Patient self-reported concerns in inflammatory bowel diseases: A gender-specific subjective quality-of-life indicator

Sex-related differences in profiles and clinical outcomes of Inflammatory bowel disease: a systematic review and meta-analysis

BACKGROUND

Inflammatory bowel disease (IBD) is a chronic and idiopathic condition that includes both Crohn's disease (CD) and ulcerative colitis (UC). The impact of sex on the disease course and the clinical outcomes not fully understood. Our systematic review and meta-analysis aims to explore the differences in the clinical outcomes in IBD.

METHOD

A systematic review and meta-analysis was done by searching in the PubMed /MEDLINE, Embase, and Scopus databases. We used the Random-Effects model to estimate risk ratios (RR) for binary outcomes and mean difference and hedges' g for continuous outcomes.

RESULT

A total of 44 unique studies were included. Our analysis revealed distinct sex differences in various outcomes of IBD. Anxiety was more prevalent in females (RR: 0.73; 95% CI [0.64, 0.82]) and females in the CD subgroup (RR: 0.76; 95% CI [0.62, 0.93]; p = 0.01. While depression was diagnosed more frequently in females (RR: 0.80; 95% CI [0.66, 0.97] in the total population of the study, subgroup analysis showed no sex difference. Additionally, quality of life scores were worse in females in the total population (Hedges' g: 0.24; 95% CI [0.05, 0.42]) with no significant difference in subgroup analyses. A significantly higher mortality risk was estimated in males (RR: 1.26; 95% CI [1.07, 1.48]) and in subgroup analysis for males with UC (RR: 1.48; 95% CI [1.19, 1.84]; p = 0.00) with no significant difference in CD. Regarding disease location, male patients were less likely to present with proctitis (RR: 0.67; 95% CI [0.50, 0.91]) when compared to females. Males had more frequent indications for surgery (RR: 1.10; 95% CI [1.01, 1.20]), however, no significant difference was found in subgroup analyses for CD or UC. Also, males were older at the time of admission (MD: 1.39 years; 95% CI [0.10, 2.68]). No significant sex differences were found in terms of hospitalization rates or disease behavior.

CONCLUSION

In conclusion, our meta-analysis shows that males face higher risks of early mortality and require more IBD surgeries, whereas females experience greater levels of anxiety and depression. These findings emphasize the need to consider sex disparities in IBD management.

Impact of Spiritual End-of-Life Support on the Quality of Life for Leukemia Patients

Objective: Patients with leukemia suffer from significant psychological, spiritual, and social symptoms. Therefore, the current research aimed to study the impact of spiritual end-of-life support on the quality of life for leukemia patients. Method : To this end, the present quasi-experimental research with a pre-test and post-test design was performed. The sample included 60 cancer patients randomly assigned to intervention and control groups through the method of permutation block. The experimental group received spiritual support intervention for eight sessions of 60 minutes, while the control group received no intervention. Patients filled out the questionnaire of World Health Organization Quality of Life. The World Health Organization conducts a three-phase assessment to measure the quality of life. These phases include a pre-test, which is conducted before any intervention takes place. Then comes the post-test, which occurs after the intervention. Finally, there is a follow-up assessment conducted two months after the post-test. The obtained results were analyzed by repeated-measures analysis and independent samples t-test using SPSS software. Results: The findings from the repeated measures analysis revealed that there was a statistically significant interaction between time and group (P = 0.01). In other words, being compared to the control group, the spiritual support significantly increased the life quality of the patients in the experimental group. The experimental group witnessed a sustained enhancement in the quality of life for a period of two months following the intervention (follow-up, P = 0.01). Conclusion: Ultimately, the provision of spiritual support has the potential to enhance the overall well-being of individuals approaching the end of their lives, offering solace and aiding them in comprehending the true essence and purpose of their existence.

