Maternal correlates of health status in adolescents with inflammatory bowel disease

Fatigue in pediatric inflammatory bowel diseases: A systematic review and a single center experience

OBJECTIVES

We aimed to review the literature on fatigue in pediatric inflammatory bowel diseases (PIBD), to explore how it is measured, and approximate its rate in an inception pediatric cohort.

METHODS

Studies on fatigue were systematically reviewed and selected by two authors. Next, we retrieved the two fatigue-related questions of the IMPACT-III questionnaire at 4 and 12 months after diagnosis from a prospectively maintained cohort of PIBD patients, each scoring 0-100 (lower scores imply more fatigue), and 44 healthy controls.

RESULTS

The systematic review identified 14 studies reporting fatigue in children, of which nine had fatigue as the primary outcome and only two provided rates of fatigue. No standalone index was identified for measuring fatigue specifically for PIBD. Of 80 children included in the inception cohort, 62 (78%) scored an average of ≤75 on the two IMPACT-III questions (approximating at least mild fatigue), 26 (33%) scored ≤50 (at least moderate fatigue) and nine (11%) scored ≤25 (severe fatigue). In comparison, only four (9%) healthy children scored at least moderate fatigue (p = 0.007). Fatigue rates at 12 months were only slightly and nonsignificantly lower. Fatigue of any severity was reported in 92% children with active disease versus 63% of those in clinical remission (p = 0.01).

CONCLUSION

Literature reporting on fatigue in PIBD is scarce, and no PIBD-specific tool is available to measure fatigue. In our cohort, fatigue-related questions were frequently scored low in children with IBD, mainly among children with active disease but also during clinical remission.

Parent and Family Functioning in Pediatric Inflammatory Bowel Disease

Although the impact of pediatric inflammatory bowel disease (IBD) extends beyond the patient to their parents and families, the focus of previous literature has largely been on investigating the patient’s medical and psychosocial functioning, with less consideration of the family system. Having a comprehensive understanding of parent and family functioning within the context of pediatric IBD is important given the role parents and family members have in the successful management of the disease and caring of the child. The current review paper aggregates the empirical research regarding parent and family functioning, including comparisons to normative samples, other illness groups, and how functioning relates to child psychosocial and health outcomes. Extant literature on parents and families in pediatric IBD has largely focused on the variables of parenting stress, parent psychosocial functioning, parent quality of life, and family functioning. Summary findings elucidate the complex relationships between parents, families, and children affected by IBD and highlight the importance of assessing parent and family functioning within pediatric IBD. The current review also offers implications for clinical practice, notes the limitations of the present literature, and provides recommendations for future research.

Parental Psychological Factors and Quality of Life of Children With Inflammatory Bowel Disease

OBJECTIVES

Parents have a central role in the management of children with inflammatory bowel disease (IBD). Alterations in parental psychological well-being may affect the patient's health-related quality of life (HRQoL). This study aimed to evaluate the correlation between maternal and paternal distress, anxiety, depression and pain catastrophizing and the HRQoL of patients with IBD.

METHODS

Children with IBD ages 8 to 18 years and their parents were prospectively recruited. Children answered questionnaires on HRQoL while parents completed an assessment of distress, anxiety, depression, and pain catastrophizing. Univariate and multivariate regression models analysis were used to evaluate correlations between parental measures and patient's HRQoL and between the factors related to children health and parental psychological suffering.

RESULTS

One hundred patients (45 Crohn disease, 55 ulcerative colitis), 90 mothers and 62 fathers were enrolled. Parents had high levels of distress while anxiety, depression, and pain catastrophizing levels were relatively low. Parental distress had the most substantial correlation with children's HRQoL and was associated with patients' disease activity and recent flares. On multivariate regression analysis, parental factors explained less than 20% of the variance in the children's HRQoL scores. Mothers suffered from psychological alterations more frequently than fathers, but the parental inter-rater agreement was strong in regards to distress and anxiety.

CONCLUSIONS

Parental distress is high and correlates with the HRQoL of children with IBD. Interventions aimed at evaluating and managing parental distress should be considered during the management of children with IBD.

