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Edwards CS, Baudino MN, Roberts CM, Basile NL, Dattilo TM, Gamwell KL, Jacobs NJ, Edwards DS, Tung J, Parker CV, Chaney JM. The contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024; 78:77-84. [PMID: 38291697 DOI: 10.1002/jpn3.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Clinical disease activity associated with inflammatory bowel disease (IBD) can place physical limitations on youths' activities of daily living. In turn, functional limitations potentially contribute to youths' heightened experience of IBD-induced intrusions on a wide range of routine and valued activities (i.e., illness intrusiveness), which can increase their risk for depressive symptoms. The present study examined the contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in youth with IBD. METHODS Youth (N = 180) completed the Functional Disability Inventory (FDI), Illness Intrusiveness Scale-Child (IIS-C), and Children's Depression Inventory-2 (CDI-2). Physicians completed the Physicians Global Assessment of disease activity (PGA). RESULTS Results revealed a mediating effect for functional disability in the association between disease activity and depressive symptoms (PGA → FDI → CDI-2); illness intrusiveness mediated the association between functional disability and depressive symptoms (i.e., FDI → IIS-C → CDI-2). Serial mediation revealed that clinical disease activity conferred an indirect effect on youth depressive symptoms through the sequential effects of functional disability and illness intrusiveness (i.e., PGA → FDI → IIS-C → CDI-2). CONCLUSIONS Taken together, these findings indicate that youth who encounter more physical limitations as a function of clinical disease activity are more likely to experience an amplified sense of IBD-related intrusions on their ability to participate in meaningful activities. In turn, heightened illness intrusiveness increases the likelihood of depressive symptoms. Clinical interventions that help youth maintain adequate functional ability in the face of IBD disease activity and encourage involvement in positively valued activities could decrease the negative impact of IBD on youths' emotional adjustment.
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Affiliation(s)
- Clayton S Edwards
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Marissa N Baudino
- Baylor College of Medicine - Texas Children's Hospital, Houston, Texas, USA
| | - Caroline M Roberts
- Baylor College of Medicine - Texas Children's Hospital, Houston, Texas, USA
| | - Nathan L Basile
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Taylor M Dattilo
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Kaitlyn L Gamwell
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Noel J Jacobs
- Department of Psychology, Oklahoma City University, Oklahoma City, Oklahoma, USA
| | - Desti S Edwards
- Pediatric Gastroenterology, Oklahoma Children's Hospital OU Health, Oklahoma City, Oklahoma, USA
| | - Jeanne Tung
- Pediatric Gastroenterology, Oklahoma Children's Hospital OU Health, Oklahoma City, Oklahoma, USA
| | - Colton V Parker
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - John M Chaney
- Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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Gorbounova I, van Diggelen TR, Slack K, Murphy LK, Palermo TM. Appraisals of Pain in Pediatric Inflammatory Bowel Disease: A Qualitative Study With Youth, Parents, and Providers. CROHN'S & COLITIS 360 2022; 4:otac040. [PMID: 36778512 PMCID: PMC9802382 DOI: 10.1093/crocol/otac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Indexed: 11/07/2022] Open
Abstract
Background Pain is a predominant symptom of inflammatory bowel disease (IBD), and is influenced by cognitive, emotional, and behavioral factors. The cognitive-affective model of symptom appraisal (CAMSA) has been used to understand how youth view symptoms in chronic conditions. We sought to (1) determine how youth with IBD and their parents appraise pain, and how their perspectives fit within CAMSA, and (2) explore health care providers' understanding and communication about pain. Methods Participants included 19 youth ages 10-17 years with chronic IBD pain and their parents, and 5 IBD providers from a gastroenterology clinic. Separate semi-structured qualitative interviews with youth, parents, and providers were conducted. Interview prompts were adapted from CAMSA, previous studies of pediatric pain and symptom monitoring, and a qualitative study in adults with IBD pain. Interviews were analyzed according to principles of reflexive thematic analysis. Results Three key components of CAMSA (IBD Threat, Fear/Worry, and Biased Attending) were identified in youth and parent dyads. Some youth showed Biased Attending, including difficulty disengaging, while other youth simply monitored pain. The overarching theme for provider interviews was Gastroenterologists view pain as a secondary (rather than primary) treatment issue. Conclusions CAMSA is potentially applicable to pain appraisal in youth with IBD and their parents. When health care providers communicate about pain, they should consider how symptom uncertainty may be influenced by threat, fear/worry, and biased attending. Further studies are needed to develop and test psychosocial interventions to reduce fear and threat of pain in youth with IBD in partnership with families and providers.