Depression in Women With Inflammatory Bowel Disease: A Multifaceted Approach for a Multidimensional Problem

The prevalence of depression is higher in patients with inflammatory bowel disease (IBD) than in the general population. Women are more significantly affected by depression among those with IBD and in the general population. This review presents evidence on sex-based differences in depression pathogenesis and the effect of depression on various factors associated with IBD that affect women's lives, including sexual dysfunction, body image dissatisfaction, fertility, and overall quality of life. We also discuss sex-specific effects on IBD treatment, disease activity, and health care costs. Interestingly, women with IBD tend to seek and are more receptive to depression-related information. Given the underdiagnosis and undertreated nature of depression in individuals with IBD, effective screening and an optimal integrative treatment approach with relevant sex-specific needs are discussed. Evidence regarding the efficacy of psychotherapy, antidepressant pharmacotherapy, and IBD-specific therapy for depression is discussed. This review summarizes evidence of the effect of depression on both personal and professional aspects of the daily lives of women with IBD, which extends beyond negative moods. It applies this information to screening and integrative treatment, resulting in a holistic approach to this multidimensional problem. We also discuss how depression affects males with IBD differently from females. Finally, we discuss the need for gender-based studies on depression in individuals with IBD.

Depressive and Anxiety Disorders in Patients with Inflammatory Bowel Diseases: Are There Any Gender Differences?

Gender differences were identified in the frequency and clinical presentations of inflammatory bowel disease (IBD) and depressive and anxiety disorders, which are more common in IBD patients than in the general population. The present manuscript provides a critical overview of gender differences in the frequency and clinical course of mood and anxiety disorders in IBD patients, with the aim of helping clinicians provide individualized management for patients. All of the included studies found that IBD patients reported a higher frequency of depressive and anxiety disorders than the general population. These findings should encourage healthcare providers to employ validated tools to monitor the mental health of their IBD patients, such as the Patient Health Questionnaire (PHQ-9). In addition, most studies confirm that women with IBD are more likely than men to develop affective disorders and show that up to 65% of women with IBD have depressive and anxiety disorders. Women with IBD require close mental health monitoring and ultimately a multidisciplinary approach involving mental health professionals. Drug treatment in women should be individualized and medications that may affect mental health (e.g., corticosteroids) should be thoroughly reconsidered. Further data are needed to ensure individualized treatment for IBD patients in a framework of precision medicine.

How knowledge time influenced anxiety, depression, stress and quality of life levels in patients suffering from Crohn disease: a cross-sectional multicenter study

BACKGROUND AND AIM OF THE WORK

The diagnosis of Crohn Disease (CD) represents a turning point in the life of patients, which inevitably marks them. The present study represents a direct "feed-back" from patients suffering from Crohn disease, in order to reveal how the diagnosis of CD changed lifestyles and psychological conditions in their patients.

METHODS

An observational, cross sectional, online, snowball sampling study was conducted through participants suffered from CD and belonged to social networks and Facebook groups. For each participant, sampling characteristics, a series of lifestyle habits Before to After the diagnosis of CD and anxiety, depression, and stress conditions were investigated.

RESULTS

A total of 785 participants agreed to participate. As Participants underwent significant challenges in their lifestyles after the CD diagnosis (p<0.001), specifically their reduced their smoking habits, alcohol and drugs intakes and also their diets both in high sugar and fatty compositions. Anxiety and stress levels were not statistical different among participants according to years of the knowledge of their CDs. Meanwhile, as regards depression condition, significantly higher levels were recorded among participants who knew their CD until 5 and 25 years, respectively (p=0.031).

CONCLUSIONS

From the study emerges several aspects of quality of life compromised, a fact supported by the analysis of psychophysical sequelae, which allowed to lay the groundwork for further studies, studying the comorbidity of this disease with other factors. Future randomized controlled trials should deepen the correlation between eating disorders and CD, a link little explored in the literature.

Impact of Female Gender in Inflammatory Bowel Diseases: A Narrative Review

Inflammatory bowel diseases show a gender bias, as reported for several other immune-mediated diseases. Female-specific differences influence disease presentation and activity, leading to a different progression between males and females. Women show a genetic predisposition to develop inflammatory bowel disease related to the X chromosome. Female hormone fluctuation influences gastrointestinal symptoms, pain perception, and the state of active disease at the time of conception could negatively affect the pregnancy. Women with inflammatory bowel disease report a worse quality of life, higher psychological distress, and reduced sexual activity than male patients. This narrative review aims to resume the current knowledge of female-related features in clinical manifestations, development, and therapy, as well as sexual and psychological implications related to inflammatory bowel disease. The final attempt is to provide gastroenterologists with a roadmap of female-specific differences, to improve patients' diagnosis, management, and treatment.

