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Binumon KV, Ezhumalai S, Janardhana N, Chand PK. Development and Validation of Brief Family Intervention for Young Adults with Substance Use Disorder: A Qualitative Study. JOURNAL OF PSYCHIATRY SPECTRUM 2024; 3:28-35. [PMID: 38264216 PMCID: PMC10803291 DOI: 10.4103/jopsys.jopsys_38_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background Substance abuse is more prevalent in young adults, putting them at risk for chronic use and early onset of dependence on substances. A well-documented relationship exists between substance use and poor family functioning. Traditional family intervention approaches are time-consuming. Aim To develop a brief family intervention for parents of young adults with substance use disorder. Methods A qualitative research design was used. Extensive literature searches and key informant interviews (face to face) with young adults (n = 5), their parents (n = 5), and mental health professionals (n = 5) were conducted. The interviews were audio recorded. A thematic analysis was conducted using Braun and Clarke's six-step approach, and intervention strategies were identified by examining the themes. In addition, experts were consulted to ensure the content validity of the BFI. Results The BFI program combines psychoeducation and behavioral techniques for parents. BFI involves seven sessions with parents, 45-60 min each, over one week. The BFI sessions consisted of (1) Engagement and Assessment, (2) Healthy Family Functioning, (3) Psychoeducation, (4) Relapse Prevention, (5) Communication Skill Training, (6) Problem-Solving Skill Training, and (7) Parental Monitoring and Supervision. Conclusion Considering all stakeholders' perspectives, the BFI manual for young adults with substance use disorder has been developed. However, additional research is required to evaluate its feasibility and effectiveness.
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Affiliation(s)
| | - Sinu Ezhumalai
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
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2
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Gamwell KL, Roberts CM, Kraft JD, Edwards CS, Baudino MN, Grunow JE, Jacobs NJ, Tung J, Mullins LL, Chaney JM. Factor analysis of the stigma scale-child in pediatric inflammatory bowel disease. J Psychosom Res 2023; 164:111095. [PMID: 36495755 DOI: 10.1016/j.jpsychores.2022.111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Illness stigma, or perceived stigma related to a chronic health condition, is pervasive among youth with inflammatory bowel disease (IBD). However, no studies exist examining the psychometric properties of illness stigma measures in this population. Using a modified version of the Child Stigma Scale originally developed for youth with epilepsy, the current study investigated the factor structure and validity of this adapted measure (i.e., Stigma Scale - Child; SS-C) in youth with IBD. METHODS Factor analyses were conducted to determine the most parsimonious factor structure for the adapted 8-item Stigma Scale - Child in a sample of 180 youth with IBD. Correlations were conducted to assess convergent validity, and a multiple regression was conducted to further evaluate the measure's predictive validity of child depressive symptoms. RESULTS The most parsimonious model for the SS-C is a one-factor solution with an error covariance between the two items assessing concealment/disclosure of IBD diagnosis. CONCLUSIONS The SS-C is a psychometrically sound illness stigma measure in pediatric IBD that demonstrates strong convergent validity with psychosocial adjustment factors such as thwarted belongingness, illness uncertainty, and illness intrusiveness, as well as strong predictive validity with youth depressive symptoms. The SS-C is a viable option for use as a brief screener in youth with IBD across clinical and research settings.
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Affiliation(s)
- Kaitlyn L Gamwell
- University of South Carolina School of Medicine, Department of Pediatrics, Greenville, SC, United States of America; Prisma Health Children's Hospital, Department of Pediatric Pain Medicine, Greenville, SC, United States of America.