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Affiliation(s)
- Irina Gorbounova
- Address correspondence to: Irina Gorbounova, MD, 593 Eddy Street, LL Providence, RI 02903, USA ()
| | | | - Katherine Slack
- WSU’s Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Lexa K Murphy
- Department of Psychology, Seattle University, Seattle, Washington, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
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3
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Cesa KT, Cunningham CA, Noll RB, Kim SC. Parental Distress in Pediatric Inflammatory Bowel Diseases: Associations With Time From Diagnosis, Disease Activity, and Demographic Factors. CROHN'S & COLITIS 360 2022; 4:otac019. [PMID: 35783219 PMCID: PMC9237933 DOI: 10.1093/crocol/otac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 11/14/2022] Open
Abstract
Background There are limited studies examining caregiver distress when raising a child with inflammatory bowel disease (IBD). The aim of this study was to investigate the occurrence of symptoms of distress (anxiety, depression, and post-traumatic stress disorder [PTSD]) among parents with children with IBD and associations with disease severity, time from diagnosis, and demographic factors. Methods We conducted a cross-sectional study with parents of children (2-17 years) diagnosed with IBD. There were 2 cohorts: (1) recently diagnosed cohort (<6 months from diagnosis); (2) established diagnosis cohort (>1 year from diagnosis). Parents completed measures of anxiety, depression, and PTSD, while children completed surveys on the symptoms of their IBD. Results Fifty-two parents in the recently diagnosed cohort and 103 parents in the established diagnosis cohort completed surveys. For the entire cohort of parents, we found the mean scores on all measures of distress were within the normal ranges with 20%, 13%, and 8% of parents reporting moderate-to-severe symptoms of anxiety, depression, and PTSD, respectively. Symptoms of anxiety and depression were not significantly associated with time from diagnosis; symptoms of anxiety and PTSD were significantly associated with patients' IBD clinical activity. Conclusions Parents with children with IBD are remarkably resilient to distress even soon after their child's diagnosis. Despite considerable resilience, routine brief caregiver screening for symptoms of anxiety during annual visits seems reasonable and feasible.
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Affiliation(s)
- Kevin T Cesa
- Address correspondence to: Kevin T. Cesa, MD, Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA ()
| | - Catherine A Cunningham
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert B Noll
- Department of Child Development, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sandra C Kim
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Liang LX, Liu Y, Shi YJ, Jiang TT, Zhang HR, Liu BH, Xu PZ, Shi TY. Family care and subjective well-being of coronary heart disease patients after percutaneous coronary intervention: Mediating effects of coping strategies. Int J Nurs Sci 2022; 9:79-85. [PMID: 35079608 PMCID: PMC8766782 DOI: 10.1016/j.ijnss.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Li-Xia Liang
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yu Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ya-Jie Shi
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Hong-Ru Zhang
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bing-Han Liu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Peng-Zhu Xu
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tie-Ying Shi
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Corresponding author.
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5
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Reed B, Rea KE, Claar RL, van Tilburg MAL, Levy RL. Passive Coping Associations With Self-Esteem and Health-Related Quality of Life in Youth With Inflammatory Bowel Disease. Front Psychol 2021; 12:670902. [PMID: 34248766 PMCID: PMC8263929 DOI: 10.3389/fpsyg.2021.670902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Pediatric patients with inflammatory bowel disease (IBD) may experience chronic stress related to disease symptoms and treatment, with negative consequences to their health-related quality of life (HRQOL). Lower HRQOL among pediatric patients with IBD has been associated with worse disease-related symptoms and psychological functioning, while higher HRQOL has been associated with more adaptive coping with disease symptoms and treatment. In addition, patients’ self-esteem may impact the selection and use of coping strategies through global cognitions about their abilities and perceived competence. The current study seeks to extend existing research on HRQOL in youth with IBD by examining cross-sectional associations among self-esteem and passive coping strategies. Youth ages 9–18 with IBD (n = 147) rated their HRQOL using a disease-specific measure, typical strategies used to cope with pain or GI symptoms, and their general self-esteem. Mediation analyses were performed using regression-based techniques and bootstrapping. Results indicated that greater self-esteem was positively associated with HRQOL but negatively associated with passive coping. Controlling for disease activity, age, and gender, significant indirect effects were found in the relation between self-esteem and HRQOL through passive coping. Multiple mediation analyses using the three passive coping subscales found that self-esteem was indirectly associated with HRQOL through its effects specifically on catastrophizing as a passive coping strategy. Results suggest that pediatric patients’ general self-esteem can impact their HRQOL through passive coping and specifically, maladaptive cognitions (e.g., catastrophizing). Interventions aimed at addressing both self-esteem and catastrophizing as a passive coping strategy may offer promise for improving HRQOL in youth with IBD.