Construction of an Explanatory Model for Quality of Life in Outpatients with Ulcerative Colitis

Introduction

To date, no studies have reported explanatory models of health-related quality of life (HRQoL) in patients with ulcerative colitis. Therefore, this study aimed to examine HRQoL and its related factors in outpatients with ulcerative colitis to construct an explanatory model.

Methods

We conducted a cross-sectional survey at a clinic in Japan. The HRQoL was evaluated using the 32-item Inflammatory Bowel Disease Questionnaire. We extracted explanatory variables of HRQoL from demographic, physical, psychological, and social factors reported in previous studies and created a predictive explanatory model. The relationship between explanatory variables and the questionnaire total score was examined using Spearman's rank correlation coefficient, the Mann-Whitney test, or the Kruskal-Wallis test. We conducted multiple regression and path analyses to examine the effect of explanatory variables on the total score.

Results

We included 203 patients. Variables that were associated with the total score were the partial Mayo score (r = -0.451), treatment side effects (p = 0.004), the Hospital Anxiety and Depression Scale-Anxiety score (r = -0.678), the Hospital Anxiety and Depression Scale-Depression score (r = -0.528), and the availability of an advisor during difficult times (p = 0.001). The model included the partial Mayo score, treatment side effects, the Hospital Anxiety and Depression Scale-Anxiety score, and the availability of an advisor during difficult times as explanatory variables of the total score that showed the best goodness-of-fit (adjusted R2 = 0.597). The anxiety score exerted the greatest negative effect on the questionnaire total score (β = -0.586), followed by the partial Mayo score (β = -0.373), treatment side effects (β = 0.121), and availability of an advisor during difficult times (β = -0.101).

Conclusion

Psychological symptoms exerted the strongest direct effect on HRQoL in outpatients with ulcerative colitis and mediated the relationship between social support and HRQoL. Nurses should listen carefully to the concerns and anxieties of patients to ensure that a social support system is provided by leveraging multidisciplinary collaborations.

Inflammatory Bowel Disease-related Behaviours [IBD-Bx] Questionnaire: Development, Validation and Prospective Associations with Fatigue

BACKGROUND AND AIMS

Disease-related behaviours that may maintain or worsen symptom burden remain largely unexplored in inflammatory bowel disease [IBD]. In this study, we developed and validated an instrument assessing IBD-related, modifiable behaviours and explored which behaviours prospectively correlate with fatigue, a debilitating and common symptom in IBD.

METHODS

Initially, 72 items reflecting IBD-related behaviours were generated based on literature review and input from clinicians and people diagnosed with IBD. During wave 1, 495 IBD patients rated to what extent each behaviour was applicable to them. Additionally, disease activity, fatigue, IBD-related concerns and psychological variables were assessed. During a follow-up visit 4-12 weeks later [wave 2], a random selection of 92 patients from wave 1 completed the measures assessing the IBD-related behaviours, disease activity and fatigue once more.

RESULTS

A principal component analysis with oblique rotation revealed seven components in the 72 IBD behaviours, which could be interpreted as: [1] Avoiding food and activities, [2] Access to toilets, [3] Avoidance of sex, [4] Cognitive avoidance, [5] Not sharing with others, [6] Alternative treatments and [7] Disease management. Each component was reduced to three to five representative items, resulting in a final, 25-item IBD-Bx questionnaire showing good concurrent validity [alphas > 0.63] and reliability. Almost all components were cross-sectionally related to levels of fatigue. Avoiding food and activities and Access to toilets significantly predicted fatigue at wave 2 when controlling for baseline fatigue.

CONCLUSIONS

The IBD-Bx is a valid and reliable questionnaire of IBD-related behaviours, some of which predict future fatigue burden.