Coping Among Parents of Teens With Inflammatory Bowel Disease

Parents of teens with inflammatory bowel disease must prepare their children for independent disease self-management. This study characterizes the stressors and coping strategies adopted among parents of teens with inflammatory bowel disease. Teens aged 16-22 years with inflammatory bowel disease who were consecutively seen by a pediatric gastroenterologist prior to transition to adult-centered care and their parents completed sociodemographic data, and two validated questionnaires for coping (Coping Health Inventory for Parents) and stress (Pediatric Inventory for Parents). Sixty-six patient-parent pairs were enrolled in this study-impairment was highest in role function (e.g., trying to attend to the needs of other family members, being unable to go to work, and feeling uncertain about how to maintain consistent discipline). These concerns seemed to be most pronounced among parents of children 18 years and older (χ (df) = 1, p = .04) with Crohn disease (χ (df) = 1, p = .02). The top five listed concerns differed depending on the caregiver's gender. Parents of teens with inflammatory bowel disease are concerned about parenting role function. Parents of teens 18 years and older with Crohn disease reported the highest stress. Caregiver gender differences were noted.

Stressful life events and psychosocial correlates of pediatric inflammatory bowel disease activity

AIM

To investigate the association of psychiatric and psychosocial correlates with inflammatory bowel disease (IBD) activity in children and adolescents.

METHODS

A total of 85 pediatric IBD patients (in remission or active state of the disease) and their parents completed a series of questionnaires and semi-structured interviews measuring life events, depression, anxiety, family dysfunction, and parent mental health. Differences between the remission and the IBD active group and the association of any significant variable with the disease activity state were examined.

RESULTS

Parents of children being in active state of the disease reported more life events (P = 0.005) and stressful life events (P = 0.048) during the past year and more mental health symptoms (P < 0.001), while the children themselves reported higher levels of anxiety symptoms (P = 0.017) compared to the remission group. In the logistic regression multivariate analysis, the only predictor which had a significant positive effect on the probability of the patients being in active state was parent mental health symptoms (OR = 4.8; 95%CI: 1.2-25.8).

CONCLUSION

Life events, child anxiety and parent mental health symptoms may be important correlates of pediatric IBD activity and targets of thorough assessment and treatment.

Connecting Families: A Pediatric IBD Center's Development and Implementation of a Volunteer Parent Mentor Program

It is estimated that over one million people are living with inflammatory bowel disease (IBD) in the United States and that 20-25% of those are children. Pediatric IBD presents with more severe and extensive disease when compared to adults. As with all pediatric chronic illnesses, the patient as well as their parents and siblings are impacted by this diagnosis. Parents often feel afraid, isolated, stressed, angry, guilty, and overwhelmed when their child is diagnosed. Often, there is lack of structured support systems within the healthcare system to meet the complex needs of these families and they are often looking for support outside of the medical setting. Utilization of trained parent mentors as a source of support to newly diagnosed families is one method of addressing these needs. With minimal additional resources, we describe the feasibility of the development and implementation of a volunteer, parent mentoring program that went from an IBD-patient focused program to one that rapidly expanded to a hospital-wide program involving more than 200 mentors matched to over 300 mentees within a 2-year period.

Family Functioning and the Well-Being of Children With Chronic Conditions: A Meta-Analysis

For children with chronic conditions, well-being is closely related to how well their families function. Most prior research syntheses on family functioning and child well-being have focused on children with a single condition, thereby limiting the potential to aggregate and build on what is known across conditions. To address this challenge, research reports were reviewed and meta-analyses conducted of findings on the relationship between family functioning and child well-being across a range of chronic physical conditions. The sample was derived from a larger systematic review study that included 1,028 reports published between January 1, 2000 and March 31, 2014. The current review includes 53 studies in which a relationship between family functioning and child well-being was analyzed using one of four family measures: Family Adaptability and Cohesion Evaluation Scales, Family Environment Scale, Family Relationship Index, or Family Assessment Device. Most studies were cross-sectional and observational (n = 43, 81%). The most frequently studied conditions were diabetes, cancer, sickle cell disease, and asthma. In 37 studies, findings were sufficiently comparable to conduct meta-analyses. Significant correlations were identified between children's psychological health and seven of nine dimensions of family functioning. Significant correlations also were found between dimensions of family functioning and children's problem behaviors, social competence, quality of life, and, to a lesser extent, adherence and physical health. Of the family dimensions, cohesion and conflict were associated most strongly with child outcomes. Understanding the specific family variables, such as conflict, linked to varied child outcomes is key for intervention development. © 2016 Wiley Periodicals, Inc.