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Affiliation(s)
- Bonney Reed
- Department of Pediatrics, Emory & Children's Pediatric Institute, Atlanta, GA, United States
| | - Kelly E Rea
- Department of Psychology, University of Georgia, Athens, GA, United States
| | - Robyn Lewis Claar
- Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Miranda A L van Tilburg
- Department of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.,College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, United States
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, United States
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Telemedicine and Integrated Multidisciplinary Care for Pediatric IBD Patients: A Review. CHILDREN-BASEL 2021; 8:children8050347. [PMID: 33924754 PMCID: PMC8147085 DOI: 10.3390/children8050347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
The global COVID-19 pandemic brought with it an unprecedented, widespread implementation of telemedicine services, requiring pediatric inflammatory bowel disease (IBD) providers to shift in-person clinic visits to a virtual platform. With the passing of the one-year anniversary of the global pandemic, telemedicine continues to be offered and utilized. Although it remains unclear as to the extent to which telemedicine services will be used in the future, it is critical to understand how integrated multidisciplinary treatment-the standard of care in pediatric IBD-is delivered through a virtual platform. This paper provides an overview of the existing literature examining integrated multidisciplinary care for pediatric IBD provided via telemedicine. The author also presents one integrated multidisciplinary IBD program's response to the global pandemic and subsequent transition to telemedicine. Challenges around implementation and directions for future research in this area are also discussed.
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7
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Exploring the Types of Stories Hearing Parents Tell About Rearing their Children Who Use Cochlear Implants. Ear Hear 2021; 42:1284-1294. [PMID: 33859119 DOI: 10.1097/aud.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The majority of children born in the United States with hearing loss (HL) are born to parents with hearing. Many of these parents ultimately choose cochlear implantation for their children. There are now decades of research showing which these children's speech, language, listening, and education seem to benefit from cochlear implantation. To date, however, we know little about the experiences of the parents who guided these children throughout their journeys. We propose that elucidating the types of stories these parents tell is a first step toward understanding their varied experiences and has the potential to ultimately improve healthcare outcomes for both children and their families. Thus, to better understand parents' experience, we asked the following research question: what types of stories do parents with hearing tell about rearing their children with HL who use cochlear implants? DESIGN In this prospective qualitative study, we used a narrative approach. Specifically, we conducted narrative interviews with 20 hearing parents who are rearing young children (mean age = 5.4 years) born with HL who use cochlear implants. We then used thematic narrative analysis to identify recurring themes throughout the narratives that coalesced into the types of stories parents told about their experiences. FINDINGS Thematic narrative analysis revealed five story types: (1) stories of personal growth, (2) proactive stories, (3) stories of strain and inundation, (4) detached stories, and (5) stories of persistence. CONCLUSIONS In the present study, different types of stories emerged from parents' experiences that share common events-a family's baby is identified at birth with unexpected permanent HL, the family chooses to pursue cochlear implantation for their child, and then the family raises said pediatric cochlear implant user into adulthood. Despite these similarities, the stories also varied in their sensemaking. Some parents told stories in which a positive life narrative turned bad, whereas others told stories in which a narrative of surviving turned into one of thriving. These findings specifically contribute to the field of hearing healthcare by providing professionals with insight into parents' sensemaking via the types of stories they shared centered on their perceptions and experiences following their child's diagnosis of HL and their decision to pursue cochlear implantation.