Explaining the Disease Management Experiences of Patients With Inflammatory Bowel Disease: A Qualitative Study

Inflammatory bowel disease is an unpredictable, chronic, recurrent gastrointestinal disorder with a wide range of social, physical, and psychological problems experienced by patients. The identification of these concerns is important to provide better healthcare. The purpose of this study was to understand the experiences and concerns of these patients. This study was conducted using a qualitative content analysis approach. The participants were 20 inflammatory bowel disease patients. Data were collected through unstructured interviews with purposive sampling and continued until data saturation. Data were comparatively analyzed continuously and simultaneously with data collection. Data analysis revealed two themes of "tension due to possible recurrence" and "fear of decline and deterioration." The integration of these concepts suggested that patients experience "sinking into the marsh of recurrence" as a major concern that disrupts their successful management of inflammatory bowel disease. Identifying the concerns of inflammatory bowel disease patients regarding their cultural and social context is of paramount importance. The integration of such concerns into treatment can improve patients' coping abilities and improve their quality of life.

Clinical and Psychological Factors Associated with Addiction and Compensatory Use of Facebook Among Patients with Inflammatory Bowel Disease: A Cross-Sectional Study

Background

Inflammatory bowel diseases are chronic conditions characterized by incapacitating symptoms, which can compromise patient’s quality of life and social interaction. As social media use is continuously increasing and Facebook is one of the most accessed social media worldwide, this study aimed to evaluate the use of Facebook and identify clinical and psychological factors associated with addiction and compensatory use among patients.

Methods

This case-control study enrolled 100 outpatients and 100 healthy individuals, who were classified into the patient and control groups, respectively. Facebook use was evaluated using the questionnaire Psycho-Social Aspects of Facebook Use (PSAFU). The IBD Questionnaire and the 36-Item Short-Form Health Survey (SF-36) were used to measure Health-related quality of life. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale; self-esteem, using the Rosenberg Self-Esteem scale.

Results

The patient group included 54 patients with Crohn’s disease and 46 with ulcerative colitis. Facebook use was similar between the patient and control groups in all evaluated aspects (p=0.21). In the patient and the control groups, the compensatory use of Facebook was directly related to the symptoms of depression (patients: R = 0.22; p = 0.03; controls: R = 0.34; p = 0.0006) and inversely related to self-esteem scale (patients: R = −0.27; p = 0.006; controls: R = −0.37; p = 0.0001). Facebook addiction showed an inverse correlation with self-esteem (patients: R = −0.32; p = 0.001; controls: R = −0.24; p = 0.02) and quality of life (patients: IBDQ score, R = −0.30; p = 0.003; controls: SF-36 score, R = −0.29; p = 0.004).

Conclusion

The use of Facebook was not different between study groups. Psychological aspects such as depression and low self-esteem were associated with the compensatory use of Facebook in both groups, which may be related to unsatisfactory personal aspects of social interaction.

Reconstruction of individual, social, and professional life: Self-management experience of patients with inflammatory bowel disease

BACKGROUND:

Patients with inflammatory bowel disease (IBD) experience wide range of physical and psychological problems experience. The use of strategies to improve disease management by patients is of has special importance in solving these problems. The aim of present study was to discover the strategies and behaviors of patients to manage their disease.

MATERIALS AND METHODS:

The present study was conducted with a qualitative research approach and a qualitative content analysis method. The research participants included 20 patients with IBD referred to gastrointestinal wards in 2020 in Mashhad. Data were collected through unstructured interviews and purposeful sampling method and continued until data saturation. Data analysis was performed continuously and simultaneously with data collection and comparatively.

RESULTS:

Data analysis provided five themes of “Improving self-efficacy and problem-solving skills,” “Coexistence with disease,” “Reviewing and modifying of interactions,” “Adjusting job and professional conditions” and “Commitment to self-care.” The combination of these concepts indicated that is the main theme in disease management for these patients.

CONCLUSIONS:

Reconstruction of individual, social, and professional life can improve self-regulation and problem-solving skills in these patients and make them a sense of control on their lives and disease.