| | - Caroline M Roberts
- Baylor College of Medicine, Texas Children's Hospital, Division of Psychology, United States of America
| | - Jacob D Kraft
- University of Michigan, Department of Psychiatry, United States of America
| | - Clayton S Edwards
- Oklahoma State University, Department of Psychology, United States of America
| | - Marissa N Baudino
- Baylor College of Medicine, Texas Children's Hospital, Division of Psychology, United States of America
| | - John E Grunow
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, United States of America
| | - Noel J Jacobs
- University of Oklahoma Children's Physicians, General and Community Pediatrics, United States of America
| | - Jeanne Tung
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, United States of America
| | - Larry L Mullins
- Oklahoma State University, Department of Psychology, United States of America
| | - John M Chaney
- Oklahoma State University, Department of Psychology, United States of America
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3
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Roberts CM, Addante SM, Baudino MN, Edwards CS, Gamwell KL, Jacobs NJ, Tung J, Grunow JE, Mullins LL, Chaney JM. Stigma Moderates the Relation Between Peer Victimization, Thwarted Belongingness, and Depressive Symptoms in Youth with Inflammatory Bowel Disease. J Pediatr Nurs 2021; 59:137-142. [PMID: 33878539 DOI: 10.1016/j.pedn.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The stigmatizing nature of IBD symptoms may place youth at risk for being targets of peer victimization, potentially resulting in a decreased sense of social belongingness and poorer emotional adjustment. The present study tested a series of mediation and moderated mediation models examining the associations among peer victimization, thwarted social belongingness, and depressive symptoms, as well as the moderating role of IBD stigma in these associations. We hypothesized peer victimization would have an indirect effect on youth depressive symptoms through thwarted belongingness, and this effect would be amplified for youth endorsing greater IBD stigma. DESIGN AND METHODS Seventy-five youth (10-18 yrs.) diagnosed with IBD were recruited from a pediatric gastroenterology clinic. Participants completed self-report measures of IBD stigma, peer victimization, thwarted belongingness, and depressive symptoms. RESULTS As anticipated, mediation analyses revealed a significant peer victimization → thwarted belongingness → depressive symptoms indirect path. Moderated mediation analyses indicated that this indirect effect was moderated by IBD stigma and was significantly greater among youth reporting higher IBD stigma. CONCLUSIONS Youth who experience higher levels of IBD-related stigma are at increased risk for depressive symptoms as a function of the socially isolating effects of peer victimization. PRACTICE IMPLICATIONS Our findings highlight the need for routine screening and identification of the socioemotional challenges faced by youth with IBD. Clinical interventions that incorporate coping strategies aimed at minimizing youths' stigmatizing self-perceptions and improving overall social skills and social engagement may lessen the negative impact of peer victimization on youths' social and emotional adjustment.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA.
| | - Samantha M Addante
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - Clayton S Edwards
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | | | - Noel J Jacobs
- University of Oklahoma Children's Physicians, General and Community Pediatrics, USA
| | - Jeanne Tung
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, USA
| | - John E Grunow
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, USA
| | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - John M Chaney
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
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4
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Klages KL, Berlin KS, Cook JL, Keenan ME, Semenkovich K, Banks GG, Rybak TM, Ankney RL, Decker KM, Whitworth JR, Corkins MR. Examining Risk Factors of Health-Related Quality of Life Impairments Among Adolescents with Inflammatory Bowel Disease. Behav Med 2021; 47:140-150. [PMID: 34048329 DOI: 10.1080/08964289.2019.1676193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Inflammatory Bowel Disease (IBD) is a chronic, costly, and burdensome disease that is typically diagnosed during adolescence. Despite the use of effective treatments, rates of relapse and intestinal inflammation remain high and put patients at risk for long term physical and psychosocial health complications. Given the costs associated with IBD, it is critical to examine potential risk factors of poor health-related quality of life (HRQoL) among patients for the enhancement and further development of interventions. As such, the aim of the current study was to examine how sociodemographic and disease characteristics, psychosocial problems, and adherence behaviors impact HRQoL among a sample of youth with IBD. 107 adolescents with IBD and their caregiver completed self- and parent-report measures as part of a psychosocial screening service. Medical records were reviewed to obtain information regarding diagnosis, insurance, medication use, illness severity, and disease activity. Results revealed lower HRQoL scores among adolescents with more psychosocial problems (Est. = -3.08; p < .001), greater disease severity (Est. = -.40; p = .001), and those who identified as Black (Est. = -.38; p < .05). Greater disease severity (Est. = .13 p = .004), use of nonpublic insurance (Est. = .32 p = .004), and fewer psychosocial problems (Est. = -.13 p = .04) were associated with greater adherence behaviors. These findings suggest that implementing individually tailored, evidence-based psychological interventions focused on coping with psychosocial problems and symptoms may be important in enhancing adherence behaviors and HRQoL among adolescents with IBD.
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Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Sciences Center
| | | | | | | | | | | | | | | | - John R Whitworth
- Department of Pediatrics, University of Tennessee Health Sciences Center
| | - Mark R Corkins
- Department of Pediatrics, University of Tennessee Health Sciences Center
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5
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Touma N, Varay C, Baeza-Velasco C. Determinants of quality of life and psychosocial adjustment to pediatric inflammatory bowel disease: A systematic review focused on Crohn's disease. J Psychosom Res 2021; 142:110354. [PMID: 33465493 DOI: 10.1016/j.jpsychores.2020.110354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not. OBJECTIVE This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. METHOD Four international databases were consulted in March 2020: PubMed, PsychInfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies. RESULTS One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes. CONCLUSIONS Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.