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Ndengeyingoma A, Lebel V, Bigras M, Jacob MH, Lacelle M. Youngsters' perceptions of the experience of pain and utilisation of over-the-counter pain medication as needed in community: A qualitative study. J SPEC PEDIATR NURS 2021; 26:e12323. [PMID: 33393731 DOI: 10.1111/jspn.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Pain is common in youngsters. No matter its nature, youngsters' consideration of pain is complex since its communications vary as a function of several components. The aim of this study is to explore the youngsters' perception linked to their experience of physiological pain at the home/family setting, as well as their experience with the utilisation of over-the-counter pain medication as needed. DESIGN AND METHODS A qualitative exploratory study was undertaken with 22 youngsters aged 5-17 years old. Semidirected interviews led to the understanding of these components by means of the pain experiences. Thematic analysis allowed the detection of the themes and subthemes emerging from the verbatim collected with the participants. RESULTS The way pain is described is influenced by the child's development, previous experiences, and the projection of having pain. The pain communication is influenced by the severity perceived, the beliefs of the youngster experiencing pain, the comparison of the pain communication with his brothers and sisters, as well as the anticipated consequences of expressing his pain. The choice of behaviour towards pain is influenced by self-management through nonpharmacological management, with medicines if needed, and by family modelization. PRACTICE IMPLICATIONS This study confirms that previous pain experiences, beliefs related to pain tolerance and intended reactions of parents exert influence not only on the communication of pain, but also on youngsters' behaviour towards pain. It is important to consider these elements whenever youngsters' pain is evaluated.
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Affiliation(s)
| | - Valérie Lebel
- Department of Nursing, Université du Quebec en Outaouais, St-Jerome, Quebec, Canada
| | - Magali Bigras
- Centre intégré de santé et de services sociaux de l'Outaouais, GMF Universitaire de Gatineau, Gatineau, Quebec, Canada
| | - Maria H Jacob
- Department of Nursing, Université du Quebec en Outaouais, Gatineau, Québec, Canada
| | - Marika Lacelle
- Centre intégré de santé et de services sociaux de l'Outaouais, GMF Universitaire de Gatineau, Gatineau, Quebec, Canada
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Bednarikova H, Kascakova N, Furstova J, Zelinkova Z, Falt P, Hasto J, Tavel P. Life Stressors in Patients with Inflammatory Bowel Disease: Comparison with a Population-Based Healthy Control Group in the Czech Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063237. [PMID: 33800985 PMCID: PMC8003904 DOI: 10.3390/ijerph18063237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
Background: Stress has been suggested to play a potential role in inflammatory bowel disease (IBD) pathogenesis, but studies focussing on the occurrence of specific life stress events among IBD patients are scarce. Therefore, the aim of the present study was to explore the association between various life stress events and IBD. Methods: Patients with IBD (N = 98, mean age: 38.45, 54.1% men) were compared to a group of healthy controls (N = 405, mean age: 36.45, 58.0% men) originating from a health survey conducted on a representative population sample of Czech adults. The Life Stressor Checklist-Revised (LSC-R) was used to assess the stressors. Results: IBD patients had higher odds of reporting life stressors overall (p < 0.001), life stressors before the age of 16 (p < 0.004) and a higher score in traumatic stress (p < 0.005) and interpersonal violence (p < 0.001) when compared to the control group. Gender- and diagnosis-related differences are discussed. Conclusion: Reporting life stressors experienced during childhood or adulthood is strongly associated with IBD. This should be considered in illness management, especially in a severe course of IBD.
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Affiliation(s)
- Hana Bednarikova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- Department of Gastroenterology and Digestive Endoscopy, University Hospital—St. Michael’s Hospital, Satinskeho 1, 811 08 Bratislava, Slovakia
- Correspondence: ; Tel.: +421-903956665
| | - Natalia Kascakova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- 2nd Department of Internal Medicine, University Hospital Olomouc, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic;
| | - Jana Furstova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
| | - Zuzana Zelinkova
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- Department of Gastroenterology and Digestive Endoscopy, University Hospital—St. Michael’s Hospital, Satinskeho 1, 811 08 Bratislava, Slovakia
| | - Premysl Falt
- 2nd Department of Internal Medicine, University Hospital Olomouc, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic;
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Jozef Hasto
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
- Psychiatric-Psychotherapeutic Outpatient Clinic, Pro Mente Sana, Heydukova 27, 811 06 Bratislava, Slovakia
- Department of Social Work, St. Elizabeth College of Health and Social Work, Namestie 1. maja 1, 810 00 Bratislava, Slovakia
- Faculty of Medicine, Department of Psychiatry, Slovak Medical University in Bratislava, Limbova 12, 833 03 Bratislava, Slovakia
| | - Peter Tavel
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 779 00 Olomouc, Czech Republic; (N.K.); (J.F.); (Z.Z.); (J.H.); (P.T.)
