1
|
Nass BYS, Dibbets P, Markus CR. Mediating effect of coping dispositions on the association between trauma and gastrointestinal symptoms. Stress Health 2024; 40:e3380. [PMID: 38324223 DOI: 10.1002/smi.3380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are two gastrointestinal (GI) conditions known to be exacerbated by traumatic life experiences. One way in which these experiences might influence individuals' susceptibility to GI pathology, is by reducing their ability to deal with adversities effectively and predisposing them to passive coping styles that leave them vulnerable to the somatic effects of trauma. To validate this hypothesis, the present cross-sectional study assessed the mediating effect of coping dispositions on the association between trauma and GI disease activity in an adult sample of 189 bowel patients (94 IBD, 95 IBS) and 92 controls. Results confirmed that GI patients exhibit significantly more cumulative trauma, pervasive feelings of uncontrollability and passive coping strategies than controls. Moreover, the use of passive coping styles was positively associated with the accumulation of trauma and the expression of GI symptoms. Using hierarchical regression and mediation analyses, we found support for the sequential model postulating passive coping styles as (partial) mediators of trauma-induced (GI) disease manifestations. Specifically, out of all coping styles associated with cumulative trauma, behavioural disengagement most powerfully mediated the effect of trauma on GI symptom severity, accounting for 12% (IBD) to 14% (IBS) of its total effect. A somewhat smaller mediating role was observed for social support coping, the reduced reliance on which explained 7% (IBS) to 10% (IBD) of trauma's total effect. Finally, neuroticism acted as a channel through which past traumatization affected subjects' proneness to behavioural disengagement and, consequently, their GI disease activity.
Collapse
Affiliation(s)
- Boukje Y S Nass
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Dr. Rath Health Foundation, Heerlen, The Netherlands
| | - Pauline Dibbets
- Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - C Rob Markus
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
2
|
Nass BYS, Dibbets P, Markus CR. The Impact of Psychotrauma and Emotional Stress Vulnerability on Physical and Mental Functioning of Patients with Inflammatory Bowel Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6976. [PMID: 37947534 PMCID: PMC10648781 DOI: 10.3390/ijerph20216976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic health condition thought to be influenced by personal life experiences and emotional stress sensitivity (neuroticism). In the present study, we examined the impact of cumulative trauma experiences and trait neuroticism (as a measure for emotional stress vulnerability) on physical and mental functioning of n = 211 patients diagnosed with IBD (112 Crohn's disease, 99 ulcerative colitis). All patients were assessed for self-reported trauma histories, emotional stress vulnerability, clinical disease activity, functional gastrointestinal (GI) symptoms, and quality of life. Results showed that patients with severe IBD activity have endured significantly more interpersonal trauma and victimization than those with quiescent IBD. Moreover, cumulative trauma was found to exert an indirect (neuroticism-mediated) effect on patients' symptom complexity, with trauma and neuroticism conjointly explaining 16-21% of the variance in gastrointestinal and 35% of the variance in mental symptoms. Upon correction for condition (using a small group of available controls, n = 51), the predictive capacity of trauma and neuroticism increased further, with both predictors now explaining 31% of the somatic-and almost 50% of the mental symptom heterogeneity. In terms of trauma type, victimization (domestic violence and intimate abuse) proved the best predictor of cross-sample symptom variability and the only trauma profile with a consistent direct and indirect (neuroticism-mediated) effect on patients' mental (QoL) and physical fitness. Results are consistent with the growing body of evidence linking experiential vulnerability factors (trauma and neuroticism) and associated feelings of personal ineffectiveness, helplessness, and uncontrollability to interindividual differences in (GI) disease activity and quality of life.
Collapse
Affiliation(s)
- Boukje Yentl Sundari Nass
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Dr. Rath Health Foundation, 6422 RG Heerlen, The Netherlands
| | - Pauline Dibbets
- Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - C. Rob Markus
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| |
Collapse
|
3
|
Chiu HC, Lin CY, Kuo YL, Hou WL, Shu BC. Resilience among women with breast cancer surviving longer than five years: The relationship with illness perception and body image. Eur J Oncol Nurs 2023; 62:102254. [PMID: 36621263 DOI: 10.1016/j.ejon.2022.102254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to investigate the correlations and identify the relationships between the resilience, perception of illness and body image of women with breast cancer in the 5-year-or-above survivorship. METHODS We used convenient sampling to recruit from an outpatient department 106 women with breast cancer. The inclusion criteria were participants aged >20 years currently in a stable condition and were able to understand the Chinese language. Those women with mental health illness were excluded. All participants completed questionnaires on the following: demographic information, revision of illness perception (IPQ-R), body image scale (BIS), Eysenck personality questionnaire (EPQ), and resilience scale (RS). We conducted the structural equation modeling (SEM) to explore the factor structure. RESULTS SEM results showed a good fit to the data (comparative fit index = 0.97, Tucker-Lewis index = 0.94). Findings F indicated the existence of significant relationships between resilience and either illness perception or body image. Personality had a direct association with illness perception (β = 0.73, P < 0.05). Body image had an indirect effect on the relationship between resilience and illness perception (coefficient = -2.52; 95% bootstrapping CI = -31.36, -0.62). CONCLUSIONS Results indicated that illness perception is a crucial predictor for better resilience as mediated through body image. To provide adequate information to women with breast cancer can improve their perception of breast cancer more positively. Hence, their body image and their way of coping with survival life turn better.
Collapse
Affiliation(s)
- Hsing-Chan Chiu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Nursing, Tainan Municipal Hospital, Show Chwan Health Care System, Tainan, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Lung Kuo
- Department of Surgery, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Breast Medical Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wen-Li Hou
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Bih-Ching Shu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
4
|
Personality Traits and Health-Related Quality of Life in Irritable Bowel Syndrome (IBS) Patients: The Mediating Role of Illness Perceptions. PSYCHOLOGICAL STUDIES 2021. [DOI: 10.1007/s12646-021-00618-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
5
|
Knowles SR, Mikocka-Walus A. Editorial: type D personality and its relationship with depression and disease activity in inflammatory bowel disease. Aliment Pharmacol Ther 2021; 54:80-81. [PMID: 34109669 DOI: 10.1111/apt.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Simon R Knowles
- Department of Psychology, Swinburne University of Technology, Melbourne, Vic., Australia
| | | |
Collapse
|
6
|
Graf O, Urbańska BA, Uram P. Type D personality and acceptance of illness in people with inflammatory bowel diseases. Mediating role of self-esteem. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2021; 9:205-214. [PMID: 38013961 PMCID: PMC10658851 DOI: 10.5114/cipp.2021.106869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/14/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Type D personality is analyzed more and more frequently in the context of various chronic illnesses, including bowel diseases. Acceptance of illness is affected by many factors that facilitate adaptation to the difficulties and limitations and support the healing process. One of those factors may be self-esteem. PARTICIPANTS AND PROCEDURE One hundred fifty-nine individuals, aged 18 to 65, participated in the study. 67% (n = 107) stated that they have ulcerative colitis (UC), and the remaining 33% (n = 52) reported suffering from Crohn's disease (CD). The following measurement tools were used: Rosenberg Self-Esteem Scale (SES), Acceptance of Illness Scale (AIS), and Personality Type D Scale (D14). RESULTS The conducted analyses revealed significant correlations between all studied elements. Self-esteem was proven to be a full mediator in relations between one of the dimensions of type D personality, negative affectivity, as well as between both dimensions of type D personality (negative affectivity and social inhibition) and acceptance of illness in individuals with bowel diseases. However, mediation analysis did not confirm that self-esteem is a mediator between social inhibition and acceptance of illness. CONCLUSIONS The results show that self-esteem is, for an individual, an essential resource in coping with an illness and adjusting to it. Therefore, providing patient support in the scope of reinforcing self-esteem may prove to be one of the key elements affecting illness acceptance.
Collapse
Affiliation(s)
- Olga Graf
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Patrycja Uram
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| |
Collapse
|
7
|
Barello S, Guida E, Leone S, Previtali E, Graffigna G. Does patient engagement affect IBD patients' health-related quality of life? Findings from a cross-sectional study among people with inflammatory bowel diseases. Health Qual Life Outcomes 2021; 19:77. [PMID: 33678181 PMCID: PMC7938585 DOI: 10.1186/s12955-021-01724-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background Patients diagnosed with inflammatory bowel disease (IBD) are required to deal with the unpredictability of this clinical condition, which is associated with poorer health-related quality of life (HRQoL) compared to other clinical conditions. Patient engagement is currently demonstrated to relate with chronic patients’ HRQoL, but few studies have been conducted among this population. Methods A cross-sectional study was conducted among 1176 IBD patients. Data were collected on participants’ HRQoL (SIBD-Q) and patient engagement (PHE-s®). Regression analysis was used to examine the effects of patient engagement on HRQoL. Results About the half of the sample (47%) reported a low patient engagement level. 30% of the sample reported a low level of HRQoL. Psycho-emotional functioning resulted to be the aspect of HRQoL most impacted in the 37% of the sample. The regression model showed that PHE-s® is significantly related to the SIBD-Q total score (B = .585; p < .001; R squared = .343) and to the subscales’ scores—systemic symptoms (B = .572; p < .001; R squared = .327), bowel symptoms (B = .482; p < .001; R squared = .232), social (B = .485; p < .001; R squared = .234) and psycho-emotional (B = .607; p < .001; R squared = .369) functioning. Conclusions Patients who are engaged in their IBD care pathway are more likely to report higher level of HRQoL, thus offering clues to potential therapeutic approaches to ameliorating IBD patients’ wellbeing. As this is a modifiable factor, screening for patient health engagement levels, coupled with appropriate interventions, could improve care, and ultimately improve HRQoL outcomes among IBD patients.