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Affiliation(s)
- Nathalie Touma
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France.
| | - Caroline Varay
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France
| | - Carolina Baeza-Velasco
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France; Department of Psychiatric Emergency and Post-Emergency, Montpellier University Hospital Center, 371 Av du Doyen Gaston Giraud, 34090 Montpellier, France
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Cushman GK, Shih S, Stolz MG, Hinrichs RC, Jovanovic T, Lee JL, Kugathasan S, Reed B. Stressful life events, depression, and the moderating role of psychophysiological reactivity in patients with pediatric inflammatory bowel disease. J Psychosom Res 2021; 141:110323. [PMID: 33321262 PMCID: PMC7855667 DOI: 10.1016/j.jpsychores.2020.110323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The development of depressive symptoms in youth with IBD is a concerning disease complication, as higher levels of depressive symptoms have been associated with poorer quality of life and lower medication adherence. Previous research has examined the association between disease activity and depression, but few studies have examined individual differences in experience of stressful life events in relation to depressive symptoms. The purpose of the current study is to examine the relation between stressful life events and depression within pediatric IBD and to determine whether individual differences in stress response moderates this association. METHODS 56 youth ages 8-17 years old diagnosed with IBD completed questionnaires about their depressive symptoms and history of stressful life events. We assessed skin conductance reactivity (SCR) to a stressful task as an index of psychophysiological reactivity. RESULTS Stressful life events (r = 0.36, p = .007) were positively related to depressive symptoms. Youth who demonstrated a greater maximum SC level during the IBD-specific stress trial compared to baseline (n = 32) reported greater depressive symptoms. For these same participants, the relationship between stressful life events and depressive symptoms depended on SCR F(3, 28) = 4.23, p = .01, such that at moderate and high levels of SCR, a positive relationship between stressful life events and depressive symptoms was observed. CONCLUSIONS The relationship between stressful life events and depressive symptoms in youth with IBD may depend on individual differences in processing stress, such that risk may increase with greater psychophysiological reactivity.
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Affiliation(s)
| | | | | | | | | | | | | | - Bonney Reed
- Emory/Children's Pediatric Institute, United States of America.
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7
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Baudino MN, Perez MN, Roberts CM, Edwards CS, Gamwell KL, Keirns NG, Tung J, Jacobs NJ, Grunow JE, Mullins LL, Chaney JM. Stigma by Association: Parent Stigma and Youth Adjustment in Inflammatory Bowel Disease. J Pediatr Psychol 2021; 46:27-35. [PMID: 33120420 DOI: 10.1093/jpepsy/jsaa083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Examine the indirect association between parents' experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD). METHODS During routine clinic visits, 150 youth with well-controlled IBD (ages 10-18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity. RESULTS Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents' experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness. CONCLUSIONS Parents who face stigma related to their child's IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths' illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents' associative stigma and youths' illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.
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Affiliation(s)
| | - Megan N Perez
- Center for Pediatric Psychology, Oklahoma State University
| | | | | | | | | | - Jeanne Tung
- University of Oklahoma Children's Physicians Pediatric Gastroenterology
| | - Noel J Jacobs
- University of Oklahoma Children's Physicians General and Community Pediatrics
| | - John E Grunow
- University of Oklahoma Children's Physicians Pediatric Gastroenterology
| | | | - John M Chaney
- Center for Pediatric Psychology, Oklahoma State University
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8
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Roberts CM, Gamwell KL, Baudino MN, Grunow JE, Jacobs NJ, Tung J, Gillaspy SR, Hommel KA, Mullins LL, Chaney JM. The Contributions of Illness Stigma, Health Communication Difficulties, and Thwarted Belongingness to Depressive Symptoms in Youth with Inflammatory Bowel Disease. J Pediatr Psychol 2020; 45:81-90. [PMID: 31633787 DOI: 10.1093/jpepsy/jsz084] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Youth with inflammatory bowel disease (IBD) often experience difficulties communicating about their disease. It is suspected that the stigmatizing nature of IBD symptoms contributes to youths' health communication difficulties, leaving youth feeling disconnected from their social environment and potentially resulting in decreased social belongingness and poorer emotional functioning. In this study, we tested an illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms serial mediation model. It was anticipated that youth illness stigma would confer a serial indirect effect on youth depressive symptoms through the sequential effects of stigma on health communication difficulties and thwarted social belongingness. METHODS Seventy-five youth with IBD between the ages of 10 and 18 completed measures of perceived illness stigma, health communication difficulties, thwarted belongingness, and depressive symptoms. RESULTS Results indicated a significant illness stigma → thwarted belongingness → depressive symptoms simple mediation path. Importantly, findings also revealed a significant serial mediation path for illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms. CONCLUSIONS Youth who perceive greater IBD stigma appear to experience increased difficulty communicating about their IBD with others, which in turn is associated with feelings of thwarted social belongingness and ultimately elevated depressive symptoms. These findings suggest that difficulty communicating about IBD is one potential route by which illness stigma has a negative impact on youth adjustment outcomes. Results could also inform clinical interventions to address IBD stigma and health communication difficulties associated with the social and emotional challenges in youth with IBD.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Kaitlyn L Gamwell