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10
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Touma N, Varay C, Baeza-Velasco C. Determinants of quality of life and psychosocial adjustment to pediatric inflammatory bowel disease: A systematic review focused on Crohn's disease. J Psychosom Res 2021; 142:110354. [PMID: 33465493 DOI: 10.1016/j.jpsychores.2020.110354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not. OBJECTIVE This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. METHOD Four international databases were consulted in March 2020: PubMed, PsychInfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies. RESULTS One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes. CONCLUSIONS Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.
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Affiliation(s)
- Nathalie Touma
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France.
| | - Caroline Varay
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France
| | - Carolina Baeza-Velasco
- University of Paris, Laboratory of Psychopathology and Health Process (LPPS), 71 Av Edouard Vaillant, F-92100 Boulogne-Billancourt, France; Department of Psychiatric Emergency and Post-Emergency, Montpellier University Hospital Center, 371 Av du Doyen Gaston Giraud, 34090 Montpellier, France
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11
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Prendergast KL, Gowey MA, Barnes MJ, Keller CV, Horne C, Young J. Treating anxiety and depression in inflammatory bowel disease: a systematic review. Psychol Health 2021; 37:105-130. [PMID: 33499672 DOI: 10.1080/08870446.2020.1867135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Inflammatory Bowel Disease (IBD) is associated with higher rates of clinically significant anxiety and depression than in healthy populations. Psychosocial interventions targeting anxiety and depression in IBD have variable efficacy and disparate treatment approaches, making treatment recommendations difficult. The current study aimed to identify effective treatment components across psychosocial treatment approaches for anxiety and depression in IBD. DESIGN A systematic review of psychosocial treatments for anxiety and depression in IBD was conducted. Based on the Distillation and Matching Model, treatments were coded and data aggregated by intervention components, or practice elements (PE), to elucidate replicable clinical techniques. MAIN OUTCOME The percentage of studies utilizing a given PE was the primary outcome. MEASURES Among all included studies, as well as among those finding favorable, significant effects on anxiety or depression, the percentage utilizing each PE and number of PEs utilized was determined. RESULTS The most utilized PEs among included interventions were relaxation, IBD psychoeducation, cognitive restructuring, distraction, and social skills. Examining only interventions with favorable differences on specified outcomes (HRQoL, Anxiety, Depression, and/or Coping) indicated that relaxation, education, cognitive restructuring, and mindfulness were most utilized. CONCLUSION Implications for clinical practice are discussed, including the development and dissemination of treatment recommendations.
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Affiliation(s)
- Kathryn L Prendergast
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marissa A Gowey
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Margaux J Barnes
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline V Keller
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caitlin Horne
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Young
- Department of Psychology, University of Mississippi, Oxford, MS, USA.,Delta Autumn Consulting, Oxford, MS, USA
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12
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Baudino MN, Perez MN, Roberts CM, Edwards CS, Gamwell KL, Keirns NG, Tung J, Jacobs NJ, Grunow JE, Mullins LL, Chaney JM. Stigma by Association: Parent Stigma and Youth Adjustment in Inflammatory Bowel Disease. J Pediatr Psychol 2021; 46:27-35. [PMID: 33120420 DOI: 10.1093/jpepsy/jsaa083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Examine the indirect association between parents' experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD). METHODS During routine clinic visits, 150 youth with well-controlled IBD (ages 10-18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity. RESULTS Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents' experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness. CONCLUSIONS Parents who face stigma related to their child's IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths' illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents' associative stigma and youths' illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.
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Affiliation(s)
| | - Megan N Perez
- Center for Pediatric Psychology, Oklahoma State University
| | | | | | | | | | - Jeanne Tung
- University of Oklahoma Children's Physicians Pediatric Gastroenterology
| | - Noel J Jacobs
- University of Oklahoma Children's Physicians General and Community Pediatrics
| | - John E Grunow
- University of Oklahoma Children's Physicians Pediatric Gastroenterology
| | | | - John M Chaney
- Center for Pediatric Psychology, Oklahoma State University
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13
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Parent and Family Functioning in Pediatric Inflammatory Bowel Disease. CHILDREN-BASEL 2020; 7:children7100188. [PMID: 33080794 PMCID: PMC7603067 DOI: 10.3390/children7100188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022]
Abstract
Although the impact of pediatric inflammatory bowel disease (IBD) extends beyond the patient to their parents and families, the focus of previous literature has largely been on investigating the patient’s medical and psychosocial functioning, with less consideration of the family system. Having a comprehensive understanding of parent and family functioning within the context of pediatric IBD is important given the role parents and family members have in the successful management of the disease and caring of the child. The current review paper aggregates the empirical research regarding parent and family functioning, including comparisons to normative samples, other illness groups, and how functioning relates to child psychosocial and health outcomes. Extant literature on parents and families in pediatric IBD has largely focused on the variables of parenting stress, parent psychosocial functioning, parent quality of life, and family functioning. Summary findings elucidate the complex relationships between parents, families, and children affected by IBD and highlight the importance of assessing parent and family functioning within pediatric IBD. The current review also offers implications for clinical practice, notes the limitations of the present literature, and provides recommendations for future research.