Promoting psycho-social wellbeing for engaging inflammatory bowel disease patients in their care: an Italian consensus statement

BACKGROUND

Inflammatory bowel diseases (IBD) are remitting and relapsing diseases that mainly interest the gastrointestinal tract. IBD is associated with a condition of psycho-social discomfort that deeply compromises the quality of life and the competence of patient to be fully engaged in their self-management. As a consequence, effective care of IBD patients should include not only medical but also psychological support in order to improve patients' wellbeing. Although this, to date there is no standardized approach to promote psychological wellbeing of IBD patients in order to improve the perception of the quality of the care. To fill this gap, a consensus conference has been organized in order to define the psychosocial needs of IBD patients and to promote their engagement in daily clinical practice. This paper describes the process implemented and illustrates the recommendations deriving from it, which focus on the importance of a multidisciplinary approach in IBD management.

RESULTS

The consensus conference has been organized in three phases: (1) literature review about life experiences, engagement, and psychosocial needs of IBD patients; (2) workshops with IBD experts and patients' representatives; (3) drafting of statements and voting. Seventy-three participants were involved in the consensus conference, and sixteen statements have been voted and approved during the consensus process.

CONCLUSIONS

The main conclusion is the necessity of the early detection of - and, in case of need, intervention on- psycho-social needs of patients in order to achieve patient involvement in IBD care.

Assessment of patient-centered outcomes (PROs) in inflammatory bowel disease (IBD): a multicenter survey preceding a cross-disciplinary (functional) consensus

Background

With a shift in the healthcare paradigm towards a more patient-centered approach, data on inflammatory bowel disease (IBD) needs to be further explored. This study aimed to determine patient perspectives on the effect of IBD and features of patients with lower satisfaction level and compare patient and physician perception of IBD-related Quality of Care (QoC).

Methods

A previously developed pre-standardised set of questions regarding patient-centered outcome (PRO) measures for IBD, comprising 36 items, was administered in five centers, and a concomitant questionnaire for specialised physicians was adapted and administered.

Results

Overall, 1005 patients with IBD met the inclusion criteria. Sixty-five questionnaires were administered to specialised physicians. Both patients and physicians perceived the IBD-related QoC as being satisfactory. Furthermore, this study revealed areas of shortcomings where it comes to patient perceptions. Female sex and the presence of negatively impacting disease characteristics (presence of significant pain or discomfort, lack of energy, feeling fatigued most of the time, experiencing anxiety or depression in the last 2 weeks) were associated with lower satisfaction levels.

Conclusions

Our findings can be used in establishing strategies aimed at improving patient QoC and defining strategic priorities. These data can aid in improving the communication of the pressing needs of IBD patients, to both the public payers and health authorities.

A qualitative inquiry into patients' perspectives on individualized priorities for treatment outcomes in inflammatory bowel diseases

PURPOSE

Patients with inflammatory bowel diseases (IBD) experience a variety of symptoms and limitations due to their condition. While many outcome measures are available to assess IBD symptom level and disease activity, individual patients' preferences are usually not accounted for. Individualized outcome measures allow individual patients to select and weigh outcomes based on their relative importance, and have been developed in other medical disciplines. In this study, we explored IBD patients' perspectives on different strategies to prioritize IBD-specific health outcomes.

METHODS

Existing individualized measures were modified for relevance to IBD patients. We performed six focus groups, in which patients were asked to rate and weigh these measures in a series of exercises and to discuss the pros and cons of five different prioritization methods (Likert scale, ranking, selecting outcomes, distribute points, and using a rotating disk) using a semi-structured approach. A thematic analysis revealed key themes in the data.

RESULTS

Patients' thoughts could be grouped into four key themes with 2-4 subthemes each: (1) prioritizing outcomes; (2) differences between methods; (3) outcomes to include; and (4) practical use. Overall, it was challenging for many patients to prioritize outcomes. Among the different prioritization methods, the rotating disk was perceived as the most intuitive. Patients anticipated that this visualization would also help them communicate with their physician.