Collapse
Affiliation(s)
- Serena Barello
- EngageMinds Hub, Consumer, Food and Health Engagement Research Center, Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
| | - Elena Guida
- EngageMinds Hub, Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Guendalina Graffigna
- EngageMinds Hub, Consumer, Food & Health Engagement Research Center, Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Piacenza, Italy
| |
Collapse
|
8
|
Hayes B, Moller S, Wilding H, Burgell R, Apputhurai P, Knowles SR. Application of the common sense model in inflammatory bowel disease: A systematic review. J Psychosom Res 2020; 139:110283. [PMID: 33161175 DOI: 10.1016/j.jpsychores.2020.110283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The aim of this paper was to undertake a systematic review of the research utilizing the Common Sense Model (CSM) involving IBD cohorts to explain the psychosocial processes, including illness perceptions and coping styles, that underpin patient reported outcomes (PROs) - psychological distress (PD) and quality of life (QoL). METHODS Adult studies were identified through systematic searches of 8 bibliographic databases run in August 2020 including Medline, Embase, and PsychINFO. No language or year limits were applied. RESULTS Of 848 records identified, 516 were selected with seven studies evaluating the CSM mediating pathways for final review (n = 918 adult participants). Consistent with the CSM, illness perceptions were associated with PD and QoL in six and five studies respectively. Illness perceptions acted as mediators, at least partially, on the relationship between IBD disease activity and PD and/or QoL in all seven studies. Coping styles, predominantly maladaptive-based coping styles, were found to act as mediators between illness perceptions and PD and/or QoL in five studies. Perceived stress was identified in one study as an additional psychosocial process that partially explained the positive influence of illness perceptions on PD, and a negative impact on QoL. Five studies were classified as high quality and two as moderate. CONCLUSIONS The CSM can be utilised in IBD cohorts to evaluate key psychosocial processes that influence PROs. Future research should explore additional psychosocial processes within the CSM and evaluate the efficacy of targeting CSM processes to promote psychological well-being and QoL in IBD cohorts.
Collapse
Affiliation(s)
- Bree Hayes
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia
| | - Stephan Moller
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia
| | - Helen Wilding
- St Vincent's Hospital Library Service, St Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia
| | - Rebecca Burgell
- Department of Gastroenterology, Alfred Health, PO Box 315, Prahran, Victoria 3181, Australia
| | - Pragalathan Apputhurai
- Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia
| | - Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, PO Box 218, Hawthorn, Victoria 3122, Australia; Department of Gastroenterology, Alfred Health, PO Box 315, Prahran, Victoria 3181, Australia; Department of Mental Health, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Vic, 3010, Australia; Department of Gastroenterology, The Royal Melbourne Hospital, RMH, Victoria 3050, Australia.
| |
Collapse
|
9
|
Martino G, Caputo A, Schwarz P, Bellone F, Fries W, Quattropani MC, Vicario CM. Alexithymia and Inflammatory Bowel Disease: A Systematic Review. Front Psychol 2020; 11:1763. [PMID: 32973596 PMCID: PMC7466427 DOI: 10.3389/fpsyg.2020.01763] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Given the role of alexithymia—as the inability to identify, differentiate, and express emotions—in chronic and immune-mediated illness, this systematic review analyzed the prevalence of alexithymia in patients with inflammatory bowel diseases (IBDs), mainly represented by Crohn's disease (CD) and ulcerative colitis (UC). Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout this systematic review of the literature published between 2015 and 2020 in indexed sources from PubMed, PsycINFO, Scopus, and Web of Science databases. Search terms for eligible studies were: “Inflammatory bowel disease” AND “Alexithymia” [Titles, Abstract, Keywords]. Inclusion criteria were: articles written and published in English from 2015 and up to April 2020, reporting relevant and empirical data on alexithymia and IBD. Results: The initial search identified 34 indexed scientific publications. After screening, we found that five publications met the established scientific inclusion criteria. Overall, the mean value of alexithymia ranged from 39 to 53.2 [Toronto Alexithymia Scale (TAS-20) score], thus mostly falling in non-clinical range for alexithymia (≤51). Comparisons of alexithymia between patients with UC and CD highlighted that patients with CD showed externally oriented thinking and difficulties identifying feelings to a greater extent. Regarding comparisons with other samples or pathologies, patients with IBD were more alexithymic than healthy controls and less alexithymic than patients with major depressive disorder, but no difference was found when compared with patients with irritable bowel syndrome (IBS). Then, regarding correlations with other variables, alexithymia was positively associated with anxiety and depression, as well as with psychopathological symptoms and somatic complaints. Conclusion: This systematic review suggests that patients with IBD cannot be generally considered alexithymic at a clinically relevant extent. However, their greater alexithymic levels and its associations with psychological variables and somatic distress may suggest a reactivity hypothesis, in which living with IBD may progressively lead to impaired emotion recognition over time. Specifically, the relationship between IBD and IBS should be further explored, paying deeper attention to the clinical psychological functioning of CD, as IBD requires more emotional challenges to patients.
Collapse
Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Peter Schwarz
- Department of Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - C M Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| |
Collapse
|
10
|
Leone D, Gilardi D, Corrò BE, Menichetti J, Vegni E, Correale C, Mariangela A, Furfaro F, Bonovas S, Peyrin-Biroulet L, Danese S, Fiorino G. Psychological Characteristics of Inflammatory Bowel Disease Patients: A Comparison Between Active and Nonactive Patients. Inflamm Bowel Dis 2019; 25:1399-1407. [PMID: 30689871 DOI: 10.1093/ibd/izy400] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The role of new psychological factors such as psychopathological patterns and defense mechanisms in the care of inflammatory bowel disease (IBD) has been poorly investigated. We aimed to assess the psychological characteristics and defense mechanisms of IBD patients. METHODS This was a single-center, observational, cross-sectional study. Consecutive adult IBD patients were enrolled and stratified according to disease activity. Sociodemographic and clinical data were collected, and validated questionnaires (Symptom Checklist-90-R [SCL-90-R]) for psychological distress, Defense Mechanism Inventory (DMI) for psychological defense mechanisms, and Inflammatory Bowel Disease Questionnaire (IBDQ) for quality of life (QoL) were administered. RESULTS Two hundred one patients were enrolled: 101 in remission and 100 with active disease. The mean score for IBDQ was below the cutoff level (156.8 ± 37.8), with a significantly greater impairment of QoL in subjects with flares (136.5 vs 177.5, P < 0.001). Lower scores were associated with female gender. No patients had psychological scores above the cutoff for normality. Statistically higher SCL-90-R scores were found in active patients for obsessive-compulsive disorder (P = 0.026), depression (P = 0.013), anxiety (P = 0.013), phobic anxiety (P = 0.002), psychoticism (P = 0.007), global severity index (GSI) (P = 0.005) and positive symptom total (PST) (P = 0.001). A significantly increased probability of higher global indexes was associated with Crohn's disease and disease flares. None of the defensive Defense Mechanism Inventory (DMI) styles resulted above the cutoff in our cohort. CONCLUSIONS Further data are needed to demonstrate the potential key role of psychological intervention in the therapeutic strategies utilized for IBD patients, and the identification of specific psychological patterns based on the patients profile is necessary to optimize psychological intervention.
Collapse
Affiliation(s)
- Daniela Leone
- Department of Clinical Psychology, University of Milan, Milan, Italy
| | - Daniela Gilardi
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Bianca E Corrò
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Julia Menichetti
- Department of Clinical Psychology, University of Milan, Milan, Italy
| | - Elena Vegni
- Department of Clinical Psychology, University of Milan, Milan, Italy
| | - Carmen Correale
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Allocca Mariangela
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Federica Furfaro
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Stefanos Bonovas
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | | | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| |
Collapse
|
11
|
Pihl Lesnovska K, Münch A, Hjortswang H. Microscopic colitis: Struggling with an invisible, disabling disease. J Clin Nurs 2019; 28:3408-3415. [PMID: 31090966 PMCID: PMC7328780 DOI: 10.1111/jocn.14916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Background and aims Microscopic colitis causes chronic or recurrent nonbloody, watery diarrhoea, which is associated with urgency, faecal incontinence and abdominal pain. The patient's health‐related quality of life is often impaired. In microscopic colitis, health‐related quality of life has been studied using questionnaires originally constructed and validated for patients with inflammatory bowel disease. The aim of this study was to explore the impact of microscopic colitis on everyday life. Methods and results Inductive, qualitative, semi‐structured interviews were performed with 15 persons suffering from microscopic colitis. Content analysis was used to explore the impact of the condition on everyday life. The study followed the consolidated criteria for reporting qualitative research. The qualitative inductive content analysis generated one theme and five subthemes. The theme was “struggling with an invisible, disabling disease.” The five subthemes were as follows: physical experience of bowel function; associated symptoms affecting quality of life; impact of the disease on everyday life; disease‐related worry; and strategies for managing everyday life. Conclusions The semi‐structured interviews with persons suffering from microscopic colitis provided a wide spectrum of answers to the question of how everyday life is affected. Microscopic colitis can be a disabling life experience, and patients develop different strategies to adapt, cope and regain their previous performance level. Relevance to clinical practice There are new and interesting findings in our study that everyday life still remains affected even when patients are in remission. These findings have relevance in clinical practice and may create a better understanding of the patient's symptoms and situation.
Collapse
Affiliation(s)
- Katarina Pihl Lesnovska
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Münch
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
12
|
Illness Cognitions and Health-Related Quality of Life of Patients With Inflammatory Bowel Disease. Gastroenterol Nurs 2018; 41:29-37. [PMID: 29373353 DOI: 10.1097/sga.0000000000000309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Patients' cognitions about their disease and treatment are important mediators between health and quality of life of patients with chronic diseases and also explain the occurrence of individual differences in individuals' adjustment to chronic disease. The aim of this study was to examine the relationship between illness cognitions and health-related quality of life among adult patients with inflammatory bowel disease. Self-report data on illness cognition and health-related quality of life were collected from 118 people with Crohn disease or ulcerative colitis. Illness cognition of greater helplessness significantly predicted health-related quality of life in patients with inflammatory bowel disease. A relative contribution of acceptance and perceived benefits was not confirmed as a predictor of health-related quality of life. The other variables (type of disease, duration of disease, age, and episode of relapses) did not have statistical significance, except for gender. Results demonstrate that experiencing helplessness in relation to the disease, its treatment, and consequences can be generalized to patients in all areas of daily life, leading to deterioration in their overall psychological and physical functioning. These results can provide useful indicators of potential patient's adherence in treatment and self-management of inflammatory bowel disease.