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | | | - Jeanne Tung
- University of Oklahoma Health Sciences Center
| | | | | | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - John M Chaney
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
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Parent and Family Functioning in Pediatric Inflammatory Bowel Disease. CHILDREN-BASEL 2020; 7:children7100188. [PMID: 33080794 PMCID: PMC7603067 DOI: 10.3390/children7100188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Abstract
Although the impact of pediatric inflammatory bowel disease (IBD) extends beyond the patient to their parents and families, the focus of previous literature has largely been on investigating the patient’s medical and psychosocial functioning, with less consideration of the family system. Having a comprehensive understanding of parent and family functioning within the context of pediatric IBD is important given the role parents and family members have in the successful management of the disease and caring of the child. The current review paper aggregates the empirical research regarding parent and family functioning, including comparisons to normative samples, other illness groups, and how functioning relates to child psychosocial and health outcomes. Extant literature on parents and families in pediatric IBD has largely focused on the variables of parenting stress, parent psychosocial functioning, parent quality of life, and family functioning. Summary findings elucidate the complex relationships between parents, families, and children affected by IBD and highlight the importance of assessing parent and family functioning within pediatric IBD. The current review also offers implications for clinical practice, notes the limitations of the present literature, and provides recommendations for future research.
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10
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Baudino MN, Gamwell KL, Roberts CM, Grunow JE, Jacobs NJ, Gillaspy SR, Edwards CS, Mullins LL, Chaney JM. Disease Severity and Depressive Symptoms in Adolescents With Inflammatory Bowel Disease: The Mediating Role of Parent and Youth Illness Uncertainty. J Pediatr Psychol 2020; 44:490-498. [PMID: 30551150 DOI: 10.1093/jpepsy/jsy091] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objective of this study is to examine parent and youth appraisals of illness uncertainty as potential serial mediators in the relation between disease severity and youth depressive symptoms in adolescents with inflammatory bowel disease (IBD). METHODS Participants were 85 adolescents 13-18 years of age (Mage = 15.75, SD =1.51) with a confirmed diagnosis of IBD (Crohn's disease, 59%; ulcerative colitis, 41%) and a primary caregiver. At a scheduled outpatient visit, caregivers completed a measure of illness uncertainty, while adolescents completed measures of illness uncertainty and depressive symptoms. Pediatric gastroenterologists provided global estimates of disease severity. RESULTS Path analysis revealed several significant direct and indirect associations among the modeled variables. Importantly, results provided support for the hypothesized disease severity→parent illness uncertainty→youth illness uncertainty→youth depressive symptoms serial mediation path (95% confidence interval = 0.04 to 1.10). CONCLUSIONS Results indicate that increased disease activity may serve to magnify the unpredictable nature of IBD for parents, reflected in heightened perceptions of illness uncertainty. Our findings also suggest that increased parent illness uncertainty has a significant influence on youth illness uncertainty appraisals, which in turn translates into elevated depressive symptoms in adolescents with IBD. The clinical implications of our findings and suggestions for future studies are discussed.
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Abstract
Parents of teens with inflammatory bowel disease must prepare their children for independent disease self-management. This study characterizes the stressors and coping strategies adopted among parents of teens with inflammatory bowel disease. Teens aged 16-22 years with inflammatory bowel disease who were consecutively seen by a pediatric gastroenterologist prior to transition to adult-centered care and their parents completed sociodemographic data, and two validated questionnaires for coping (Coping Health Inventory for Parents) and stress (Pediatric Inventory for Parents). Sixty-six patient-parent pairs were enrolled in this study-impairment was highest in role function (e.g., trying to attend to the needs of other family members, being unable to go to work, and feeling uncertain about how to maintain consistent discipline). These concerns seemed to be most pronounced among parents of children 18 years and older (χ (df) = 1, p = .04) with Crohn disease (χ (df) = 1, p = .02). The top five listed concerns differed depending on the caregiver's gender. Parents of teens with inflammatory bowel disease are concerned about parenting role function. Parents of teens 18 years and older with Crohn disease reported the highest stress. Caregiver gender differences were noted.