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Baudino MN, Gamwell KL, Roberts CM, Grunow JE, Jacobs NJ, Gillaspy SR, Edwards CS, Mullins LL, Chaney JM. Disease Severity and Depressive Symptoms in Adolescents With Inflammatory Bowel Disease: The Mediating Role of Parent and Youth Illness Uncertainty. J Pediatr Psychol 2020; 44:490-498. [PMID: 30551150 DOI: 10.1093/jpepsy/jsy091] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objective of this study is to examine parent and youth appraisals of illness uncertainty as potential serial mediators in the relation between disease severity and youth depressive symptoms in adolescents with inflammatory bowel disease (IBD). METHODS Participants were 85 adolescents 13-18 years of age (Mage = 15.75, SD =1.51) with a confirmed diagnosis of IBD (Crohn's disease, 59%; ulcerative colitis, 41%) and a primary caregiver. At a scheduled outpatient visit, caregivers completed a measure of illness uncertainty, while adolescents completed measures of illness uncertainty and depressive symptoms. Pediatric gastroenterologists provided global estimates of disease severity. RESULTS Path analysis revealed several significant direct and indirect associations among the modeled variables. Importantly, results provided support for the hypothesized disease severity→parent illness uncertainty→youth illness uncertainty→youth depressive symptoms serial mediation path (95% confidence interval = 0.04 to 1.10). CONCLUSIONS Results indicate that increased disease activity may serve to magnify the unpredictable nature of IBD for parents, reflected in heightened perceptions of illness uncertainty. Our findings also suggest that increased parent illness uncertainty has a significant influence on youth illness uncertainty appraisals, which in turn translates into elevated depressive symptoms in adolescents with IBD. The clinical implications of our findings and suggestions for future studies are discussed.
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15
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Gamwell KL, Roberts CM, Espeleta HC, Baudino MN, Hommel KA, Grunow JE, Jacobs NJ, Gillaspy SR, Mullins LL, Chaney JM. Perceived stigma, illness uncertainty, and depressive symptoms in youth with inflammatory bowel disease: The moderating effect of mindfulness. PSYCHOL HEALTH MED 2020; 25:1037-1048. [DOI: 10.1080/13548506.2020.1714062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kaitlyn L. Gamwell
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Caroline M. Roberts
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Hannah C. Espeleta
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Marissa N. Baudino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Kevin A. Hommel
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - John E. Grunow
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Noel J. Jacobs
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stephen R. Gillaspy
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Larry L. Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
| | - John M. Chaney
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, Stillwater, OK, USA
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The Role of Distress and Pain Catastrophizing on the Health-related Quality of Life of Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2019; 69:e99-e104. [PMID: 31335840 DOI: 10.1097/mpg.0000000000002447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Inflammatory bowel disease (IBD) can be particularly challenging during the pediatric age with a relevant impact on patient's health-related quality of life (HRQoL). Disease activity accounts for only a small part of the variability in HRQoL, and psychological factors can play a significant role. We aimed to evaluate the impact of patient's distress and pain catastrophizing on children and adolescents with IBD. METHODS We prospectively recruited children aged 8 to 18 with IBD and recorded demographic and disease characteristics. Patients answered questionnaires on HRQoL (IMPACT III), distress (distress thermometer [DT]), and pain catastrophizing (Pain Catastrophizing Scale-Children [PCS-C]). Univariate and multivariate regression models analysis were used to evaluate correlations between patients' characteristics, disease activity, distress, pain catastrophizing, and HRQoL. RESULTS Seventy-one patients were enrolled (median age 13.6, 49.3% Crohn disease, 50.7% ulcerative colitis). Median HRQoL, DT, and PCS-C scores were 78.6 (interquartile range 68.0-87.1), 3.0 (1.0-5.0), and 12.0 (4.0-23.0), respectively. Patient's distress and pain catastrophizing levels significantly correlated with HRQoL. Pain catastrophizing had the strongest impact on HRQoL (Spearman correlation coefficient, ρ = 0.73), followed by distress (ρ = 0.67), and ulcerative colitis severity (ρ = 0.67). The DT and the PCS-C scores were significantly associated (ρ = 0.46). CONCLUSIONS Distress and pain catastrophizing have a significative impact on HRQoL in young patients with IBD. Physicians should recognize the role of these psychological factors and consider cognitive-behavioral therapy to optimize the patient's health.