Collapse
|
13
|
Bonacchi A, Miccinesi G, Guazzini M, Rossi A, Bacci S, Toccafondi A, Martire M, Bellotti L, Perfetto R, Catanzaro P, Adamo V, Cascinu S, Doni L, Di Costanzo F, Rosselli M. Temperament and Character Traits Associated with Health-Related Quality of Life in Cancer Patients. TUMORI JOURNAL 2018; 98:377-84. [DOI: 10.1177/030089161209800316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is an increase in the attention to factors influencing the quality of life of cancer patients. The aim of the present study was to evaluate temperament and character traits related to health-related quality of life (HRQoL) in patients with cancer. Methods Two hundred and three inpatients from three Italian oncology departments filled in the Temperament Character Inventory (TCI-140) based on Cloninger's personality model, the SF-36 questionnaire assessing HRQoL, and the Hospital Anxiety and Depression Scale (HADS). Eighty percent of patients were undergoing chemotherapy. Results Lower levels of harm avoidance and higher levels of self-directedness were significantly correlated with a better HRQoL. Regression analysis controlling for psychopathology (anxiety and depression symptoms) showed that the influence of temperament and character traits on quality of life seemed to add little to the influence of psychopathology. Conclusions The present study demonstrates the existence of some relations between HRQoL and temperament and character traits assessed using the TCI-140 questionnaire. However, among the psychological factors, psychopathology seems to retain more influence on HRQoL of cancer patients.
Collapse
Affiliation(s)
- Andrea Bonacchi
- Roberto Assagioli Research Center,
Institute of Psychosynthesis, Florence
- Clinical and Descriptive Epidemiology
Unit, Institute for Cancer Research and Prevention-ISPO, Florence
| | - Guido Miccinesi
- Clinical and Descriptive Epidemiology
Unit, Institute for Cancer Research and Prevention-ISPO, Florence
| | - Monica Guazzini
- Service Psychosomatic Medicine,
Internal Medicine and Hepatology Unit, Department of Internal Medicine, University
of Florence, Florence, Italy
| | - Alessandra Rossi
- Service Psychosomatic Medicine,
Internal Medicine and Hepatology Unit, Department of Internal Medicine, University
of Florence, Florence, Italy
| | - Silvia Bacci
- Department of Economics, Finance and
Statistics, University of Perugia, Perugia
| | | | - Mariangela Martire
- Service Psychosomatic Medicine,
Internal Medicine and Hepatology Unit, Department of Internal Medicine, University
of Florence, Florence, Italy
| | - Laura Bellotti
- Service Psychosomatic Medicine,
Internal Medicine and Hepatology Unit, Department of Internal Medicine, University
of Florence, Florence, Italy
| | - Roberta Perfetto
- Service Psychosomatic Medicine,
Internal Medicine and Hepatology Unit, Department of Internal Medicine, University
of Florence, Florence, Italy
| | | | - Vincenzo Adamo
- Department of Human Pathology, Medical
Oncology and Integrated Therapies Unit, University Hospital G Martino Messina,
Messina
| | - Stefano Cascinu
- Department of Medical Oncology,
Polytechnic University Marche Region, University Hospital, Ospedali Riuniti Umberto
I-GM Lancisi and G Salesi, Ancona
| | - Laura Doni
- Department of Medical Oncology,
University Hospital Careggi, Florence
| | | | - Massimo Rosselli
- Service Psychosomatic Medicine,
Internal Medicine and Hepatology Unit, Department of Internal Medicine, University
of Florence, Florence, Italy
| |
Collapse
|
14
|
Viganò CA, Beltrami MM, Bosi MF, Zanello R, Valtorta M, Maconi G. Alexithymia and Psychopathology in Patients Suffering From Inflammatory Bowel Disease: Arising Differences and Correlations to Tailoring Therapeutic Strategies. Front Psychiatry 2018; 9:324. [PMID: 30127753 PMCID: PMC6088187 DOI: 10.3389/fpsyt.2018.00324] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022] Open
Abstract
Comorbidity with anxiety or depression is common in patients with Inflammatory Bowel Disease (IBD) as Crohn Disease (CD) and Ulcerative Colitis (UC). Data suggest that the cognitive construct of alexithymia has high prevalence in people suffering from anxiety and mood disorders and even in people with IBD. Most studies have investigated mainly anxiety and depression, considering IBD population as a homogeneous group of patients. Little evidence shows the impact of alexithymia on the course of IBD. We evaluated a broad spectrum of psychopathological symptoms and alexithymia levels in a group of outpatients affected by IBD in clinical remission, comparing CD and UC and investigating the relationship with clinical and socio-demographic variables. One hundred and seventy IBD outpatients were screened by using the Hospital Anxiety Depression Scale (HADS), the Self-report Symptom Inventory-90-Revised (SCL-90-R) and the Toronto Alexithymia Scale (TAS-20). A high prevalence of anxious and depressive symptoms (42.35 and 25.8% respectively) together with alexithymia (31.76%) was confirmed. CD patients experienced high levels of depression (HADS Depression 35.2% p = 0.034; SCL-90-R mean 1.39 p < 0.001), somatisation (SCL-90-R mean 1.04 p < 0.001), obsessive-compulsive symptoms (SCL-90-R mean 1.2 p < 0.001), and global severity (SCL-90-R mean 1.15 p < 0.001). There is no statistical difference in the prevalence of alexithymia in both subpopulations. The levels of alexithymia are correlated to the levels of anxiety (HADS Anxiety rs = 0.516 p < 0.001), depression (HADS Depression rs = 0.556 p < 0.001; SCL-90-R rs = 0.274 p = 0.001), somatisation (SCL-90-R rs = 0.229 p = 0.005), obsessive-compulsive symptoms (SCL-90-R rs = 0.362 p < 0.001), and global severity (SCL-90-R rs = 0.265 p = 0.001). Furthermore, alexithymia is associated with a delay of diagnosis of IBD, poly-therapies and greater IBD extension. Older age, female gender, greater IBD extension, surgery, and delay of diagnosis seem to be related to a high prevalence of psychopathological symptoms such as anxiety, depression, somatisation, and obsessive-compulsive symptoms. Psychopathological symptoms and high levels of alexithymia are frequent in IBD patients and seem to be related to a high risk of poor clinical outcome. CD patients could be considered at higher risk of mental comorbidity. A more comprehensive psychiatric assessment, including alexithymia, and an integrated treatment of underlying conditions, must be taken into account in order to improve the global prognosis of the disease.
Collapse
Affiliation(s)
- Caterina A Viganò
- Biomedical and Clinical Sciences Dept. L. Sacco, Università degli Studi di Milano, Milan, Italy.,Psychiatry Unit, Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, L. Sacco Hospital, Milan, Italy
| | - Marta M Beltrami
- Biomedical and Clinical Sciences Dept. L. Sacco, Università degli Studi di Milano, Milan, Italy.,Psychiatry Unit, Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, L. Sacco Hospital, Milan, Italy
| | - Monica F Bosi
- Psychiatry Unit 2, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Riccardo Zanello
- Biomedical and Clinical Sciences Dept. L. Sacco, Università degli Studi di Milano, Milan, Italy.,Psychiatry Unit, Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, L. Sacco Hospital, Milan, Italy
| | - Marta Valtorta
- Biomedical and Clinical Sciences Dept. L. Sacco, Università degli Studi di Milano, Milan, Italy.,Psychiatry Unit, Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, L. Sacco Hospital, Milan, Italy
| | - Giovanni Maconi
- Biomedical and Clinical Sciences Dept. L. Sacco, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
15
|
de Vroege L, Emons WHM, Sijtsma K, van der Feltz-Cornelis CM. Alexithymia Has No Clinically Relevant Association With Outcome of Multimodal Treatment Tailored to Needs of Patients Suffering From Somatic Symptom and Related Disorders. A Clinical Prospective Study. Front Psychiatry 2018; 9:292. [PMID: 30087625 PMCID: PMC6066688 DOI: 10.3389/fpsyt.2018.00292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 06/12/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Alexithymia may moderate the effectiveness of treatment and may predict impaired general functioning of patients suffering from somatic symptom and related disorders (SSRD). Aim: We compared alexithymia levels in a clinical prospective study with 234 consecutive patients suffering from SSRD from the Centre of Excellence for Body, Mind, and Health, Tilburg using the Bermond-Vorst Alexithymia Questionnaire, with general population norm scores. Second, we explored treatment outcomes of a multimodal treatment tailored to patient needs by Shared Decision Making (SDM) and Patient Related Outcome Monitoring (PROM) in patients with SSRD. Third, we explored whether alexithymia is associated with treatment outcome. Fourth, we explored if the presence of a chronic medical condition (e.g., diabetes mellitus, cardiovascular diseases) affects the association of alexithymia with treatment outcomes. Results: Compared to norm scores, SSRD patients showed elevated scores on the subscales identifying, verbalizing, and fantasizing, and on the cognitive dimension. All patients benefited from treatment in terms of anxiety, depression, and physical symptoms. The association of alexithymia with treatment outcome was significant, but the effect size was negligible (range odds ratios 1.02-1.25). The association between alexithymia and treatment outcome was stronger in patients suffering from chronic medical conditions compared to patients without chronic medical conditions. However, the effect size of this association was negligible (range odds ratio 0.94-1.12). Discussion: Alexithymia scores are elevated in patients with SSRD compared to general population scores, but the level of alexithymia has no clinically relevant association with treatment outcome both in SSRD patients with and without comorbid chronic medical conditions.
Collapse
Affiliation(s)
- Lars de Vroege
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands
| | - Wilco H M Emons
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Klaas Sijtsma
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Christina M van der Feltz-Cornelis
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| |
Collapse
|
16
|
Huang IC, Lee JL, Ketheeswaran P, Jones CM, Revicki DA, Wu AW. Does personality affect health-related quality of life? A systematic review. PLoS One 2017; 12:e0173806. [PMID: 28355244 PMCID: PMC5371329 DOI: 10.1371/journal.pone.0173806] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/27/2017] [Indexed: 11/28/2022] Open
Abstract
Background Health-related quality of life (HRQOL) is increasingly measured as an outcome for clinical and health services research. However, relatively little is known about how non-health factors affect HRQOL. Personality is a potentially important factor, yet evidence regarding the effects of personality on HRQOL measures is unclear. Methods This systematic review examined the relationships among aspects of personality and HRQOL. Eligible studies were identified from Medline and PsycINFO. The review included 76 English-language studies with HRQOL as a primary outcome and that assessed personality from the psychological perspective. Individuals with various health states, including ill (e.g., cancer, cardiovascular disorders), aging, and healthy, were included in this review study. Results Some personality characteristics were consistently related to psychosocial aspects more often than physical aspects of HRQOL. Personality characteristics, especially neuroticism, mastery, optimism, and sense of coherence were most likely to be associated with psychosocial HRQOL. Personality explained varying proportions of variance in different domains of HRQOL. The range of variance explained in psychosocial HRQOL was 0 to 45% and the range of explained variance in physical HRQOL was 0 to 39%. Conclusions Personality characteristics are related to HRQOL. Systematic collection and analysis of personality data alongside HRQOL measures may be helpful in medical research, clinical practice, and health policy evaluation.