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12
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Gut-brain actions underlying comorbid anxiety and depression associated with inflammatory bowel disease. Acta Neuropsychiatr 2018; 30:275-296. [PMID: 28270247 DOI: 10.1017/neu.2017.3] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED IntroductionInflammatory bowel disease (IBD) is a chronic relapsing and remitting disorder characterised by inflammation of the gastrointestinal tract. There is a growing consensus that IBD is associated with anxiety- and depression-related symptoms. Psychological symptoms appear to be more prevalent during active disease states with no difference in prevalence between Crohn's disease and ulcerative colitis. Behavioural disturbances including anxiety- and depression-like symptoms have also been observed in animal models of IBD. RESULTS The likely mechanisms underlying the association are discussed with particular reference to communication between the gut and brain. The close bidirectional relationship known as the gut-brain axis includes neural, hormonal and immune communication links. Evidence is provided for a number of interacting factors including activation of the inflammatory response system in the brain, the hypothalamic-pituitary-adrenal axis, and brain areas implicated in altered behaviours, changes in blood brain barrier integrity, and an emerging role for gut microbiota and response to probiotics in IBD.DiscussionThe impact of psychological stress in models of IBD remains somewhat conflicted, however, it is weighted in favour of stress or early stressful life events as risk factors in the development of IBD, stress-induced exacerbation of inflammation and relapse. CONCLUSION It is recommended that patients with IBD be screened for psychological disturbance and treated accordingly as intervention can improve quality of life and may reduce relapse rates.
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13
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Stapersma L, van den Brink G, Szigethy EM, Escher JC, Utens EMWJ. Systematic review with meta-analysis: anxiety and depression in children and adolescents with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:496-506. [PMID: 29984495 DOI: 10.1111/apt.14865] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/02/2018] [Accepted: 06/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The co-existence of psychological problems and paediatric inflammatory bowel disease (IBD) is receiving increasing attention. Most studies investigated anxiety and depression, with prevalence rates varying from 0% to 50%. A systematic review is necessary to provide clear insight into the prevalence of anxiety and depression in paediatric IBD. AIM To systematically evaluate available data on the prevalence of anxiety and depressive symptoms and disorders in paediatric IBD (aged 6-18 years). METHODS Comprehensive searches were performed in Embase, Medline Ovid, Web of Science, Cochrane, PubMed, PsychInfo Ovid, and Google scholar for studies published from 1994 to 2017. Pooled prevalence rates were calculated using inverse variance heterogeneity models. Meta-regression was used to study if disease type, disease activity and gender influence prevalence. RESULTS Twenty-eight studies (N = 8107, mean age: 14.3) were identified. Pooled prevalence estimates were 16.4% (95% confidence interval [CI] 6.8%-27.3%) for anxiety symptoms and 4.2% (95% CI 3.6%-4.8%) for anxiety disorders. Pooled prevalence estimates were 15.0% (95% CI 6.4%-24.8%) for depressive symptoms and 3.4% (95% CI 0%-9.3%) for depressive disorders. Meta-regression showed no influence of disease type or gender on these prevalence rates, but studies with a higher percentage of active disease had a higher rate of depressive symptoms. CONCLUSIONS The described pooled prevalence of anxiety and depressive symptoms is lower than in adult IBD. However, due to varying instruments/cut-offs for measuring symptoms and few studies investigating disorders, the results should be interpreted with caution. Cross-cultural use of the same instruments is needed to gain better insight into prevalence rates.
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Affiliation(s)
- L Stapersma
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - G van den Brink
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - E M Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - J C Escher
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, 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
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14
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Desai D. Psychiatric morbidity in inflammatory bowel disease: Time to screen all the patients. Indian J Gastroenterol 2018; 37:281-283. [PMID: 30196517 DOI: 10.1007/s12664-018-0891-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Devendra Desai
- Division of Gastroenterology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India.