CONCLUSION

In a series of focus groups, a visual rotating disk was found to be an intuitive and holistic way to elicit the relative importance of different outcomes for individual IBD patients.

Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial

Background

Fatigue is the third most prevalent symptom for patients with inflammatory bowel disease (IBD), yet optimal strategies for its management are unclear. Treatment protocols for fatigue in other conditions have been based on cognitive-behavioural models. Targeting cognitions, emotions and behaviour related to fatigue through cognitive-behavioural therapy (CBT) may be a viable option to improve fatigue and quality of life (QoL) in IBD.

Methods

This single centre, two-arm, feasibility randomised controlled trial (RCT) aimed to assess the feasibility and initial estimates of potential efficacy of a CBT intervention for the management of IBD-fatigue. Feasibility, acceptability and initial estimates of potential efficacy outcomes were collected through self-report measures and semi-structured interviews. Participants were recruited from one tertiary referral centre. Intervention Group 1 received a CBT manual for fatigue, one 60-min and seven 30-min telephone sessions with a therapist over 8-weeks. Control Group 2 received a fatigue information sheet without therapist support. A nested qualitative study evaluated patients’ and therapists’ experiences, and IBD-healthcare professionals’ (HCPs) perceptions of the intervention.

Results

Eighty-nine participants were assessed for eligibility. Of these, 31 of the 70 eligible participants consented to participate (recruitment rate of 44%). Of the 15 participants randomised to the intervention group, 13 (87%) started it and 10 (77% of those who started) completed all 8 sessions. Follow-up questionnaires were completed by 22 (71%) participants at 3 months, 14 (45%) at 6 months and 12 (39%) at 12 months’ follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. HCPs reported that the intervention would be applicable, but time, finance and training constraints limit its implementation. Initial estimates of potential efficacy with complete case analysis showed a reduction in fatigue and an increase in QoL at 3, 6 and 12 months post-randomisation.

Conclusions

A full-scale effectiveness RCT testing CBT for IBD-fatigue is feasible and is potentially worthwhile with some changes to the protocol. However, given the small numbers, further pilot work is warranted before a full-scale RCT.

Trial registration

Registration Trial ISRCTN 17917944, Registered 2 September 2016

Perceptions of IBD within patient and community samples: a systematic review

Objective: Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition that involves a range of debilitating bowel symptoms. Adjustment to living with IBD can be negatively impacted by maladaptive cognitive and behavioural factors (e.g. negative illness representations and repressing emotions). Patient samples also report negative reactions from the general public and such perceptions can further negatively impact people living with IBD. Therefore, we aimed to systematically review literature investigating the illness perceptions, perceived stigmatisation, and negative emotional reactions toward IBD within patient and community samples. We also aimed to review how these factors impact those living with IBD (i.e. adjustment, psychological health). Design: A range of databases (e.g. Psych INFO, PubMed) were searched over two years. One reviewer individually screened titles and abstracts using the specified inclusion criteria, and this process was repeated by a second reviewer. Subsequently, the full text articles were screened and data were extracted for the 82 articles that satisfied the inclusion criteria. Following data extraction, a narrative synthesis was conducted.Results: The review of 82 studies suggested that negative illness perceptions are linked to poorer psychosocial outcomes, that patient samples frequently anticipate stigmatisation, fear relating to bowel accidents was the most common emotion reported, and that the general public direct little enacted stigma towards IBD.Conclusion: For people living with IBD: (i) poorer psychological adjustment was reported by those who held more negative perceptions and reactions toward their illness; and (ii) their concerns regarding public perceptions of IBD warrants further empirical attention. Results emphasise the importance of targeting perceptions, and facilitating education and adaptive responding during treatment.

Prospective Study of Psychological Morbidity and Illness Perceptions in Young People With Inflammatory Bowel Disease

BACKGROUND AND AIMS

Psychological morbidity is increased in young people with inflammatory bowel disease [IBD]. Illness perceptions may be an important factor. This study aimed to describe the prevalence and severity of psychological morbidity and to examine relationships between baseline illness perceptions and anxiety, depression, and health-related quality of life [HRQoL], at baseline and 12 months later, in 16-21 year olds with IBD.