Collapse
Affiliation(s)
- I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
- * E-mail:
| | - Joy L. Lee
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Pavinarmatha Ketheeswaran
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Conor M. Jones
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Dennis A. Revicki
- Outcomes Research, Evidera, Bethesda, Maryland, United States of America
| | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| |
Collapse
|
17
|
Niv G, Bar Josef S, Ben Bassat O, Avni I, Lictenstein L, Niv Y, Barnoy S. Quality of life and uncertainty in Crohn's disease. Qual Life Res 2017; 26:1609-1616. [PMID: 28181069 DOI: 10.1007/s11136-017-1509-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Crohn's disease impairs patients' perception of health and has a negative impact on health-related quality of life. Although it is apparent that uncertainty is a significant factor that decreases quality of life, it has never been studied in patients with Crohn's disease. The objective of the present study was to examine the association between level of certainty, self-epistemic authority, Internet information gathering habits, and health-related quality of life. METHODS A cross-sectional study of 105 Crohn's disease patients was conducted. Data were collected using a questionnaire composed of five parts: (1) demographic and clinical information; (2) health-related quality of life; (3) level of certainty; (4) self-epistemic authority; and (5) Internet information gathering habits regarding Crohn's disease. RESULTS A significant positive correlation was demonstrated between levels of certainty and health-related quality of life. Self-epistemic authority correlated positively with certainty, while information gathering via the Internet was related to decreased certainty. Multiple regression analysis for factors associated with health-related quality of life showed a positive association with the level of certainty, while negative associations were found between Internet information seeking and disease activity with the quality of life. CONCLUSION Level of certainty proved an important variable associated with health-related quality of life in Crohn's disease patients. Improving patients' self-epistemic authority can increase certainty and, thus, improve health-related quality of life.
Collapse
Affiliation(s)
- Galia Niv
- Rabin Medical Center, Petah Tikva, Israel
| | - Simona Bar Josef
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ofer Ben Bassat
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Irit Avni
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Lev Lictenstein
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Yaron Niv
- Gastroenterology Department, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Sivia Barnoy
- Nursing Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
| |
Collapse
|
18
|
La Barbera D, Bonanno B, Rumeo MV, Alabastro V, Frenda M, Massihnia E, Morgante MC, Sideli L, Craxì A, Cappello M, Tumminello M, Miccichè S, Nastri L. Alexithymia and personality traits of patients with inflammatory bowel disease. Sci Rep 2017; 7:41786. [PMID: 28150800 PMCID: PMC5288771 DOI: 10.1038/srep41786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/28/2016] [Indexed: 12/22/2022] Open
Abstract
Psychological factors, specific lifestyles and environmental stressors may influence etiopathogenesis and evolution of chronic diseases. We investigate the association between Chronic Inflammatory Bowel Diseases (IBD) and psychological dimensions such as personality traits, defence mechanisms, and Alexithymia, i.e. deficits of emotional awareness with inability to give a name to emotional states. We analyzed a survey of 100 patients with IBD and a control group of 66 healthy individuals. The survey involved filling out clinical and anamnestic forms and administering five psychological tests. These were then analyzed by using a network representation of the system by considering it as a bipartite network in which elements of one set are the 166 individuals, while the elements of the other set are the outcome of the survey. We then run an unsupervised community detection algorithm providing a partition of the 166 participants into clusters. That allowed us to determine a statistically significant association between psychological factors and IBD. We find clusters of patients characterized by high neuroticism, alexithymia, impulsivity and severe physical conditions and being of female gender. We therefore hypothesize that in a population of alexithymic patients, females are inclined to develop psychosomatic diseases like IBD while males might eventually develop behavioral disorders.
Collapse
Affiliation(s)
- D La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, Unit of Psychiatry, University Hospital, Palermo, Italy
| | - B Bonanno
- Department of Experimental Biomedicine and Clinical Neuroscience, Unit of Psychiatry, University Hospital, Palermo, Italy
| | - M V Rumeo
- Department of Experimental Biomedicine and Clinical Neuroscience, Unit of Psychiatry, University Hospital, Palermo, Italy
| | - V Alabastro
- Department of Experimental Biomedicine and Clinical Neuroscience, Unit of Psychiatry, University Hospital, Palermo, Italy
| | - M Frenda
- Department of Experimental Biomedicine and Clinical Neuroscience, Unit of Psychiatry, University Hospital, Palermo, Italy
| | - E Massihnia
- Unit of Nefrology II with Dialysis and Renal Transplantation, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy
| | - M C Morgante
- Biomedical Department of Internal and Specialty Medicine, Regional Reference Center for Metabolism rare pathologies, University Hospital, Palermo, Italy
| | - L Sideli
- Department of Experimental Biomedicine and Clinical Neuroscience, Unit of Psychiatry, University Hospital, Palermo, Italy
| | - A Craxì
- Biomedical Department of Internal and Specialty Medicine, Unit of Gastroenterology, University Hospital, Palermo, Italy
| | - M Cappello
- Biomedical Department of Internal and Specialty Medicine, Unit of Gastroenterology, University Hospital, Palermo, Italy
| | - M Tumminello
- Department of Economics, Management and Statistics, University of Palermo, Palermo, Italy
| | - S Miccichè
- Department of Physics and Chemistry, University of Palermo, Palermo, Italy
| | - L Nastri
- Department of Experimental Biomedicine and Clinical Neuroscience, Unit of Psychiatry, University Hospital, Palermo, Italy
| |
Collapse
|
19
|
Jordan C, Sin J, Fear NT, Chalder T. A systematic review of the psychological correlates of adjustment outcomes in adults with inflammatory bowel disease. Clin Psychol Rev 2016; 47:28-40. [PMID: 27318795 DOI: 10.1016/j.cpr.2016.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic long term condition which poses significant psychosocial adjustment challenges. The purpose of this review was to systematically identify psychological factors related to adjustment in adults with IBD with the aim of suggesting evidence based targets that may be modifiable though psychological intervention. Twenty five studies met inclusion criteria and were included in the systematic review and a narrative synthesis was conducted. A wide range of psychological variables were addressed covering six broad categories; personality traits, interpersonal traits, stress and coping, emotions and emotional control, IBD related cognitions and non IBD related cognitions. The most consistent relationship was found between certain emotion focused coping strategies and worse adjustment outcomes in IBD. Some evidence also hi-lighted a relationship between personality traits (such as neuroticism,) perceived stress, emotions and emotional control (such as alexithymia) and IBD related cognitions (such as illness perceptions) and negative adjustment outcomes. The results of this review suggest that interventions to improve adjustment in IBD may benefit from a focus on coping strategies, perceived stress and IBD related cognitions.
Collapse
Affiliation(s)
- Cheryl Jordan
- Faculty of Nursing and Midwifery, Kings College London, 57 Waterloo Road, London SE1 8WA, United Kingdom
| | - Jacqueline Sin
- King's College London Prize Fellowship, NIHR BRC Clinical Lecturer, Health Service & Population Research Department, IoPPN, King's College London, United Kingdom; NIHR Post Doctoral Research Fellow, Population Health Research Institute, St George's, University of London, United Kingdom
| | - Nicola T Fear
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom
| |
Collapse
|
20
|
Mahalli AAE, Alharthi HMA. Assessment of health-related quality of life of patients with inflammatory bowel diseases in Eastern Province, Saudi Arabia. J Infect Public Health 2016; 10:93-101. [PMID: 27020642 DOI: 10.1016/j.jiph.2016.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/22/2016] [Accepted: 02/20/2016] [Indexed: 01/30/2023] Open
Abstract
Inflammatory bowel disease patients have impaired quality of life with physical, social and emotional dysfunction. This project aimed to assess the effects of socio-demographic and clinical variables on quality of life and to identify its predictors. In a cross-sectional paper-based study, 50 consecutive non-selected patients attending the teaching hospital completed a disease-specific McMaster quality of life tool. Socio-demographic and clinical data were collected from patients' records. The t-test and Mann-Whitney test were used to determine the probability of significant differences between quality of life domains and independent variables. Multiple linear regression was used to determine quality of life predictors. Younger and highly educated patients had higher social scores. Those with shorter disease durations had higher systemic scores. Patients in remission had higher systemic, social, bowel and overall scores. Relapse was a significant predictor of decreased systemic, social, bowel and overall scores. Long disease duration was a significant predictor of decreased systemic and overall scores. Younger age at disease onset was a significant predictor of decreased emotional score. However, high education was a significant predictor of improved social score. Relapse, long disease duration, low education and young age at disease onset were associated with low quality of life. Prospective studies should investigate how interventions addressing these predictors may lead to improved quality of life.
Collapse
Affiliation(s)
- Azza A E Mahalli
- College of Applied Medical Sciences, University of Dammam, Saudi Arabia.
| | - Hana M A Alharthi
- College of Applied Medical Sciences, University of Dammam, Saudi Arabia.
| |
Collapse
|
21
|
Najafimanesh Z, Karambakhsh AR, Salesi M, Mohammadi J. Prediction of Quality of Life by Type D Personality and Illness Perception Factors in Patients With Coronary Artery Disease: A Structural Equation Model. HEALTH SCOPE 2016. [DOI: 10.17795/jhealthscope-27673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Uguz F, Kucuk A, Cicek E, Kayhan F, Salli A, Guncu H, Çilli AS. Quality of life in rheumatological patients: The impact of personality disorders. Int J Psychiatry Med 2015; 49:199-207. [PMID: 25930734 DOI: 10.1177/0091217415582183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Rheumatological diseases are associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently observed in these patients. This study examined the impact of personality disorders on the QoL of patients with rheumatological diseases. METHOD The study sample consisted of 142 participants including patients suffering from rheumatological disease with a personality disorder (n = 30), without any personality disorder (n = 112), and healthy control participants without physical or psychiatric disorders (n = 60). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) were used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief. RESULTS The subscale scores of physical health, psychological health, and social relationships were significantly lower in patients with rheumatological disease regardless of the existence of personality disorder compared with the control participants. Rheumatological patients with a personality disorder had significantly lower subscale scores of psychological health (p = 0.003) and social relationships (p < 0.003) compared with patients without any personality disorder. CONCLUSIONS Personality disorders seem to be a relevant factor that maybe associated with QoL in patients suffering from rheumatological disease.