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15
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Gamwell KL, Baudino MN, Bakula DM, Sharkey CM, Roberts CM, Grunow JE, Jacobs NJ, Gillaspy SR, Mullins LL, Chaney JM. Perceived Illness Stigma, Thwarted Belongingness, and Depressive Symptoms in Youth With Inflammatory Bowel Disease (IBD). Inflamm Bowel Dis 2018; 24:960-965. [PMID: 29688469 DOI: 10.1093/ibd/izy011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Studies have begun to identify psychosocial factors associated with depressive symptoms in youth with IBD. However, despite considerable speculation in the literature regarding the role of perceived stigma in both social and emotional adjustment outcomes, youth appraisals of stigma have yet to receive empirical attention. The primary purpose of this study was to examine the indirect effect of perceived illness stigma on depressive symptoms through its impact on social belongingness. METHODS Eighty youth (Mage = 14.96) with IBD completed measures of illness stigma, thwarted belongingness, and depressive symptoms during a scheduled clinic visit. Pediatric gastroenterologists provided estimates of disease activity. Analyses examined the direct and indirect effects of illness stigma on perceived thwarted belongingness and depressive symptoms. RESULTS Bootstrapped regression results revealed significant illness stigma → depressive symptoms (β = 0.33, 95% CI, 0.108 to 0.526), illness stigma → thwarted belongingness (β =0.41, 95% CI, 0.061 to 0.739), and thwarted belongingness → depressive symptoms (β =0.32, 95% CI, 0.143 to 0.474) direct paths. Mediation analyses revealed a significant illness stigma → thwarted belongingness → depressive symptoms indirect path (β = 0.14, 95% CI, 0.034 to 0.310), suggesting increased appraisals of illness stigma impede youths' perceptions of social belongingness, which in turn, contribute to elevated depressive symptoms. CONCLUSIONS Youth perceptions of illness stigma negatively impact social belongingness and depressive symptoms in youth with IBD. Further, decreased perceptions of social belongingness may be one potential route through which stigma influences emotional adjustment outcomes. Results support clinical observations regarding the relevance of illness stigma and social functioning as targets of intervention for improving emotional adjustment in youth with IBD. 10.1093/ibd/izy011_video1izy011.video15775252424001.
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Affiliation(s)
| | | | - Dana M Bakula
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | | | | | - John E Grunow
- University of Oklahoma Health Sciences Center Children's Hospital, Oklahoma City, OK
| | - Noel J Jacobs
- University of Oklahoma Health Sciences Center Children's Hospital, Oklahoma City, OK
| | - Stephen R Gillaspy
- University of Oklahoma Health Sciences Center Children's Hospital, Oklahoma City, OK
| | - Larry L Mullins
- Department of Psychology, Oklahoma State University, Stillwater, OK
| | - John M Chaney
- Department of Psychology, Oklahoma State University, Stillwater, OK
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16
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Reed-Knight B, van Tilburg MAL, Levy RL, Langer SL, Romano JM, Murphy TB, DuPen MM, Feld AD. Maladaptive Coping and Depressive Symptoms Partially Explain the Association Between Family Stress and Pain-Related Distress in Youth With IBD. J Pediatr Psychol 2018; 43:94-103. [PMID: 28541526 PMCID: PMC5896627 DOI: 10.1093/jpepsy/jsx082] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/24/2017] [Accepted: 04/29/2017] [Indexed: 12/31/2022] Open
Abstract
Objective To extend existing research on the pain burden experienced by youth with inflammatory bowel disease (IBD) by examining the complexity of psychosocial factors involved in pain-related distress. Methods Parents completed measures of family stress and their child's pain-related expressions of distress and coping. Youth with IBD rated their depressive symptoms (n = 183 dyads). Mediation analyses were performed using regression-based techniques and bootstrapping. Results Greater family stress was positively related to children's pain-related expressions of distress and passive coping. Significant indirect effects were found in the relationship between family stress and expressed pain-related distress through parent-reported passive coping, depressive symptoms, and both passive coping and depressive symptoms sequentially. Conclusions Results suggest that family stress can place children at risk for greater expressed pain-related distress through effects on coping and depressive symptoms. Addressing psychosocial difficulties is important for closing the gap between disability and health in youth with IBD.
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Affiliation(s)
- Bonney Reed-Knight
- Children’s Healthcare of Atlanta
- Division of Gastroenterology, Hepatology, & Nutrition, Emory University School of Medicine
- GI Care for Kids
| | | | - Rona L Levy
- School of Social Work, University of Washington
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University
| | - Joan M Romano
- Department of Psychiatry & Behavioral Sciences, Psychiatry & Behavioral Sciences, University of Washington
| | | | | | - Andrew D Feld
- Gastroenterology Kaiser Permanente, Washington
- Clinical Professor of Medicine, University of Washington
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17
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Abautret-Daly Á, Dempsey E, Riestra S, de Francisco-García R, Parra-Blanco A, Rodrigo L, Medina C, Connor TJ, Harkin A. Association between psychological measures with inflammatory anddisease-related markers of inflammatory bowel disease. Int J Psychiatry Clin Pract 2017; 21:221-230. [PMID: 28353360 DOI: 10.1080/13651501.2017.1306081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed at investigating the associations between inflammatory mediators, symptoms and psychological disturbances in inflammatory bowel disease (IBD) patients. METHODS IBD patients and patient controls were examined during a single visit to a gastroenterology clinic. Disease activity was assessed using the Mayo index for ulcerative colitis (UC), inflammatory bowel disease questionnaire (IBDQ), Crohn's disease activity index (CDAI) and Crohn's disease endoscopic index of severity (CDEIS). Gene expression of inflammatory mediators were measured in intestinal biopsies and whole blood samples along with circulating concentrations of interleukin (IL)-6, interferon (IFN)γ, C-reactive protein (CRP), kynurenine and tryptophan. Validated depression, anxiety and quality of life scores were used to assess psychological well-being. RESULTS Patients who were symptomatic had the highest depression and anxiety scores, together with increased intestinal expression of IL-1β, IL-6 and matrix metalloproteinase-9, increased circulating IL-6 and CRP, and an increased circulating kynurenine:tryptophan ratio. Increased Hamilton depression (HAM-D) scores in IBD patients were observed independent of the psychological impact of acute symptoms. CONCLUSIONS Active IBD is associated with symptoms of depression and anxiety and with a raised circulating inflammatory mediator profile. Patients with active IBD exhibiting psychological symptoms should undergo psychological evaluation to ensure the psychological aspects of the condition are considered and addressed.