Quality of Life in Swiss Paediatric Inflammatory Bowel Disease Patients: Do Patients and Their Parents Experience Disease in the Same Way?

BACKGROUND AND AIMS

Inflammatory bowel diseases (IBDs) may impair quality of life (QoL) in paediatric patients. We aimed to evaluate in a nationwide cohort whether patients experience QoL in a different way when compared with their parents.

METHODS

Sociodemographic and psychosocial characteristics were prospectively acquired from paediatric patients and their parents included in the Swiss IBD Cohort Study. Disease activity was evaluated by the Paediatric Crohn's Disease Activity Index (PCDAI) and the Paediatric Ulcerative Colitis Activity Index (PUCAI). We assessed QoL using the KIDSCREEN questionnaire. The QoL domains were analysed and compared between children and parents according to type of disease, parents' age, origin, education and marital status.

RESULTS

We included 110 children and parents (59 Crohn's disease [CD], 45 ulcerative colitis [UC], 6 IBD unclassified [IBDU]). There was no significant difference in QoL between CD and UC/IBDU, whether the disease was active or in remission. Parents perceived overall QoL, as well as 'mood', 'family' and 'friends' domains, lower than the children themselves, independently of their place of birth and education. However, better concordance was found on 'school performance' and 'physical activity' domains. Marital status and age of parents significantly influenced the evaluation of QoL. Mothers and fathers being married or cohabiting perceived significantly lower mood, family and friends domains than their children, whereas mothers living alone had a lower perception of the friends domain; fathers living alone had a lower perception of family and mood subscores.

CONCLUSION

Parents of Swiss paediatric IBD patients significantly underestimate overall QoL and domains of QoL of their children independently of origin and education.

Shorter time since inflammatory bowel disease diagnosis in children is associated with lower mental health in parents

AIM

This study assessed the mental health of parents of children with inflammatory bowel disease (IBD), compared their mental health with age-matched and gender-matched references and examined parental and child predictors for mental health problems.

METHODS

A total of 125 mothers and 106 fathers of 125 children with active and inactive IBD from the Swiss IBD multicentre cohort study were included. Parental mental health was assessed by the Symptom Checklist 27 and child behaviour problems by the Strengths and Difficulties Questionnaire. Child medical data were extracted from hospital records.

RESULTS

While the mothers reported lower mental health, the fathers' mental health was similar, or even better, than in age-matched and gender-matched community controls. In both parents, shorter time since the child's diagnosis was associated with poorer mental health. In addition, the presence of their own IBD diagnosis and child behaviour problems predicted maternal mental health problems.

CONCLUSIONS

Parents of children with IBD may need professional support when their child is diagnosed, to mitigate distress. This, in turn, may help the child to adjust better to IBD. Particular attention should be paid to mothers who have their own IBD diagnosis and whose children display behaviour problems.

Focus groups for developing a peer mentoring program to improve self-management in pediatric inflammatory bowel disease

OBJECTIVES

Inflammatory bowel disease (IBD) presents challenges for self-management in many areas. A peer mentoring program may offer advantages over other forms of self-management interventions because youth may be more receptive to learning self-management skills from a peer than from a parent or professional. The purpose of the present study was to identify themes from focus groups to inform development of a peer mentoring program for improving self-management in pediatric IBD.

METHODS

Focus groups were conducted for youth ages 12 to 17, stratified by age (3 groups; n = 14), young adults ages 18 to 20 (1 group; n = 5), and parents of the youth (3 groups; n = 17). Broad questions covered program goals, general program characteristics, mentor/mentee characteristics, and family involvement, and transcriptions were analyzed via directed content analysis, with the a priori codes specified as the broad questions above.

RESULTS

Participants identified the primary goals of a program as support, role model, information/education, and fun. They described a program that would include a year-long, 1-on-1 mentor relationship with a peer who has had IBD for at least a year, educational group activities, fun activities that are not focused on IBD, expectations for in-person contact 1 to 2 times per month, and mentor-to-mentor and parent support.