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Anticipatory care of children and adolescents with inflammatory bowel disease: a primer for primary care providers. Curr Opin Pediatr 2019; 31:654-660. [PMID: 31205126 DOI: 10.1097/mop.0000000000000795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW About 10-20% of patients with newly diagnosed inflammatory bowel disease (IBD) are under 18 years of age, with incidence increasing in young children. Children with IBD have unique healthcare needs, which require coordination between primary care providers and pediatric gastroenterologists to provide appropriate care. This review highlights some key elements of anticipatory care in pediatric IBD, including vaccination, risk of serious infection and malignancy, psychosocial and educational needs, and cannabis use. RECENT FINDINGS Therapies for IBD that include anti-tumor necrosis factor medications, especially when combined with corticosteroids are associated with higher risks of serious infections. Vaccination remains the best way to prevent infections. Live vaccinations should be avoided during immunosuppression, but the schedule should be otherwise completed, including vaccination for influenza, pneumococcus and meningococcus, and human papillomavirus. Malignancy risk is increased in IBD patients, both because of disease factors and resulting from immunomodulatory medications. Children with IBD are at risk for mental health disorders and negative educational outcomes, so identification of at-risk children and early intervention are important. SUMMARY High-quality care in pediatric IBD requires coordination between pediatric gastroenterologists and primary care providers, with careful attention paid to the specific needs of children with IBD.
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PREDA CM, MANUC T, ISTRATESCU D, LOUIS E, BAICUS C, SANDRA I, DICULESCU M, REENAERS C, van KEMSEKE C, NITESCU M, TIERANU C, SANDU CG, OPREA-CALIN G, TUGUI L, VIZIRU S, CIORA CA, GHEORGHE LS, MANUC M. Environmental Factors in Romanian and Belgian Patients with Inflammatory Bowel Disease - a Retrospective Comparative Study. MAEDICA 2019; 14:233-239. [PMID: 31798738 PMCID: PMC6861727 DOI: 10.26574/maedica.2019.14.3.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background:Several environmental factors have been associated with onset of inflammatory bowel diseases (IBD): smoking, hygiene, microorganisms, oral contraceptive pills (OCPs), non-steroid anti-inflammatory drugs, antibiotics, appendectomy, diet, breastfeeding, vitamin D, stress and ambient air pollution. The aim of this study was to investigate the prevalence of these factors in a Romanian and Belgian population with IBD. Material and methods:A total of 129 patients with an IBD diagnosis (76 from Romania and 53 from Belgium) participated in an interview and were asked to fill in a questionnaire regarding environmental factors before and after the onset of IBD; 35 Romanian and 21 Belgian healthy individuals constituted the control group. Results:A total of 40 patients with ulcerative colitis (UC) and 89 with Crohn's disease (CD) were included. Gender distribution was 43% males and 57% females. They had a median age of 42 years (range between 19-74 years), a median disease duration of eight years and 79% were in clinical remission. Both Romanian and Belgian IBD patients reported an increased antibiotic consumption before IBD onset compared to controls: 58% vs 10% (p<0.001) and 51% vs 5% (p<0.001), respectively. Belgian IBD patients declared significantly more frequent OCP use (53% vs 9%, p <0.001), they were breastfed in a lower proportion (49% vs 76%, p <0.001) and had experienced a higher level of psychosocial stress (p<0.001). Conclusion:Antibiotic consumption before IBD onset may play a pivotal role in IBD development in both Romanian and Belgian populations. In Belgian patients, OCP consumption, a higher level of psychosocial stress and lack of breastfeeding may also be involved.