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Affiliation(s)
- Áine Abautret-Daly
- a Neuropsychopharmacology Research Group, Trinity College Institute of Neuroscience, Trinity College , Dublin 2 , Ireland.,b School of Pharmacy and Pharmaceutical Sciences, Trinity College , Dublin 2 , Ireland
| | - Elaine Dempsey
- a Neuropsychopharmacology Research Group, Trinity College Institute of Neuroscience, Trinity College , Dublin 2 , Ireland.,b School of Pharmacy and Pharmaceutical Sciences, Trinity College , Dublin 2 , Ireland
| | - Sabino Riestra
- c Department of Gastroenterology , Hospital Central de Asturias , Oviedo , Spain
| | | | - Adolfo Parra-Blanco
- c Department of Gastroenterology , Hospital Central de Asturias , Oviedo , Spain
| | - Luis Rodrigo
- c Department of Gastroenterology , Hospital Central de Asturias , Oviedo , Spain
| | - Carlos Medina
- b School of Pharmacy and Pharmaceutical Sciences, Trinity College , Dublin 2 , Ireland.,d Trinity Biomedical Sciences Institute, Trinity College , Dublin 2 , Ireland
| | - Thomas J Connor
- e Neuroimmunology Research Group, School of Medicine and Trinity College Institute of Neuroscience, Trinity College , Dublin 2 , Ireland
| | - Andrew Harkin
- a Neuropsychopharmacology Research Group, Trinity College Institute of Neuroscience, Trinity College , Dublin 2 , Ireland.,b School of Pharmacy and Pharmaceutical Sciences, Trinity College , Dublin 2 , Ireland
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18
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Effect of threatening life experiences and adverse family relations in ulcerative colitis: analysis using structural equation modeling and comparison with Crohn's disease. Eur J Gastroenterol Hepatol 2017; 29:577-586. [PMID: 28350749 DOI: 10.1097/meg.0000000000000826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS We published that threatening life experiences and adverse family relations impact Crohn's disease (CD) adversely. In this study, we examine the influence of these stressors in ulcerative colitis (UC). PATIENTS AND METHODS Patients completed demography, economic status (ES), the Patient-Simple Clinical Colitis Activity Index (P-SCCAI), the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), the Short-Form Health Survey (SF-36), the Brief Symptom Inventory (BSI), the Family Assessment Device (FAD), and the List of Threatening Life Experiences (LTE). Analysis included multiple linear and quantile regressions and structural equation modeling, comparing CD. RESULTS UC patients (N=148, age 47.55±16.04 years, 50.6% women) had scores [median (interquartile range)] as follows: SCAAI, 2 (0.3-4.8); FAD, 1.8 (1.3-2.2); LTE, 1.0 (0-2.0); SF-36 Physical Health, 49.4 (36.8-55.1); SF-36 Mental Health, 45 (33.6-54.5); Brief Symptom Inventory-Global Severity Index (GSI), 0.5 (0.2-1.0). SIBDQ was 49.76±14.91. There were significant positive associations for LTE and SCAAI (25, 50, 75% quantiles), FAD and SF-36 Mental Health, FAD and LTE with GSI (50, 75, 90% quantiles), and ES with SF-36 and SIBDQ. The negative associations were as follows: LTE with SF-36 Physical/Mental Health, SIBDQ with FAD and LTE, ES with GSI (all quantiles), and P-SCCAI (75, 90% quantiles). In structural equation modeling analysis, LTE impacted ES negatively and ES impacted GSI negatively; LTE impacted GSI positively and GSI impacted P-SCCAI positively. In a split model, ES had a greater effect on GSI in UC than CD, whereas other path magnitudes were similar. CONCLUSION Threatening life experiences, adverse family relations, and poor ES make UC patients less healthy both physically and mentally. The impact of ES is worse in UC than CD.