CONCLUSIONS

Many of the suggestions from the focus groups correspond with research findings associated with successful mentoring programs. Using participants' suggestions and empirically based best practices for mentoring may result in an effective peer mentoring program for improving self-management in youth with IBD.

Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome

Irritable bowel syndrome (IBS) is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role. The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors, interacting with peripheral/central neuroendocrine and immune changes, may induce symptoms of IBS, modulate symptom severity, influence illness experience and quality of life, and affect outcome. The present review focuses on the role of negative affects, including depression, anxiety, and anger, on pathogenesis and clinical expression of IBS. The potential role of the autonomic nervous system, stress-hormone system, and immune system in the pathophysiology of both negative affects and IBS are taken into account. Psychiatric comorbidity and subclinical variations in levels of depression, anxiety, and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS, such as sensorimotor functions, gut microbiota, inflammation/immunity, and symptom reporting.

Assessing psychosocial risk in pediatric inflammatory bowel disease: validation of the Psychosocial Assessment Tool 2.0_General

AIM

The aim of this study was to present the preliminary psychometric properties of the Psychosocial Assessment Tool 2.0_General (PAT2.0_GEN), a brief screener for psychosocial risk in families of children with inflammatory bowel disease (IBD).

METHODS

Caregivers of 42 youth with IBD were recruited and administered a battery of measures including the PAT2.0_GEN and well-validated measures of child emotional and behavioral functioning at baseline and at a 6-month follow-up.

RESULTS

Internal consistency for the PAT2.0_GEN total score was good (α=0.82). Baseline was significantly associated with the 6-month follow-up (r=0.79, P<0.001). Significant correlations between the baseline PAT2.0 _GEN total score and caregiver-reported Child Behavior Checklist total scores at baseline (r=0.74, P<0.001) and at a 6-month follow-up (r=0.62, P<0.001) support the content and predictive validity of the PAT2.0_GEN. Baseline PAT2.0_GEN was also significantly correlated with youth-reported Child Behavior Checklist total scores at baseline (r=0.37, P=0.02) but not at the 6-month follow-up (r=0.23, P=0.17).

CONCLUSIONS

A number of indicators support the concurrent and predictive utility of the PAT2.0_GEN. The PAT2.0_GEN is a promising tool for screening psychosocial risk that could facilitate the provision of psychosocial services to those patients most in need.

Parenting stress in pediatric IBD: relations with child psychopathology, family functioning, and disease severity

OBJECTIVE

Parenting stress in pediatric inflammatory bowel disease (IBD) has been under-examined. Data validating use of the Pediatric Inventory for Parents (PIP), a measure of parenting stress associated with caring for a chronically ill child, in chronic diseases with intermittent, unpredictable disease courses, such as IBD, are needed. This study presents validity data in support of the PIP in pediatric IBD and examines relations between parenting stress and important psychosocial and medical outcomes.

METHODS

Adolescents (N = 130) with IBD and their caregivers across 3 sites completed measures of parenting stress, family functioning, and emotional/behavioral functioning. Disease severity was also assessed for each participant.

RESULTS

The PIP demonstrates excellent internal consistency. Parenting stress was significantly higher among those with unhealthy general family functioning and those with children with borderline or clinically elevated internalizing symptoms. Caregiving stress was greater among parents of youth with more active Crohn's disease.

CONCLUSION

Results supported the reliability and validity of the PIP for assessing caregiving stress in pediatric IBD. Routine assessment of parenting stress is recommended, particularly among parents reporting unhealthy family functioning and parents of youth with borderline or clinically elevated internalizing symptoms and more active disease.

Psychosocial issues in pediatric inflammatory bowel disease: report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

Pediatric inflammatory bowel disease (IBD) can affect many areas of psychosocial functioning, and comprehensive medical care includes consideration of psychosocial issues as well as disease factors. The purpose of this clinical report is to review research on psychosocial functioning in pediatric IBD and to provide recommendations for care providers in the areas of psychopathology, health-related quality of life, and social, family, and school functioning. Youth with IBD are at increased risk for difficulty in all areas reviewed, and many psychosocial factors are associated with disease activity, which highlights the importance of monitoring psychosocial functioning as part of clinical care. Several interventions have empirical support or show promise for addressing psychosocial difficulty, and recommendations for monitoring and treating these issues are provided.