Collapse
Affiliation(s)
- Faruk Uguz
- Department of Psychiatry, Meram Faculty of Medicine, University of Necmettin Erbakan, Konya, Turkey
| | - Adem Kucuk
- Department of Rheumatology, Meram Faculty of Medicine, University of Necmettin Erbakan, Konya, Turkey
| | - Erdinc Cicek
- Department of Psychiatry, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Fatih Kayhan
- Department of Psychiatry, Faculty of Medicine, Mevlana University, Konya, Turkey
| | - Ali Salli
- Department of Psychiatry, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Hatice Guncu
- Department of Psychiatry, Meram Faculty of Medicine, University of Necmettin Erbakan, Konya, Turkey
| | - Ali Savas Çilli
- Department of Psychiatry, Meram Faculty of Medicine, University of Necmettin Erbakan, Konya, Turkey
| |
Collapse
|
23
|
Coping Strategies and Psychological Outcomes of Patients with Inflammatory Bowel Disease in the First 6 Months After Diagnosis. Inflamm Bowel Dis 2015; 21:2272-80. [PMID: 26099065 DOI: 10.1097/mib.0000000000000476] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with reduced physical and mental well-being. The first 6 months after diagnosis is an important time in a patient's life with IBD. On top of the physical symptoms, psychological characteristics, such as coping strategies and personality, may contribute to impaired or improved health-related quality of life (HRQOL), anxiety, and depression. This study aimed to measure the stability of coping strategies and personality over the first 6 months after diagnosis and identify the associations of coping strategies and personality traits with the level of HRQOL and degree of anxiety and depression. This study aimed to measure HRQOL, anxiety, depression, IBD symptoms, coping, and personality at baseline and 6 months. METHODS Questionnaires about HRQOL, anxiety, depression, IBD symptoms, coping, personality, and demographic information were administered to patients at baseline and 6 months after diagnosis. RESULTS Personality characteristics were stable over the first 6 months but coping strategies were not. Maladaptive coping strategies were associated with worse outcomes but adaptive coping strategies were not associated with better outcomes. All measures of HRQOL improved. Neuroticism was associated with worse psychological anxiety, depression, and HRQOL outcomes. CONCLUSIONS This is the first study to psychologically test patients with IBD during the first 6 months after diagnosis. Generally, the HRQOL of patients with IBD improves over this time. Maladaptive coping is associated with worse psychological anxiety, depression, and HRQOL physical outcomes; although until an interventional study is performed, reverse causation cannot be ruled out.
Collapse
|
24
|
Schoultz M, Atherton I, Watson A. Mindfulness-based cognitive therapy for inflammatory bowel disease patients: findings from an exploratory pilot randomised controlled trial. Trials 2015; 16:379. [PMID: 26303912 PMCID: PMC4549082 DOI: 10.1186/s13063-015-0909-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/12/2015] [Indexed: 12/24/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition with a relapsing disease course. Managing the relapsing nature of the disease causes daily stress for IBD patients; thus, IBD patients report higher rates of depression and anxiety than the general population. Mindfulness-based Cognitive Therapy (MBCT) is an evidence-based psychological program designed to help manage depressive and stress symptoms. There has been no randomized controlled trial (RCT) testing the use of MBCT in IBD patients. The purpose of this pilot study is to test the trial methodology and assess the feasibility of conducting a large RCT testing the effectiveness of MBCT in IBD. Methods The IBD patients, who were recruited from gastroenterology outpatient clinics at two Scottish NHS Boards, were randomly allocated to an MBCT intervention group (n = 22) or a wait-list control group (n = 22). The MBCT intervention consisted of 16 hours of structured group training over 8 consecutive weeks plus guided home practice and follow-up sessions. The wait-list group received a leaflet entitled ‘Staying well with IBD’. All participants completed a baseline, post-intervention and 6-month follow up assessment. The key objectives were to assess patient eligibility and recruitment/dropout rate, to calculate initial estimates of parameters to the proposed outcome measures (depression, anxiety, disease activity, dispositional mindfulness and quality of life) and to estimate sample size for a future large RCT. Results In total, 350 patients were assessed for eligibility. Of these, 44 eligible patients consented to participate. The recruitment rate was 15 %, with main reasons for ineligibility indicated as follows: non-response to invitation, active disease symptoms, planned surgery or incompatibility with group schedule. There was a higher than expected dropout rate of 44 %. Initial estimates of parameters to the proposed outcomes at post-intervention and follow-up showed a significant improvement of scores in the MBCT group when compared to the control for depression, trait anxiety and dispositional mindfulness. The sample-size calculation was guided by estimates of clinically important effects in depression scores. Conclusions This pilot study suggests that a multicentre randomized clinical trial testing the effectiveness of MBCT for IBD patients is feasible with some changes to the protocol. Improvement in depression, trait anxiety and dispositional mindfulness scores are promising when coupled with patients reporting a perceived improvement of their quality of life. Trial registration ISRCTN27934462. 2 August 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0909-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mariyana Schoultz
- Centre for Health Science, School of Health Sciences, University of Stirling, Inverness, Scotland, UK.
| | - Iain Atherton
- Nursing, Midwifery & Social Care, Napier University, Edinburgh, Scotland, UK.
| | - Angus Watson
- Raigmore Hospital NHS Highland, Inverness, Scotland, UK.
| |
Collapse
|
25
|
Freitas TH, Andreoulakis E, Alves GS, Miranda HLL, Braga LLBC, Hyphantis T, Carvalho AF. Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease. World J Gastroenterol 2015; 21:6713-6727. [PMID: 26074710 PMCID: PMC4458782 DOI: 10.3748/wjg.v21.i21.6713] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/12/2015] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship between sense of coherence, psychological distress and health related quality of life in inflammatory bowel disease (IBD).
METHODS: This cross-sectional study enrolled a consecutive sample of 147 IBD (aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service. Sixty-four participants met diagnostic criteria for Crohn’s disease, while eighty-three patients had ulcerative colitis. Socio-demographic data (education, age, race, gender, gross monthly income and marital status), disease-related variables (illness activity, relapse rate in past 2 years, history of surgery and time since diagnosis), sense of coherence (Antonovsky’s SOC scale), psychological distress symptoms (Hospital Anxiety and Depression Scale) and health-related quality of life (HRQoL; WHOQOL-Bref) were assessed. Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQoL in patients with IBD and to provide indications for possible moderating or mediating effects. In addition, formal moderation and mediation analyses (Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC, psychological distress symptoms and HRQoL.
RESULTS: Lower SOC scores (std beta= -0.504; P < 0.001), female gender (std beta = 0.176; P = 0.021) and White race (std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms, while lower levels of SOC (std beta = -0.438; P < 0.001) and higher relapse rate (std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms. A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms, as the interaction term (time since diagnosis X SOC) had beta coefficients of -0.191 (P = 0.009) and -0.172 (P = 0.026), respectively. Lower levels of anxiety symptoms (std beta = -0.369; P < 0.001), higher levels of SOC (std beta = 0.231; P = 0.016) and non-White race (std beta = -0.229; P = 0.006), i.e., mixed-race, which represented the reference category, were independently associated with higher levels of overall HRQoL. Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL. In addition, anxiety mediated the association between SOC and satisfaction with health, as well as its relationship with physical, mental, and social relations HRQoL. Depressive symptoms also mediated the association between SOC and mental HRQoL.
CONCLUSION: Our data indicated that SOC is an important construct, as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.
Collapse
|
26
|
Abstract
Crohn's disease is associated with substantially impaired health-related quality of life (HRQoL). Even in the absence of active disease, patients with Crohn's disease report lower HRQoL, poorer function, and greater concerns, than those without disease. Achievement of disease remission in Crohn's disease, whether by pharmacological or surgical means, is associated with improved HRQoL, although the durability of the improvement seen after intestinal resection is uncertain because of the high rate of postoperative disease recurrence. This review focuses on the available literature on HRQoL in patients with Crohn's disease with an emphasis on the effects of intestinal resection and immunomodulatory therapy.
Collapse
|
27
|
Magalhães J, Castro FDD, Carvalho PB, Moreira MJ, Cotter J. Quality of life in patients with inflammatory bowel disease: importance of clinical, demographic and psychosocial factors. ARQUIVOS DE GASTROENTEROLOGIA 2015; 51:192-7. [PMID: 25296078 DOI: 10.1590/s0004-28032014000300005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022]
Abstract
CONTEXT Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. OBJECTIVES To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. METHODS Ninety two patients with Crohn's disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32) and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. RESULTS IBDQ-32 scores were significantly lower in female patients (P<0.001), patients with an individual perception of a lower co-workers support (P<0.001) and career fulfillment (P<0.001), patients requiring psychological support (P = 0.010) and pharmacological treatment for anxiety or depression (P = 0.002). A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001) and the perception of a lower co-workers support (P = 0.025) and career fulfillment (P = 0.001). CONCLUSIONS The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.
Collapse
Affiliation(s)
- Joana Magalhães
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - Francisca Dias de Castro
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - Maria João Moreira
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - José Cotter
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| |
Collapse
|
28
|
Abstract
This study determines perceived self-efficacy, personal characteristics and quality of life among Turkish adult primary care patients. The research used descriptive cross-sectional design. The sample group had moderate perceived self-efficacy and was mostly satisfied with quality of life. These findings help health professionals to improve quality of life in healthy adults.
