Crohn's Disease Activity Index. These patients had a higher rate of depression than patients with CD in remission with no abdominal pain (55.6% versus 29.9%; P = 0.03), similar to patients with abdominal pain from active CD (55.6% versus 44.8%; P = 0.62). CONCLUSIONS A proportion of children with CD in remission have FAP. These children are at significant risk of depression. Future studies are needed to determine whether depression contributes to functional pain development or if pain itself leads to depression. Especially given that functional pain may exaggerate disease activity, clinicians caring for children with CD and FAP should consider evaluating for depressive disorders before escalating therapy.
Collapse
|
24
|
Thompson RD, Craig AE, Mrakotsky C, Bousvaros A, DeMaso DR, Szigethy E. Using the Children's Depression Inventory in youth with inflammatory bowel disease: support for a physical illness-related factor. Compr Psychiatry 2012; 53:1194-9. [PMID: 22682678 PMCID: PMC4017927 DOI: 10.1016/j.comppsych.2012.04.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 03/21/2012] [Accepted: 04/18/2012] [Indexed: 11/26/2022] Open
Abstract
The objective of the present investigation was to evaluate the factor structure of the Children's Depression Inventory (CDI) in adolescents with inflammatory bowel disease (IBD) to better understand the CDI's psychometric properties in a medically complicated population. An exploratory factor analysis was performed on CDI data collected from a clinical sample of 191 youth with IBD, aged 11 to 17 years. Exploratory factor analysis with quartimax rotation yielded 3 factors: mood, behavioral/motivational, and somatic complaints. Only the somatic factor (ie, fatigue, sleep, decreased appetite, and worry about aches and pain) showed a significant positive correlation with IBD severity. The CDI holds promise as a brief measure for the assessment of depressive features psychometrically independent of IBD severity and common steroid treatments as well as of nongastrointestinal specific somatic complaints in a sample of adolescents with IBD. Continued work in this area of research appears promising in honing the assessment of depressive and somatic symptoms in youths with IBD.
Collapse
Affiliation(s)
- Rachel D. Thompson
- Departments of Psychiatry and Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Anna E. Craig
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Christine Mrakotsky
- Departments of Psychiatry and Pediatrics, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Athos Bousvaros
- Departments of Psychiatry and Pediatrics, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - David R. DeMaso
- Departments of Psychiatry and Pediatrics, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eva Szigethy
- Departments of Psychiatry and Pediatrics, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| |
Collapse
|
25
|
Srinath AI, Walter C, Newara MC, Szigethy EM. Pain management in patients with inflammatory bowel disease: insights for the clinician. Therap Adv Gastroenterol 2012; 5:339-57. [PMID: 22973418 PMCID: PMC3437534 DOI: 10.1177/1756283x12446158] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients' lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population.
Collapse
Affiliation(s)
- Arvind Iyengar Srinath
- Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | |
Collapse
|
26
|
Goodhand J, Hedin CR, Croft NM, Lindsay JO. Adolescents with IBD: the importance of structured transition care. J Crohns Colitis 2011; 5:509-19. [PMID: 22115368 DOI: 10.1016/j.crohns.2011.03.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 03/26/2011] [Accepted: 03/26/2011] [Indexed: 02/08/2023]
Abstract
Children and adolescents with inflammatory bowel disease (IBD) tend to have more extensive and severe disease than adults. IBD presenting in childhood interferes with growth, education and employment as well as psychosocial and sexual development, frequently delaying adolescent developmental milestones. Transition, in the context of healthcare, is the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions to adult-orientated healthcare systems. Although no single model has been widely adopted and despite a paucity of data, recent guidelines from Europe and the USA propose the formation of specialist transition clinics for adolescent patients with IBD. In order to develop a successful transition service, the barriers that arise because of differences between paediatric and adult IBD services need to be identified. In this article, we review the concept of transitional care for adolescents with IBD, highlighting the important differences in not only, paediatric and adult IBD, but also paediatric and adult IBD services. We consider the consequences of failed transition, and describe the limited published data reporting different approaches to transition in IBD, before outlining our own approach.