Disability in inflammatory bowel disease

Disability can include different aspects of patient’s quality of life from physical to psychosocial to employment. Disability in IBD patients contributes to loss of workplace personnel, increased sick leave, and other indirect costs to society. Considerations for more expensive treatment regimens should include their potential to reduce indirect costs to the individual patients and to society in general. The recently developed tool could help establish specific criteria in a set of these diseases that have varied effects and severity.

Effects of guided imagery with relaxation training on anxiety and quality of life among patients with inflammatory bowel disease

BACKGROUND

Inflammatory Bowel Disease (IBD) impacts quality of life (QoL). Psychological factors influence the course of the disease and should be targeted for intervention.

METHODS

Our study was a prospective, randomised control trial. Fifty-six outpatients were randomly chosen and allocated to a treatment group or a waiting-list control group. Treatment group patients attended three relaxation-training sessions and received an audio disc for home practice. Evaluations performed pre and post-treatment: state anxiety was assessed with the State-Trait Anxiety Inventory, QoL with the IBD Questionnaire. The Visual Analogue Scale assessed pain, depression, stress and mood. Patients completed a symptom monitoring diary. The control group's symptoms were monitored without study-related treatment.

RESULTS

Thirty-nine subjects completed the study and were included in the data analysis. Following the relaxation-training intervention, the treatment group's (n = 18) measured results showed a statistically significant improvement as compared to the control group (n = 21) (time by treatment interaction): anxiety levels decreased (p < 0.01), QoL and mood improved (p < 0.05), while levels of pain and stress decreased (p < 0.01).

CONCLUSIONS

Findings indicate IBD patients may benefit from relaxation training in their holistic care. New studies as well as further investigation of the subject are warranted.

Inflammatory bowel disease

This article reviews the etiology, clinical characteristics, and treatment of inflammatory bowel disease (IBD) and associated psychological sequelae in children and adolescents with this lifelong disease. Pediatric-onset IBD, consisting of Crohn's disease and ulcerative colitis, has significant medical morbidity and in many young persons is also associated with psychological and psychosocial challenges. Depression and anxiety are particularly prevalent and have a multifaceted etiology, including IBD-related factors such as cytokines and steroids used to treat IBD and psychosocial stress. A growing number of empirically supported interventions, such as cognitive behavioral therapy, hypnosis, and educational resources, help youth and their parents cope with IBD as well as the psychological and psychosocial sequelae. While there is convincing evidence that such interventions can help improve anxiety, depression, and health-related quality of life, their effects on IBD severity and course await further study.

The contributions of child behavioral functioning and parent distress to family functioning in pediatric inflammatory bowel disease

The objective of this study was to examine the relative contributions of both parental and adolescent functioning to family functioning in adolescent patients with inflammatory bowel disease (IBD) and their families. Participants were 45 adolescents (27 male, 18 female) 13-17 years old (M = 15.41 years, SD = 1.32) with IBD and their parents. Families completed measures of patient behavioral functioning and depression, parent distress and family functioning. Disease severity assessments were completed via data provided by patients' gastroenterologists. Results indicated that parent-reported patient behavioral problems accounted for a significant 26% of variance in family functioning. Post-hoc analysis revealed that externalizing behavior problems accounted for the majority of this variance compared to internalizing behavior problems. These results suggest that externalizing problems may have a more significant impact on these families than previous research indicates. Moreover, externalizing behaviors may significantly impact family adaptation and should be taken into consideration during routine clinical care. Further research is needed to replicate and expand upon these findings.

Patient and parent psychosocial factors associated with health-related quality of life in pediatric inflammatory bowel disease

OBJECTIVES

The aim of the study was to examine the mediating role of youth depressive symptoms in the relation between parent distress and youth health-related quality of life (HRQOL) in a sample of adolescents with inflammatory bowel disease (IBD).

PATIENTS AND METHODS

Sixty-two adolescents, ages 13 to 17 years, with a confirmed diagnosis of IBD completed assessments of depressive symptoms and HRQOL. Each adolescent's primary caregiver completed a measure of parent stress related to his or her child's illness. Pediatric gastroenterologists provided data for disease severity assessments.