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Effect of psychosocial stressors on patients with Crohn's disease: threatening life experiences and family relations. Eur J Gastroenterol Hepatol 2016; 28:1073-81. [PMID: 27203602 DOI: 10.1097/meg.0000000000000666] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Threatening life experiences and adverse family relations are major psychosocial stressors affecting mental and physical health in chronic illnesses, but their influence in Crohn's disease (CD) is unclear. We assessed whether these stressors would predict the psychological and medical condition of CD patients. METHODS Consecutive adult CD patients completed a series of instruments including demography, Patient Harvey-Bradshaw Index (P-HBI), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), short-form survey instrument (SF-36), brief symptom inventory (BSI), family assessment device (FAD), and list of threatening life experiences (LTE). Associations of FAD and LTE with P-HBI, SIBDQ, SF-36, and BSI were examined by multiple linear and quantile regression analyses. RESULTS The cohort included 391 patients, mean age 38.38±13.95 years, 59.6% women, with intermediate economic status. The median scores were as follows: P-HBI 4 (2-8), FAD 1.67 (1.3-2.1), LTE 1 (0-3), SF-36 physical health 43.75 (33.7-51.0), SF-36 mental health 42.99 (34.1-51.9), and BSI-Global Severity Index 0.81 (0.4-1.4). The SIBDQ was 47.27±13.9. LTE was associated with increased P-HBI in all quantiles and FAD in the 50% quantile. FAD and LTE were associated with reduced SIBDQ (P<0.001). Higher LTE was associated with lower SF-36 physical and mental health (P<0.001); FAD was associated with reduced mental health (P<0.001). FAD and LTE were associated positively with GSI in all quantiles; age was associated negatively. CONCLUSION CD patients with more threatening life experiences and adverse family relations were less healthy both physically and mentally. Physicians offering patients sociopsychological therapy should relate to threatening life experiences and family relations.
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Brooks AJ, Rowse G, Ryder A, Peach EJ, Corfe BM, Lobo AJ. Systematic review: psychological morbidity in young people with inflammatory bowel disease - risk factors and impacts. Aliment Pharmacol Ther 2016; 44:3-15. [PMID: 27145394 DOI: 10.1111/apt.13645] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/08/2016] [Accepted: 04/12/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Psychological morbidity in young people aged 10-24 years, with inflammatory bowel disease (IBD) is increased, but risk factors for and impacts of this are unclear. AIM To undertake a systematic literature review of the risk factors for and impact of psychological morbidity in young people with IBD. METHODS Electronic searches for English-language articles were performed with keywords relating to psychological morbidity according to DSM-IV and subsequent criteria; young people; and IBD in the MEDLINE, PsychInfo, Web of Science and CINAHL databases for studies published from 1994 to September 2014. RESULTS One thousand four hundred and forty-four studies were identified, of which 30 met the inclusion criteria. The majority measured depression and anxiety symptoms, with a small proportion examining externalising behaviours. Identifiable risk factors for psychological morbidity included: increased disease severity (r(2) = 0.152, P < 0.001), lower socioeconomic status (r(2) = 0.046, P < 0.001), corticosteroids (P ≤ 0.001), parental stress (r = 0.35, P < 0.001) and older age at diagnosis (r = 0.28, P = 0.0006). Impacts of psychological morbidity in young people with IBD were wide-ranging and included abdominal pain (r = 0.33; P < 0.001), sleep dysfunction (P < 0.05), psychotropic drug use (HR 4.16, 95% CI 2.76-6.27), non-adherence to medication (12.6% reduction) and negative illness perceptions (r = -0.43). CONCLUSIONS Psychological morbidity affects young people with IBD in a range of ways, highlighting the need for psychological interventions to improve outcomes. Identified risk factors provide an opportunity to develop targeted therapies for a vulnerable group. Further research is required to examine groups under-represented in this review, such as those with severe IBD and those from ethnic minorities.
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Affiliation(s)
- A J Brooks
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - G Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - A Ryder
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - E J Peach
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - B M Corfe
- Molecular Gastroenterology Research Group, Academic Unit of Surgical Oncology, Department of Oncology, The Medical School, Sheffield, UK
| | - A J Lobo
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
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Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2016; 22:752-62. [PMID: 26841224 DOI: 10.1097/mib.0000000000000620] [Citation(s) in RCA: 360] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies. METHODS Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research. RESULTS (1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohn's disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset. CONCLUSIONS The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatment.
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