Collapse
Affiliation(s)
- J Goodhand
- Digestive Diseases Clinical Academic Unit, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, United Kingdom.
| | | | | | | |
Collapse
|
27
|
Increased risks of developing anxiety and depression in young patients with Crohn's disease. Am J Gastroenterol 2011; 106:1670-7. [PMID: 21537359 DOI: 10.1038/ajg.2011.142] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Crohn's disease (CD) is associated with substantial psychosocial burden and increased risks for mental health disorders. This retrospective cohort study compared the risks of developing anxiety disorders and depression and incidences of psychotropic medication use between young CD patients and matched CD-free controls. METHODS Medical claims, prescription drug claims, enrollment, and demographic data for patients <18 years diagnosed with CD were obtained from the MarketScan database (1 January 2000-30 June 2006). Each CD patient was matched with five CD-free controls based on exact age, sex, and months of health plan enrollment. Incidence rates and risks of developing anxiety disorders and depression and psychotropic medication use in the 6 months after the index date were compared, as were risks of developing persistent anxiety or depression (receiving medical services related to a diagnosis of anxiety or depression or psychotropic therapy for >1 year). RESULTS After adjustment for patient characteristics, the risks of developing anxiety disorders (hazard ratio (HR) [95% confidence interval (CI);[equals;2.28 [1.65-3.17]) and depression (HR [95% CI;[equals;1.74 [1.35-2.25]) after CD diagnosis were significantly greater for the CD cohort (N=2,144) than for CD-free controls (N=10,720). Patients with CD also had greater risks of developing persistent anxiety and persistent depression (HR [95% CI;[equals;4.35 [2.22-8.50] and 2.75 [1.73-4.38], respectively). CONCLUSIONS Compared with matched CD-free controls, young patients with CD had significantly greater risks of developing anxiety disorders and depression, were more likely to receive psychotropic treatments, and had significantly greater risks of developing persistent anxiety and depression.
Collapse
|
28
|
Abstract
This article reviews the etiology, clinical characteristics, and treatment of inflammatory bowel disease (IBD) and associated psychological sequelae in children and adolescents with this lifelong disease. Pediatric-onset IBD, consisting of Crohn's disease and ulcerative colitis, has significant medical morbidity and in many young persons is also associated with psychological and psychosocial challenges. Depression and anxiety are particularly prevalent and have a multifaceted etiology, including IBD-related factors such as cytokines and steroids used to treat IBD and psychosocial stress. A growing number of empirically supported interventions, such as cognitive behavioral therapy, hypnosis, and educational resources, help youth and their parents cope with IBD as well as the psychological and psychosocial sequelae. While there is convincing evidence that such interventions can help improve anxiety, depression, and health-related quality of life, their effects on IBD severity and course await further study.
Collapse
|
29
|
Timmer A, Preiss JC, Motschall E, Rücker G, Jantschek G, Moser G. Psychological interventions for treatment of inflammatory bowel disease. Cochrane Database Syst Rev 2011:CD006913. [PMID: 21328288 DOI: 10.1002/14651858.cd006913.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of psychological interventions in inflammatory bowel diseases (IBD) is controversial. OBJECTIVES To assess the effects of psychological interventions (psychotherapy, patient education, relaxation techniques) on health related quality of life, coping, emotional state and disease activity in IBD. SEARCH STRATEGY We searched the specialized register of the IBD/FBD Group, CENTRAL (Issue 5, 2010) and from inception to April 2010: Medline, Embase, LILACS, Psyndex, CINAHL, PsyInfo, CCMed, SOMED and Social SciSearch. Conference abstracts and reference lists were also checked. SELECTION CRITERIA Randomized, quasi-randomized and non randomized controlled trials of psychological interventions in children or adults with IBD with a minimum follow up time of 2 months. DATA COLLECTION AND ANALYSIS Data were extracted and study quality was independently assessed by two raters. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random effects model. MAIN RESULTS Twenty-one studies were eligible for inclusion (1745 participants, 8 RCT, 4 QRCT, 8 NRCT; 19 in adults, 2 in adolescents). Most studies used multimodular approaches. The risk of bias was high for all studies.In adults, psychotherapy had no effect on quality of life at around 12 months (3 studies, 235 patients, SMD -0.07; 95% CI -0.33 to 0.19), emotional status (depression, 4 studies, 266 patients, SMD 0.03; 95% CI -0.22 to 0.27) or proportion of patients not in remission (5 studies, 287 patients, OR 0.85; 95% CI 0.48 to 1.48). Results were similar at 3 to 8 months. There was no evidence for statistical heterogeneity or subgroup effects based on type of disease or intensity of the therapy. In adolescents, there were positive short term effects of psychotherapy on most outcomes assessed including quality of life (2 studies, 71 patients, SMD 0.70; 95% CI 0.21 to 1.18) and depression (1 study, 41 patients, SMD -0.62; 95% CI -1.25 to 0.01).Educational interventions were ineffective with respect to quality of life at 12 months (5 studies, 947 patients, SMD 0.11; 95% CI -0.02 to 0.24), depression (3 studies, 378 patients, SMD -0.08; 95% CI -0.29 to 0.12) and proportion of patients not in remission (3 studies, 434 patients, OR 1.00; 95% CI 0.65 to 1.53). AUTHORS' CONCLUSIONS There is no evidence for efficacy of psychological therapy in adult patients with IBD in general. In adolescents, psychological interventions may be beneficial, but the evidence is limited. Further evidence is needed to assess the efficacy of these therapies in subgroups identified as being in need of psychological interventions, and to identify what type of therapy maybe most useful.