RESULTS

Multiple regression analyses revealed that adolescent depressive symptoms fully mediated the relation between parent distress and several dimensions of HRQOL (ie, general well-being, emotional functioning, social functioning, and total HRQOL). Moreover, mediation was observed after statistically controlling for the effect of disease severity, IBD diagnosis, and significant demographic parameters on HRQOL.

CONCLUSIONS

Findings suggest that adolescent depressive symptoms may serve as the mechanism through which parent distress is linked to poorer HRQOL in adolescents with IBD. Close monitoring of parent illness-related distress and adolescent depressive symptoms, as well as clinical interventions targeting these factors, is needed to promote optimal outcomes in adolescents with IBD.

Family functioning and health-related quality of life in adolescents with pediatric inflammatory bowel disease

OBJECTIVES

To examine the relationship between family functioning and health-related quality of life (HRQOL) in a sample of adolescents with inflammatory bowel disease (IBD), and to specify the domains of family functioning with which these families experience difficulties.

METHODS

Sixty-two adolescents, aged 13-17 years, with a confirmed diagnosis of IBD completed assessments of HRQOL. Each adolescent's primary caregiver completed a measure of family functioning. Pediatric gastroenterologists provided data for disease severity assessments.

RESULTS

A series of multivariate analyses of variance showed that adolescents from families with clinically elevated difficulties in problem solving, communication, and general family functioning endorsed lower HRQOL (i.e., social functioning, general well-being) after statistically controlling the effects of disease severity and diagnosis. As many as 25% of families reported clinically elevated difficulties across domains of family functioning.

CONCLUSIONS

Findings suggest that family functioning may be an important predictor of HRQOL among the adolescents with IBD, and that many families experience difficulties in their daily interactions. Close monitoring of family functioning may be a salient feature for prevention and intervention efforts and beneficial in promoting optimal psychosocial outcomes among the adolescents with IBD.

Coping skills for reducing pain and somatic symptoms in adolescents with IBD

BACKGROUND

The current study involved the development and evaluation of a skills-based, psychological intervention for adolescent females with inflammatory bowel disease (IBD) and their parents. Psychological interventions were used to improve coping with pain and other somatic physical symptoms, as well as improve parental responses to children and adolescents who experience such symptomatology.

METHODS

Thirteen and 11 adolescent females and one of their parents made up the treatment and wait-list control groups, respectively, for a total of 24 parent-child dyads. Adolescents and parents attended a 1-day intervention that taught disease-related coping skills, pain management, relaxation techniques, communication, and limit setting (parents only). The treatment day was followed by 6 weeks of Web-based skill review including homework assignments and weekly group chat sessions.

RESULTS

Following treatment, significant improvements were found in adolescents' somatic symptoms and adaptive coping strategies. Further, parents reported reductions in irrational thoughts and improved behavioral reactions related to their daughter's physical symptoms. Implications of these findings, as well as limitations and future directions, are discussed.

CONCLUSION

Overall, preliminary support suggests that programmatic psychosocial interventions for reducing physical symptoms and improving coping may be beneficial for adolescents with IBD and their families.

Functional disability in paediatric patients with recurrent abdominal pain

BACKGROUND

Recurrent abdominal pain (RAP) is common in childhood, affecting approximately 12% of children and adolescents. Children with RAP tend to experience impairments in functioning, such as increased school absences, anxiety and depression.

METHODS

The current study investigated the potential influences on the relation between functional disability and RAP in 100 school-aged children. A series of hierarchical regression analyses were conducted to test two models: main effects and moderation of the relation between abdominal pain symptoms, child anxiety, child depression, maternal emotional distress, maternal encouragement of child illness behaviour and functional disability.

RESULTS

The results indicated support for abdominal pain symptoms and child depression in predicting functional disability. The results also indicated that child anxiety and child depression each moderated the relation between pain symptoms and functional disability.

CONCLUSIONS

Implications of the findings are discussed in terms of potential influences on the development of functional disability in youth.