Collapse
|
29
|
Vilhena E, Pais-Ribeiro J, Silva I, Pedro L, Meneses RF, Cardoso H, da Silva AM, Mendonça D. Psychosocial factors as predictors of quality of life in chronic Portuguese patients. Health Qual Life Outcomes 2014; 12:3. [PMID: 24405802 PMCID: PMC3896766 DOI: 10.1186/1477-7525-12-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 12/20/2013] [Indexed: 01/09/2023] Open
Abstract
Background Chronic illnesses are diseases of long duration and generally of slow progression. They cause significant quality of life impairment. The aim of this study was to analyse psychosocial predictors of quality of life and of subjective well-being in chronic Portuguese patients. Methods Chronic disease patients (n = 774) were recruited from central Portuguese Hospitals. Participants completed self-reported questionnaires assessing socio-demographic, clinical, psychosocial and outcome variables: quality of life (HRQL) and subjective well-being (SWB). MANCOVA analyses were used to test psychosocial factors as determinants of HRQL and SWB. Results After controlling for socio-demographic and clinical variables, results showed that dispositional optimism, positive affect, spirituality, social support and treatment adherence are significant predictors of HRQL and SWB. Similar predictors of quality of life, such as positive affect, treatment adherence and spirituality, were found for subgroups of disease classified by medical condition. Conclusions The work identifies psychosocial factors associated with quality of life. The predictors for the entire group of different chronic diseases are similar to the ones found in different chronic disease subgroups: positive affect, social support, treatment adherence and spirituality. Patients with more positive affect, additional social support, an adequate treatment adherence and a feel-good spirituality, felt better with the disease conditions and consequently had a better quality of life. This study contributes to understanding and improving the processes associated with quality of life, which is relevant for health care providers and chronic diseases support.
Collapse
Affiliation(s)
- Estela Vilhena
- Sciences Department, School of Technology, Polytechnic Institute of Cávado and Ave (IPCA), Barcelos, Portugal.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Affiliation(s)
- Young Jae Byun
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Chang Soo Eun
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| |
Collapse
|
31
|
Banovic I, Gilibert D, Andronikof A, Jebrane A, Ajdukovic I, Cosnes J. The causal representation of outpatients with Crohn's disease: is there a link between psychological distress and clinical disease activity? PSYCHO-SOCIAL MEDICINE 2013; 10:Doc08. [PMID: 24403966 PMCID: PMC3884561 DOI: 10.3205/psm000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Because of the fluctuating and occasional character of Crohn's disease (CD), patients have to cope with a changeable condition of health. Personal perceived control is known to be an important element of adaptation to their medical condition. The objectives of this work are to determine if perceived personal control is predictive of the clinical activity of the disease and of psychological distress (depression, anxiety). METHODS The Hospital Anxiety Depression Scale (HADS), the causal dimension scale and the Clinical Global Impression (CGI; assessing perceived severity) were administered to 160 patients affected by Crohn's disease. Indicators of inflammation (CRP), disease duration and clinical activity of the disease were also asessed. RESULTS Globally, CD patients perceive their disease as being personally neither controllable nor uncontrollable. Whereas psychological distress is significantly higher when the disease is active, the relationship between the variables appears complex. The feeling of personal control is explained by the clinical activity of the disease (p=.0001) and by the perception that CD is unstable (p<.00001) and globally impacts the life of patients (p=.001). Nevertheless perception of personal control does not explain the clinical activity of the disease. Finally, psychological distress is explained by the perception that the medical team is unable to control the disease (p=.00001) and by the global consequences of the disease on life (p<.005). CONCLUSIONS Psychological treatments should take these dimensions into account so as to improve the well-being and medical conditions of patients.
Collapse
Affiliation(s)
- Ingrid Banovic
- Laboratoire IPSé (EA 4432), Paris Ouest-Nanterre-La Défense, Université de Bourgogne, Pôle AAFE, Dijon, France
| | | | - Anne Andronikof
- Laboratoire IPSé (EA 4432), Paris Ouest-Nanterre-La Défense, France
| | - Ahmed Jebrane
- Institut Mathématiques de Bourgogne (IMB), UMR du CNRS, Université de Bourgogne, Dijon, France
| | - Ivan Ajdukovic
- SPMS (EA 4180), Université de Bourgogne, Pôle AAFE, Dijon, France
| | - Jaques Cosnes
- Service de Gastroentérologie et Nutrition, CHU Saint-Antoine, Université Pierre et Marie Curie, Paris VI, France
| |
Collapse
|
32
|
McCombie AM, Mulder RT, Gearry RB. Psychotherapy for inflammatory bowel disease: a review and update. J Crohns Colitis 2013; 7:935-49. [PMID: 23466412 DOI: 10.1016/j.crohns.2013.02.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psychotherapy may be a useful intervention for inflammatory bowel disease (IBD) patients. We systematically reviewed all randomized controlled trials that have been performed in psychotherapy for inflammatory bowel disease patients. METHODS Systematic searches were undertaken on 1 and 8 March, 2012 of studies of psychotherapy for IBD. RESULTS Eighteen studies (19 papers) were included in this review. Psychotherapy was found to have minimal effect on measures of anxiety, depression, QOL and disease progression although shows promise in reducing pain, fatigue, relapse rate and hospitalisation, and improving medication adherence. It may also be cost effective. CONCLUSIONS The effects of psychotherapy on IBD is mixed: future studies should determine whether patient screening or measuring different dependent variables improves outcomes and whether particular psychotherapies are superior over others.
Collapse
Affiliation(s)
- Andrew M McCombie
- Department of Medicine, University of Otago, Christchurch, New Zealand.
| | | | | |
Collapse
|
33
|
Knowles SR, Cook SI, Tribbick D. Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients. J Crohns Colitis 2013; 7:e471-8. [PMID: 23541738 DOI: 10.1016/j.crohns.2013.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/18/2013] [Accepted: 02/28/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Individuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort. METHODS Eighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). RESULTS Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (11)=12.86, p=0.30, χ(2)/N=1.17, SRMR<0.05, RMSEA<0.05, GFI>0.96, CFI>0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping. CONCLUSIONS The preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.
Collapse
Affiliation(s)
- S R Knowles
- Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia; Faculty of Medicine, Dentistry, & Health Sciences, The University of Melbourne, Melbourne, Australia; Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia.
| | | | | |
Collapse
|
34
|
Knowles SR, Gass C, Macrae F. Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: A preliminary exploration using Structural Equation Modeling. J Crohns Colitis 2013; 7:e344-50. [PMID: 23453888 DOI: 10.1016/j.crohns.2013.01.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/14/2013] [Accepted: 01/29/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS This study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD. METHODS Seventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale. RESULTS Exploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ(2) (25)=27.84, p=.32, χ(2)/N=1.11, CFI>0.99, RMSEA<0.04, SRMR<0.07, GFI>0.93). Illness perceptions had a significant direct influence on depression (β=0.49, p<0.001), anxiety (β=0.55, p<0.001), and family functioning (β=-0.17, p<0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction. CONCLUSIONS The findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.
Collapse
Affiliation(s)
- S R Knowles
- Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia.
| | | | | |
Collapse
|
35
|
Substantial impact of illness perceptions on quality of life in patients with Crohn's disease. J Crohns Colitis 2013; 7:e292-301. [PMID: 23218732 DOI: 10.1016/j.crohns.2012.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/11/2012] [Accepted: 11/10/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) negatively impact patients' health-related quality of life (HRQOL). We used the common sense model to examine the contribution of illness perceptions and coping to HRQOL, in addition to clinical and socio-demographic characteristics. This provides insight into potential targets for psychological interventions aimed at improving HRQOL. METHODS Consecutive CD patients undergoing colonoscopy were included. Disease activity was assessed by a clinical and an endoscopic index. Patients completed questionnaires assessing illness perceptions (IPQ-R), coping (Utrecht Coping List), self-perceived health, neuroticism, and HRQOL. Hierarchical multiple regression analyses were performed to assess the contribution of illness perceptions and coping to HRQOL. Illness perceptions were compared to patients with rheumatoid arthritis, myocardial infarction (MI), and head and neck cancer (HNC). RESULTS Of 82 CD patients, mean age was 42±14years. Clinical and endoscopic active disease was present in 42 (52%) and 49 (60%) patients, respectively. HRQOL was strongly impaired by clinical active disease (r=-0.79), self-perceived health (r=-0.60), and perceived consequences of CD (r=-0.54), but correlated poorly with endoscopic disease activity (r=-0.29). Illness perceptions significantly contributed 3-27% to HRQOL. Coping had no contributory role. CD patients perceived similarly strong consequences of their illness as patients with MI and HNC and had the strongest thoughts about the chronic nature of their illness. CONCLUSIONS CD has a similar impact on patients' daily lives as was observed in patients with MI and HNC. Illness perceptions contribute to HRQOL and should therefore be incorporated in clinical practice, thereby improving HRQOL.
Collapse
|
36
|
Schoultz M, Atherton I, Hubbard G, Watson AJ. Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease: a protocol for systematic review of prospective cohort studies. Syst Rev 2013; 2:8. [PMID: 23343187 PMCID: PMC3579756 DOI: 10.1186/2046-4053-2-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/07/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease is an idiopathic chronic disease that affects around 28 million people worldwide. Symptoms are distressing and have a detrimental effect on patients' quality of life. A possible link between exacerbation of symptoms and psychological factors has been suspected but not established. Previous reviews concerned with this link had conceptual and methodological limitations. In this paper we set out a protocol that lays the foundations for a systematic review that will address these shortcomings. The aim of this review is to provide researchers and clinicians with clarity on the role of psychological factors in inflammatory bowel disease symptom exacerbation. METHOD/DESIGN We will identify all original, published, peer reviewed studies relevant to the topic and published in English from inception to November 2012. The databases MEDLINE, EMBASE, CINAHL and PsychINFO will be systematically searched. The search terms will include: inflammatory bowel disease, Crohn's disease, ulcerative colitis, psychological stress, mental stress, life stress, family stress, hassles, social stress, coping, mood disorders, anxiety and depression in sequential combinations.Studies will be screened according to predetermined inclusion and exclusion criteria by two reviewers. We will include clinical prospective cohort studies of all human participants aged 18 years or over with a diagnosis of inflammatory bowel disease. All eligible papers will be independently and critically appraised using the Critical Appraisal Skills Programme (CASP) tool by two reviewers. Two reviewers will independently extract and synthesise data from the studies using a predefined data extraction sheet. Disagreements will be resolved by discussion between reviewers and a third party will be consulted if agreement is not reached. Synthesised data will be analysed using Bradford Hill criterion for causality. If data permits, meta-analysis will be performed. DISCUSSION This study will provide the most comprehensive review and synthesis of current evidence around the link between psychological factors and symptom exacerbation in inflammatory bowel disease. Results will inform clinicians in appropriate intervention development for this patient group that would reduce symptom exacerbation and therefore improve patients' quality of life.