Collapse
Affiliation(s)
- Antje Timmer
- Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Achterstrasse 30, Bremen, Germany, 28359
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND Fatigue is common, disabling yet underappreciated, in patients with chronic diseases, including inflammatory bowel disease (IBD). AIMS To examine the literature and determine the prevalence and patterns of fatigue in IBD patients, to identify opportunities and directions for future research in this area. METHODS A systematic review using PubMed and Ovid Medline databases was conducted using search terms 'fatigue', 'Crohn', 'colitis' and 'inflammatory bowel disease'. A review of fatigue in other similar chronic diseases was also performed. RESULTS Ten studies were found to include data on fatigue in IBD patients; all were conducted between 1999 and 2009. However, only one study (in children) measured fatigue in IBD patients as a primary outcome. In patients in remission, the prevalence of fatigue in IBD patients ranges from 41 to 48%. Data are sparse and conflicting on whether fatigue severity is proportional to disease severity/activity. CONCLUSIONS Despite the clinical reality of fatigue, there are few published studies examining fatigue in IBD as a primary outcome. More data are needed on the prevalence, correlation between disease activity and fatigue severity, and putative pathogenic pathways involved in fatigue pathogenesis, before ultimately elucidating targeted therapies for fatigue in IBD patients.
Collapse
Affiliation(s)
- D R van Langenberg
- Monash University Department of Gastroenterology & Hepatology, Medicine, Box Hill Hospital, Box Hill, Melbourne, Vic., Australia.
| | | |
Collapse
|
31
|
Abstract
This article reviews the etiology, clinical characteristics, and treatment of inflammatory bowel disease (IBD) and associated psychological sequelae in children and adolescents with this lifelong disease. Pediatric-onset IBD, consisting of Crohn's disease and ulcerative colitis, has significant medical morbidity and in many young persons is also associated with psychological and psychosocial challenges. Depression and anxiety are particularly prevalent and have a multifaceted etiology, including IBD-related factors such as cytokines and steroids used to treat IBD and psychosocial stress. A growing number of empirically supported interventions, such as cognitive behavioral therapy, hypnosis, and educational resources, help youth and their parents cope with IBD as well as the psychological and psychosocial sequelae. While there is convincing evidence that such interventions can help improve anxiety, depression, and health-related quality of life, their effects on IBD severity and course await further study.
Collapse
|
32
|
Goodhand JR, Wahed M, Rampton DS. Management of stress in inflammatory bowel disease: a therapeutic option? Expert Rev Gastroenterol Hepatol 2009; 3:661-79. [PMID: 19929586 DOI: 10.1586/egh.09.55] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is increasing evidence that psychological stress and associated mood disorders are linked with, and can adversely affect the course of, inflammatory bowel disease (IBD). Unfortunately, owing to methodological difficulties inherent in undertaking appropriately targeted and blinded trials, there are limited high-quality data regarding the effects on IBD of interventions aimed to ameliorate stress and mood disorders. Nevertheless, patients want psychological intervention as well as conventional medical strategies. Emerging trial evidence supports the suggestion that psychologically orientated therapy may ameliorate IBD-associated mood disorders, but there are no strong data as of yet to indicate that stress management has a beneficial effect on the activity or course of IBD. As yet, which, when and how interventions targeted at psychological stress and mood disturbances should be offered to individual patients with IBD is not clear.
Collapse
Affiliation(s)
- James R Goodhand
- Centre for Gastroenterology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
| | | | | |
Collapse
|