Inflammatory bowel disease

This article reviews the etiology, clinical characteristics, and treatment of inflammatory bowel disease (IBD) and associated psychological sequelae in children and adolescents with this lifelong disease. Pediatric-onset IBD, consisting of Crohn's disease and ulcerative colitis, has significant medical morbidity and in many young persons is also associated with psychological and psychosocial challenges. Depression and anxiety are particularly prevalent and have a multifaceted etiology, including IBD-related factors such as cytokines and steroids used to treat IBD and psychosocial stress. A growing number of empirically supported interventions, such as cognitive behavioral therapy, hypnosis, and educational resources, help youth and their parents cope with IBD as well as the psychological and psychosocial sequelae. While there is convincing evidence that such interventions can help improve anxiety, depression, and health-related quality of life, their effects on IBD severity and course await further study.

A meta-analytic review of the psychosocial adjustment of youth with inflammatory bowel disease

OBJECTIVE

To conduct a meta-analytic review of psychosocial adjustment of youth with inflammatory bowel disease (IBD).

METHODS

Nineteen studies with a total of 1167 youth with IBD (M age = 14.33, 50% female) were included. Effect size (ES) estimates were calculated for anxiety symptoms & disorders, depressive symptoms & disorders, internalizing symptoms & disorders, externalizing symptoms, quality of life (QOL), social functioning, and self-esteem. Separate ESs were calculated for comparisons between IBD and youth with chronic illnesses versus healthy youth.

RESULTS

Youth with IBD had higher rates of depressive disorders and internalizing disorders than youth with other chronic conditions. Youth with IBD had higher parent-reported internalizing symptoms, lower parent- and youth-reported QOL, and lower youth-reported social functioning compared to healthy youth.

CONCLUSIONS

Clinical attention to depressive disorders, QOL, and social functioning may be particularly salient in the context of pediatric IBD.

Strategies to improve quality of life in adolescents with inflammatory bowel disease

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.

Parental beliefs and worries regarding adolescent chronic pain

OBJECTIVES

To explore relationships between beliefs and worries held by parents of adolescents with chronic, nondisease specific, musculoskeletal pain and (1) parental pain promoting behaviors, (2) the adolescent's pain-related disability, (3) family functioning, and (4) parenting stress.

METHODS

A retrospective chart review was conducted for 138 adolescents with chronic musculoskeletal pain syndromes presenting at an outpatient pediatric multidisciplinary pain management clinic. Adolescents reported on pain, disability, and parental pain promoting behaviors. Parents reported on their beliefs about the cause of and their responsibility for the adolescent's pain, worry about the adolescent's physical and emotional/behavioral health, parental pain promoting behaviors, family functioning, and parenting stress.

RESULTS

Parental beliefs that the cause of the adolescent's pain was "medical only" significantly moderated the relationship between adolescent pain and disability. Adolescent disability was positively correlated with parental worry about the adolescent's physical, but not emotional/behavioral, health. Parental worries about both physical and emotional/behavioral health were positively correlated with parents' use of pain promoting behaviors. A positive relationship between poorer family functioning and parenting stress was found to be partially mediated by parent beliefs that the adolescent's pain was "medical only."

DISCUSSION

These findings provide insight into the complex interrelationships that exist among parents' beliefs and worries about adolescent pain, parental pain promoting behavior, adolescent disability, family functioning, and parenting stress that may have implications for treatment decisions made on the adolescent's behalf.

Psychological factors affecting pediatric inflammatory bowel disease

PURPOSE OF REVIEW

Psychological factors affecting pediatric inflammatory bowel disease, intervention and other therapeutic resources are reviewed.

RECENT FINDINGS

Children with inflammatory bowel disease are at risk for more difficulties in psychosocial functioning than healthy children, particularly depression, anxiety and social difficulties. Psychosocial difficulties are generally similar to those found in other pediatric chronic illnesses and are clinically significant in only a subset of those with inflammatory bowel disease. Conflicting results have been reported for the areas of family dysfunction and body image, and few studies have been published in the areas of stress/coping and eating disorders. One pilot study suggests psychotherapy is effective for depressed adolescents with inflammatory bowel disease.

SUMMARY

The scant existing research limits conclusions about which children are most at risk for experiencing problems. Future research should investigate a range of psychosocial outcomes and risk factors for developing problems. Prevention and intervention strategies aimed at improving psychosocial functioning in children with inflammatory bowel disease should be developed and evaluated.

Challenges and strategies of children and adolescents with inflammatory bowel disease: a qualitative examination

Background

The aims of this study were to understand the lived experience and elements of quality of life as depicted by children and adolescents with inflammatory bowel disease (IBD).