Collapse
Affiliation(s)
- Mariyana Schoultz
- Centre for Health Science, School of Nursing, Midwifery and Health, University of Stirling, Inverness, Scotland, UK.
| | | | | | | |
Collapse
|
37
|
von Rimscha S, Moergeli H, Weidt S, Straumann D, Hegemann S, Rufer M. Alexithymia and health-related quality of life in patients with dizziness. Psychopathology 2013; 46:377-83. [PMID: 23296255 DOI: 10.1159/000345357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 09/29/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alexithymia is a personality trait characterized by deficits in regulating, experiencing and verbalizing emotions and has been assumed to be associated with a tendency to express emotional arousal through somatization. Although such a tendency is often observed in patients with dizziness, the exact relationship of alexithymia to dizziness is not yet known. The aim of this study was to examine alexithymic characteristics in patients with dizziness and its relation to health-related quality of life (HRQoL). SAMPLING AND METHODS We assessed 208 patients from an interdisciplinary center for vertigo and balance disorders for characteristics of alexithymia (20-item Toronto Alexithymia Scale), HRQoL (Short-Form 12 Health Survey, SF-12), dizziness (Dizziness Handicap Inventory), depression and anxiety (Hospital Anxiety and Depression Scale). Hierarchical regression analyses were used to evaluate the relationship between alexithymia, dizziness and HRQoL. RESULTS We found that difficulties in identifying and describing feelings, two important factors of alexithymia, were significantly related to more severe symptoms of dizziness. More pronounced alexithymic characteristics were associated with lower HRQoL, especially in the mental dimension of the SF-12. The results remained significant after controlling for possibly confounding variables such as socioeconomic status and depression. CONCLUSIONS These findings contribute to a better understanding of affect regulation in patients with dizziness, which is important for the development of psychotherapeutic interventions suitable for alexithymic patients with dizziness.
Collapse
Affiliation(s)
- Sonja von Rimscha
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
38
|
Psychological issues in inflammatory bowel disease: an overview. Gastroenterol Res Pract 2012; 2012:106502. [PMID: 22778720 PMCID: PMC3388477 DOI: 10.1155/2012/106502] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/18/2012] [Accepted: 04/19/2012] [Indexed: 12/20/2022] Open
Abstract
Inflammatory bowel disease (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) is a chronic and disabling disease with unknown etiology. There have been some controversies regarding the role of psychological factors in the course of IBD. The purpose of this paper is to review that role. First the evidence on role of stress is reviewed focusing on perceived stress and patients' beliefs about it in triggering or exacerbating the course of IBD. The possible mechanisms by which stress could be translated into IBD symptoms, including changes in motor, sensory and secretory gastrointestinal function, increase intestinal permeability, and changes in the immune system are, then reviewed. The role of patients' concerns about psychological distress and their adjustment to disease, poor coping strategies, and some personality traits that are commonly associated with these diseases are introduced. The prevalence rate, the timing of onset, and the impact of anxiety and depression on health-related quality of life are then reviewed. Finally issues about illness behavior and the necessity of integrating psychological interventions with conventional treatment protocols are explained.
Collapse
|
39
|
Iglesias-Rey M, Barreiro-de Acosta M, Caamaño-Isorna F, Vázquez Rodríguez I, Lorenzo González A, Bello-Paderne X, Domínguez-Muñoz JE. Influence of alexithymia on health-related quality of life in inflammatory bowel disease: are there any related factors? Scand J Gastroenterol 2012; 47:445-53. [PMID: 22300356 DOI: 10.3109/00365521.2012.654403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Alexithymia is a personality trait characterized by difficulty to perceive and express emotions. Previous studies have indicated a high prevalence of alexithymia in patients with inflammatory bowel disease (IBD) but results have been inconsistent. The aim of the present study was to investigate the prevalence of alexithymia in a large IBD cohort and to establish the impact of alexithymia on health-related quality of life (HRQOL) in these patients. MATERIAL AND METHODS A cross-sectional prospective study was undertaken including 534 consecutive IBD patients. Independent variables were measured using one socio-demographic and clinical questionnaire, the hospital anxiety and depression scale (HADS) and the Toronto alexithymia scale (TAS-26). Dependent variables were measured using the short form 36 health survey (SF-36) and the inflammatory bowel disease questionnaire (IBDQ-36). Multiple linear regression and logistic regression were performed to identify factors associated with HRQOL. RESULTS Participation rate was 91.3%. The overall prevalence of alexithymia was 30.2% (95% CI: 26.0-35.0), with no difference between Crohn's disease and ulcerative colitis. The most affected scales in quality of life were general health (mean = 48.35, 95% CI: 46.43-50.27), vitality (mean = 55.81, 95% CI: 53.59-58.04) and systemic symptoms (mean = 5.19, 95% CI: 5.08-5.29). Alexithymia was significantly associated with an impaired quality of life (OR = 3.34, 95% CI: 1.98-5.65). "Difficulty identifying feelings" and "externally oriented thinking" were the alexithymia factors related to the impaired HRQOL. CONCLUSIONS Alexithymia is highly prevalent in IBD and represents a significant determinant of HRQOL. Alexithymia and its components need to be taken into consideration in the management of IBD patients.
Collapse
Affiliation(s)
- Marta Iglesias-Rey
- Foundation for Research in Digestive Diseases (FIENAD), Santiago de Compostela, Spain
| | | | | | | | | | | | | |
Collapse
|
40
|
Knowles SR, Wilson JL, Connell WR, Kamm MA. Preliminary examination of the relations between disease activity, illness perceptions, coping strategies, and psychological morbidity in Crohn's disease guided by the common sense model of illness. Inflamm Bowel Dis 2011; 17:2551-7. [PMID: 21425208 DOI: 10.1002/ibd.21650] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 12/17/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND An individual's psychological adjustment to illness is influenced by disease severity, illness perceptions, and coping strategies. A more precise understanding of the contribution of each of these factors to a patient's well-being may influence the kind of psychological support required by patients. This study therefore aimed to characterize the contributors to psychological well-being in patients with Crohn's disease (CD). The design was a cross-sectional questionnaire-based study. METHODS Ninety-six CD patients (34 males, 62 females, mean age 38 years) attending a tertiary hospital inflammatory bowel disease outpatient clinic were studied. Disease severity was evaluated according to the Crohn's Disease Activity Index (CDAI), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). RESULTS Combining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ(2) (7) = 10.42, P = 0.17, χ(2) /N = 1.49, root mean square error of approximation (RMSEA) < 0.07, comparative fit index (CFI) > 0.97, Goodness-of-fit index (GFI) > 0.97). Disease activity had a significant direct influence on illness perceptions (β = 51, P < 0.001). In turn, illness perceptions had a significant direct influence on depression and anxiety (β = 41, P < 0.001, β = 0.40, P < 0.001, respectively). Use of emotional coping strategies was associated significantly (P < 0.001) with the presence of anxiety and depression. CONCLUSIONS There is an interrelationship between disease activity, illness perceptions, coping strategies, and depression and anxiety. These aspects of psychological processing provide a framework and direction for the psychological support that patients with CD require.
Collapse
Affiliation(s)
- S R Knowles
- Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia.
| | | | | | | |
Collapse
|
41
|
Flett GL, Baricza C, Gupta A, Hewitt PL, Endler NS. Perfectionism, psychosocial impact and coping with irritable bowel disease: a study of patients with Crohn's disease and ulcerative colitis. J Health Psychol 2011; 16:561-71. [PMID: 21346015 DOI: 10.1177/1359105310383601] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The current research examined trait perfectionism, perfectionistic self-presentation, coping styles and sickness impact in 51 patients with either ulcerative colitis or Crohn's disease. Our results confirmed that trait perfectionism and perfectionistic self-presentation were associated with greater sickness impact. Moreover, the link between perfectionism and the psychosocial impact of illness was still evident after controlling for neuroticism, optimism and the physical impact of the disease. Perfectionism was also associated with emotional preoccupation coping. The results suggest that perfectionism is a factor that is associated with maladaptive coping and it amplifies the reported impact of irritable bowel diseases.
Collapse
|
42
|
Oliveira FM, Emerick APDC, Soares EG. Aspectos epidemiológicos das doenças intestinais inflamatórias na macrorregião de saúde leste do Estado de Minas Gerais. CIENCIA & SAUDE COLETIVA 2010; 15 Suppl 1:1031-7. [DOI: 10.1590/s1413-81232010000700009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 02/25/2008] [Indexed: 01/08/2023] Open
Abstract
A doença de Crohn e a colite ulcerativa são entidades clínicas distintas, porém relacionadas, que se incluem no grupo das doenças intestinais inflamatórias. Esse artigo trata-se de um estudo epidemiológico a fim de descrever a produção do conhecimento em doenças inflamatórias intestinais, levando em consideração os casos de internações registrados, decorrentes do agravamento da doença, nas unidades de saúde da macrorregião de saúde leste do Estado de Minas Gerais. As doenças inflamatórias intestinais são consideradas um dos grandes problemas da população moderna, uma vez que geram repercussões importantes na qualidade de vida de seus portadores, acarretando alterações no âmbito social, psicológico e profissional. Durante o período de 1998 a 2005, foram registradas 363 internações hospitalares, em função das doenças intestinais inflamatórias, distribuídas em 184 e 179 casos nos gêneros masculino e feminino, respectivamente. Em função da escassez de estudos e do número de internações na macrorregião leste do Estado de Minas Gerais, pesquisas devem ser conduzidas a fim de delinear o perfil dos pacientes portadores de doenças inflamatórias intestinais, bem como detectar as possíveis alterações biopsicossociais a fim de promover uma assistência multiprofissional, humanizada e baseada em evidências.