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Affiliation(s)
- Carmen Monica PREDA
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Teodora MANUC
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Doina ISTRATESCU
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Edouard LOUIS
- Department of Gastroenterology University Hospital CHU Liège, Belgium
| | - Cristian BAICUS
- ”Carol Davila” University of Medicine and Pharmacy, Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Irina SANDRA
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Mircea DICULESCU
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | | | - Cristian TIERANU
- Elias Emergency Hospital, Gastroenterology & Hepatology Department, Bucharest, Romania
| | - Corina Georgiana SANDU
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriela OPREA-CALIN
- ”Carol Davila” University of Medicine and Pharmacy, Internal Medicine Department, University Emergency Hospital, Bucharest, Romania
| | - Letitia TUGUI
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Siyana VIZIRU
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Cosmin-Alexandru CIORA
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Liliana-Simona GHEORGHE
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Mircea MANUC
- ”Carol Davila” University of Medicine and Pharmacy, Gastroenterology & Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
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Walker LS. Commentary: Understanding Somatic Symptoms: From Dualism to Systems, Diagnosis to Dimensions, Clinical Judgement to Clinical Science. J Pediatr Psychol 2019; 44:862-867. [PMID: 31241136 DOI: 10.1093/jpepsy/jsz050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/24/2019] [Accepted: 05/15/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lynn S Walker
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center
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20
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The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs. J Psychosom Res 2019; 119:26-33. [PMID: 30947814 DOI: 10.1016/j.jpsychores.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. METHODS We performed a cross-sectional study of children (aged 8-17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. RESULTS Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2-3 on the pIBD-INTERMED "mental health/cognitive threat" item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17-24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00-122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70-43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00-45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. CONCLUSIONS The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.
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Pain and quality of life in youth with inflammatory bowel disease: the role of parent and youth perspectives on family functioning. Pain Rep 2019; 4:e715. [PMID: 31041418 PMCID: PMC6455693 DOI: 10.1097/pr9.0000000000000715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/28/2018] [Accepted: 12/29/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Daily pain experiences are a common feature of pediatric inflammatory bowel disease (IBD), which can negatively influence their health-related quality of life (HRQOL). A holistic, family systems approach is needed to further our understanding of daily pain experiences in youth with IBD and their influence on youth's HRQOL. Objectives The study's objectives were to (1) provide a detailed description of daily pain experiences in youth with IBD, (2) investigate the relative contribution of family functioning and pain in explaining youth's HRQOL, and (3) explore differences in parental and youth perspectives. Methods Sixty youth with IBD (8-17 years) and a parent completed questionnaires to assess family functioning, HRQOL, and pain experiences within the past week. A subsample of 16 youth completed an online diary (7 days) about their pain experiences. Results When including any pain experiences, higher youth-reported family satisfaction and lower pain intensity were related to better HRQOL, whereas higher parent-reported family cohesion and satisfaction indirectly related to youth HRQOL through lower pain intensity. When only accounting for abdominal pain, pain intensity related negatively with HRQOL, and only parent-reported cohesion showed an indirect relation with HRQOL through pain intensity. Diary data revealed large heterogeneity: abdominal pain, described as cramping, sharp, and/or stinging was most frequent, but other pain symptoms (eg, back pain and headache) often co-occurred. Conclusion The findings provide a rich picture of the daily pain experiences of youth with IBD and underscore the importance of a family systems approach to understand how family functioning and pain symptoms influence HRQOL.
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Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress Triggers Flare of Inflammatory Bowel Disease in Children and Adults. Front Pediatr 2019; 7:432. [PMID: 31709203 PMCID: PMC6821654 DOI: 10.3389/fped.2019.00432] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 10/07/2019] [Indexed: 12/15/2022] Open
Abstract
Inflammatory bowel disease (IBD) is an idiopathic inflammatory disease characterized by chronic and relapsing manifestations. It is noteworthy that the prevalence of IBD is gradually increasing in both children and adults. Currently, the pathogenesis of IBD remains to be completely elucidated. IBD is believed to occur through interactions among genetics, environmental factors, and the gut microbiota. However, the relapsing and remitting course of IBD underlines the importance of other modifiers, such as psychological stress. Growing evidence from clinical and experimental studies suggests that stress acts as a promoting or relapsing factor for IBD. Importantly, recent studies have reported an increasing incidence of anxiety or depression in both children and adults with IBD. In this article, we review the mechanisms by which stress affects IBD, such as via impaired intestinal barrier function, disturbance of the gut microbiota, intestinal dysmotility, and immune and neuroendocrine dysfunction. With regard to both children and adults, we provide recent evidence to describe how stress can affect IBD at various stages. Furthermore, we emphasize the importance of mental healing and discuss the value of approaches targeting stress in clinical management to develop enhanced strategies for the prevention and treatment of IBD.
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Affiliation(s)
- Yue Sun
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Lu Li
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Runxiang Xie
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Kui Jiang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Hailong Cao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
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