Methods

Eighty participants with IBD, ranging in age from 7 to 19 years, were interviewed about the impact of IBD on their daily lives.

Results

Findings demonstrated that IBD profoundly affects children and adolescents. These young patients experience concerns and discomfort as a result of IBD symptoms and treatments. They commonly feel, in varying degrees, a sense of vulnerability and diminished control over their lives and future, and perceive themselves as "different" from healthy peers and siblings. Despite these negative impacts, participants also described effective means of coping with IBD, and reported that support from family members and friends contributes to coping. A positive attitude and other strategies were also described as strengths contributing to quality of life.

Conclusion

Clinical assessments need to consider the experiences and perceptions of children as they manage their IBD. Implications for clinical practice are discussed.

Psychosocial functioning in pediatric inflammatory bowel disease

BACKGROUND

The purpose of this article is to review research on psychosocial functioning in pediatric inflammatory bowel disease (IBD) and to provide recommendations for future research.

METHODS

A literature search was conducted using the MEDLINE and PsychInfo computerized databases and bibliographies of relevant articles.

RESULTS

Compared with healthy children, children with IBD are at greater risk of difficulties behavioral/emotional functioning, particularly depression and anxiety, social functioning, and self-esteem. Conflicting results have been reported for the areas of family dysfunction and body image, and few studies have been published in the areas of stress and coping and eating problems. Psychosocial difficulties are clinically significant in only a subset of those with IBD and are generally similar to those found in other pediatric chronic illnesses.

CONCLUSIONS

The scant existing research limits conclusions about which children are most likely to experience problems. Future research should investigate a range of psychosocial outcomes, including developmentally appropriate outcomes for adolescents, and risk factors for developing problems. Prevention and intervention strategies aimed at improving psychosocial functioning in children with IBD should be developed and evaluated.

Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory

The Functional Disability Inventory (FDI; Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39-58) assesses activity limitations in children and adolescents with a variety of pediatric conditions. This study evaluated the psychometric properties of the FDI in pediatric pain patients. Participants included 596 patients with chronic abdominal pain, ages 8-17, and a subset of their parents (n = 151) who completed the FDI and measures of pain, limitations in school activities, and somatic and depressive symptoms at a clinic visit. Test-retest reliability was high at 2 weeks (child report, .74; parent-report, .64) and moderate at 3 months (child report, .48; parent report, .39). Internal consistency reliability was excellent, ranging from .86 to .91. Validity was supported by significant correlations of child- and parent-report FDI scores with measures of school-related disability, pain, and somatic symptoms. Study results add to a growing body of empirical literature supporting the reliability and validity of the FDI for functional assessment of pediatric patients with chronic pain.

Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory

The Functional Disability Inventory (FDI; Walker LS, Greene JW. The functional disability inventory: measuring a neglected dimension of child health status. J Pediatr Psychol 1991;16:39-58) assesses activity limitations in children and adolescents with a variety of pediatric conditions. This study evaluated the psychometric properties of the FDI in pediatric pain patients. Participants included 596 patients with chronic abdominal pain, ages 8-17, and a subset of their parents (n = 151) who completed the FDI and measures of pain, limitations in school activities, and somatic and depressive symptoms at a clinic visit. Test-retest reliability was high at 2 weeks (child report, .74; parent-report, .64) and moderate at 3 months (child report, .48; parent report, .39). Internal consistency reliability was excellent, ranging from .86 to .91. Validity was supported by significant correlations of child- and parent-report FDI scores with measures of school-related disability, pain, and somatic symptoms. Study results add to a growing body of empirical literature supporting the reliability and validity of the FDI for functional assessment of pediatric patients with chronic pain.

Pediatric inflammatory bowel disease

The treatment of children and families affected by pediatric IBD requires an awareness of the diverse psychobiologic effects of the disorder over the course of child, adolescent [53], and adult development [52]. Optimal treatment requires careful coordination of various medical, educational, and rehabilitative services and concerned, empathetic, continuity of care by knowledgeable clinicians [4]. In many cases, this care must also include individual psychotherapeutic work with affected youngsters at crucial junctures to help deal with the social and psychological stresses of IBD, as well supportive casework for parents and siblings.