Collapse
|
43
|
Psychological distress, somatization, and defense mechanisms associated with quality of life in inflammatory bowel disease patients. Dig Dis Sci 2010; 55:724-32. [PMID: 19255844 DOI: 10.1007/s10620-009-0762-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 02/03/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical parameters predict health-related quality of life (HRQOL) in inflammatory bowel disease (IBD), but some patients have impaired HRQOL despite being in clinical remission. OBJECTIVE To identify personality and psychological distress variables associated with HRQOL in IBD. METHOD In a cross-sectional study of 185 IBD patients, the General Health Questionnaire, the Hopkins' Symptoms Distress Checklist, the Defense Style Questionnaire and the Life Style Index were administered. The Inflammatory Bowel Disease Questionnaire was used for the assessment of HRQOL. RESULTS Psychological distress was associated with impaired HRQOL in a dose-response fashion. Somatization mediated the relationships of anxiety and depression with HRQOL. Few years of education, more extensive use of the reaction-formation defense mechanism and higher rates of somatization were the variables most closely and independently associated with impaired HRQOL. CONCLUSIONS Somatization and reaction-formation are independent correlates of disease-specific HRQOL in IBD patients, and this could be relevant to psychological interventions.
Collapse
|
44
|
|
45
|
Gili M, Bauzà N. [Quality of life and personality in inflammatory bowel disease]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32 Suppl 2:3-8. [PMID: 19900621 DOI: 10.1016/s0210-5705(09)72598-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present article reviews recent studies analyzing the association between health-related quality of life (HRQoL) and personality in inflammatory bowel disease (IBD). HRQoL is especially important in chronic diseases, since the strategic goals of treatment are to relieve symptoms, delay progression and improve functional quality. Some studies show that HRQoL in patients with IBD is significantly lower than that in the general population. Few studies have analyzed the association between personality and IBD and the results are contradictory. The most prevalent personality disorders in IBD are avoidant personality disorder and obsessive-compulsive personality disorder. Some results of a longitudinal study corroborating impaired HRQoL in these patients and the presence of one or more personality disorders in 57% of the sample are discussed.
Collapse
Affiliation(s)
- Margarita Gili
- Instituto Universitario de Investigación en Salud, Universitat de les Illes Balears, Palma de Mallorca, España.
| | | |
Collapse
|
46
|
Karwowski CA, Keljo D, Szigethy E. Strategies to improve quality of life in adolescents with inflammatory bowel disease. Inflamm Bowel Dis 2009; 15:1755-64. [PMID: 19472359 DOI: 10.1002/ibd.20919] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Inflammatory bowel disease (IBD), which encompasses Crohn's disease (CD) and ulcerative colitis (UC), are chronic and debilitating conditions with unpredictable courses and complicated treatment. Pediatric IBD carries implications that extend beyond the health of the gastrointestinal tract. When these lifelong illnesses are diagnosed during adolescence, a critical developmental period, the transition to adulthood can be even more turbulent. Like other chronic diseases of childhood, patients with IBD are at risk for depression, anxiety, social isolation, and altered self-image, which can all negatively affect health-related quality of life (HRQOL). The review will draw from pertinent adult and pediatric literature about HRQOL over the past 10 years using a PubMed literature search to summarize instruments with which HRQOL is measured, and address factors that affect HRQOL in adolescents and young adults with IBD. Psychosocial interventions that have been utilized to improve quality of life in this population will also be covered. Identifying patients with impaired quality of life is of paramount importance, as is implementing strategies that may improve HRQOL, so that they may have an easier transition to adulthood while living with IBD.
Collapse
Affiliation(s)
- Christine A Karwowski
- Children's Hospital of Pittsburgh, Division of Gastroenterology, Pittsburgh, Pennsylvania 15213, USA
| | | | | |
Collapse
|
47
|
Hall PA, Rodin GM, Vallis TM, Perkins BA. The consequences of anxious temperament for disease detection, self-management behavior, and quality of life in Type 2 diabetes mellitus. J Psychosom Res 2009; 67:297-305. [PMID: 19773022 DOI: 10.1016/j.jpsychores.2009.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 02/28/2009] [Accepted: 05/27/2009] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study is to examine the consequences of anxious temperament for disease detection, self-management behavior, and quality of life in Type 2 diabetes mellitus (T2DM). METHOD A sample of 204 individuals newly diagnosed with T2DM completed measures of anxious temperament, self-management behavior, and quality of life; participants also supplied a blood sample for glycated hemoglobin (A1C) analysis at initial diagnosis (baseline) and at 6-month follow-up (as indicators of disease progression at diagnosis and achieved glycemic control, respectively). RESULTS Anxious temperament was inversely associated with A1C at both baseline and at 6-month follow-up. However, the association between anxious temperament and A1C at follow-up was mostly accounted for by the association between anxious temperament and baseline A1C and not by the uptake of self-management behaviors after diagnosis. Higher levels of anxious temperament were also associated with an increased likelihood of having been diagnosed with a prediabetic condition but were associated with poorer quality of life at both time points. CONCLUSION Anxious temperament appears to be a double-edged sword that may facilitate early detection but not subsequent behavioral or emotional adjustment to T2DM.
Collapse
|
48
|
Boye B, Lundin KEA, Leganger S, Mokleby K, Jantschek G, Jantschek I, Kunzendorf S, Benninghoven D, Sharpe M, Wilhelmsen I, Blomhoff S, Malt UF, Jahnsen J. The INSPIRE study: do personality traits predict general quality of life (Short form-36) in distressed patients with ulcerative colitis and Crohn's disease? Scand J Gastroenterol 2009; 43:1505-13. [PMID: 18777439 DOI: 10.1080/00365520802321196] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the role of personality as a predictor of Short form-36 (SF-36) in distressed patients (perceived stress questionnaire, PSQ) with ulcerative colitis (UC) and Crohn's disease (CD). MATERIAL AND METHODS Fifty-four patients with CD and 55 with UC (age 18-60 years) who had relapsed in the previous 18 months, i.e. with an activity index (AI) for UC or CD> or =4, PSQ> or =60, and without severe mental or other major medical conditions, completed the Buss-Perry Aggression Questionnaire (BPA), the Neuroticism and Lie scales of the Eysenck Personality Questionnaire (EPQ-N and -L), the Multidimensional Health Locus of Control Scale (LOC) (Internal (I), Powerful Other (PO), Chance (C)), the Toronto Alexithymia Scale (TAS) and the SF-36. RESULTS Multiple linear regression analyses controlling for gender, age and clinical disease activity (AI) in separate analyses for UC and CD showed that the mental and vitality subscales were predicted by neuroticism in both UC and CD. The highest explained variance was 43.8% on the "mental" subscale in UC. The social function subscale was related to alexithymia only in UC, while the role limitation and pain subscales were related to personality in CD only. The physical function subscale related differently to personality in UC and CD. CONCLUSIONS While mental and vitality subscales were predicted by neuroticism in both UC and CD, other subscales had different relationships to personality, suggesting different psychobiological interactions in UC and CD.
Collapse
Affiliation(s)
- Birgitte Boye
- Institute of Psychiatry, University of Oslo, Norway.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Banovic I, Gilibert D, Cosnes J. Perception of improved state of health and subjective quality of life in Crohn's disease patients treated with Infliximab. J Crohns Colitis 2009; 3:25-31. [PMID: 21172244 DOI: 10.1016/j.crohns.2008.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 10/23/2008] [Accepted: 10/23/2008] [Indexed: 02/08/2023]
Abstract
UNLABELLED BACKGROUND AND AIMS AND METHOD: Although Infliximab is a very potent therapy of refractory Crohn's disease, its administration requires iterative infusions in hospital and there are concerns regarding its long-term safety. The aim of this study was to assess in a sample of 51 patients suffering from CD the impact of type of treatment (intravenous Infliximab versus conventional therapy without Infliximab) on the evaluation of the state of health (CGI) and the quality of life (MOS-SF36). Secondary variables were also assessed: the impact of depression (MADRS), the impact of activity of the disease (Harvey-Bradshaw Index). RESULTS Overall, the assessments made using the CGI and the SF-36 revealed that the two types of treatment did not differ on the assessment of state of health and quality of life. A downward influence of depression and activity of the disease was observed. CONCLUSION Patients considered more efficacy of Infliximab than its potential side effects. It seems important to assess and to consider depression in order to improve medical care setting of Crohn's disease.
Collapse
Affiliation(s)
- Ingrid Banovic
- Université de Bourgogne, Equipe Ipsé-Université P10-Nanterre (EA3984), France
| | | | | |
Collapse
|
50
|
Aszalós Z. [Neurological and psychiatric aspects of some gastrointestinal diseases]. Orv Hetil 2008; 149:2079-86. [PMID: 18952527 DOI: 10.1556/oh.2008.28480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The gastrointestinal tract is controlled by the independent enteric nervous system. It is also closely connected to the central nervous system, and bi-directional communication exists between them. The communication involves neural pathways as well as immune and endocrine mechanisms. The brain-gut axis plays a prominent role in the modulation of gut functions. Signals from different sources (e.g. sound, sight, smell, somatic and visceral sensations, pain) reach the brain. These inputs are modified by memory, cognition and affective mechanisms and integrated within the neural circuits of the central nervous system, spinal cord, autonomic and enteral nervous systems. These inputs can have physiologic effects, such as changes in motility, secretion, immune function, and blood flow to the gastrointestinal tract. One of the most important neurotransmitters is serotonin that plays a key role in the pathogenesis of the most common chronic functional gastrointestinal disorder: the irritable bowel syndrome. It is a biopsychosocial disease, resulting from the dysregulation of the brain-gut axis. Endogenous pain facilitation rather than inhibition, pathologic gradation of visceral perception and reduced threshold for pain are all evident in these patients. Abuse history is common in their anamnesis. Exaggerated conscientiousness, perfectionism, oversensitivity, feeling of deficiency in effectiveness, and higher demand for social parity, neuroticism and alexithymia have been detected among their constant personality features. Females are also characterized by gender role conflict and low assertiveness. Antidepressants and psychotherapy have important roles in their treatment. Also patients with inflammatory bowel disease are characterized by neuroticism and alexithymia and altered mother-child attachment is often described in their anamnesis. Autonomic neuropathy is a frequent and early neurological complication. Reflux disease and obstructive sleep apnea mutually generate each other and their severities significantly correlate. In the celiac disease the most common neurological manifestations are ataxia, peripheral neuropathy and myopathy. Up to 85% of patients with histologically proven coeliac disease have no gastrointestinal symptoms; consequently, measurement of antigliadin antibody titre is therefore vital in all cases of idiopathic ataxia. Complete resolution of neurological symptoms is the result of gluten-free diet.
Collapse
Affiliation(s)
- Zsuzsa Aszalós
- Semmelweis Egyetem, Altalános Orvostudományi Kar, II. Belgyógyászati Klinika, Budapest.
| |
Collapse
|