METHODS

IBD patients [n = 121] completed measures of anxiety, depression, HRQoL, and illness perceptions [IPQ-R] at baseline and follow-up [n = 100, 83%].

RESULTS

Among the 121 patients at baseline [median age 19.3 years, 40% female, 62% Crohn's disease, 73% in clinical remission], 55% reported elevated symptoms of anxiety/depression and 83% reported low HRQoL. Negative illness perceptions at baseline were significantly correlated with greater anxiety, depression, and lower HRQoL at baseline and follow-up. In regression analysis at baseline, the IPQ-R domain of greater perception of a cyclical nature of IBD was an independent predictor of anxiety, and a greater perceived emotional impact of IBD was an independent predictor of anxiety, depression, and HRQoL. Female gender and clinical relapse were also independent predictors of lower HRQoL. After controlling for baseline measures, clinical risk factors and illness perceptions did not explain additional variance in psychological morbidity at follow-up.

CONCLUSIONS

A high prevalence of psychological morbidity, stable over 1 year, was demonstrated in young people with IBD. Having negative illness perceptions, being female, and having active disease predicted those at greatest risk of psychological morbidity. Illness perceptions may be an appropriate target for psychological interventions.

School-related experience and performance with inflammatory bowel disease: results from a cross-sectional survey in 675 children and their parents

Objective

We describe school performance and experience in children with inflammatory bowel disease (IBD) across Germany and Austria. Predictors of compromised performance and satisfaction were evaluated to identify subgroups of increased risk.

Design

This cross-sectional analysis was based on a postal survey in children aged 10-15 with Crohn's disease, ulcerative colitis or unclassified IBD and their families. Multivariate regression analysis was used to assess influential factors on parental satisfaction with school, attending advanced secondary education (ASE), having good marks and having to repeat a class. Satisfaction was assessed based on the Child Healthcare-Satisfaction, Utilisation and Needs instrument (possible range 1.00-5.00).

Results

Of 1367 families contacted, 675 participated in the study (49.4%). Sixty-eight participants (10.2%) had repeated a year, 312 (46.2%) attended ASE. The median school satisfaction score was 2.67 (IQR 2.00-3.33). High socioeconomic status (SES) and region within Germany were predictive for ASE (OR high SES 8.2, 95% CI 4.7 to 14.2). SES, female sex and region of residence predicted good marks. Grade retention was associated with an active disease course (OR 2.7, 95% CI 1.4 to 5.3) and prolonged periods off school due to IBD (OR 3.9, 95% CI 1.8 to 8.6).

Conclusions

A severe disease course impacted on the risk of grade retention, but not on type of school attended and school marks. Low satisfaction of parents of chronically ill children with the school situation underlines the need for a more interdisciplinary approach in health services and health services research in young people.

Patient-reported healthcare expectations in inflammatory bowel diseases

BACKGROUND

Patient-reported experience is an important component of a holistic approach to quality of care. Patients' expectations of treatments and global disease management may indicate their illness representations and their satisfaction and hopes regarding quality of care.

OBJECTIVE

To study expectations of patients with inflammatory bowel disease.

METHODS

Two focus groups were conducted with 14 patients to explore their expectations about treatments and disease management. From qualitative content analyses of focus group discussions, we built a 22-item expectations questionnaire that was sent to 1756 patients of the Swiss IBD cohort. Answers were collected on a visual analog scale from 0 to 100, and medians (interquartile range [IQR]) calculated. Factor analysis identified main expectation dimensions, and multivariate analyses were performed to describe associations with patient characteristics.

RESULTS

Of 1094 patients (62%) included in the study, 54% were female, 54% had Crohn's disease, 35% had tertiary education, and 72% were employed. Expectation dimensions comprised realistic, predictive, and ideal expectations and were linked to information, communication, daily care, and disease recognition. Half (11 of 22) of the expectations were ranked as very high (median score > 70), the 2 most important being good coordination between general practitioners and specialists (median score: 89, IQR: 71-96) and information on treatment adverse events (89, IQR: 71-96). Women had overall higher levels of expectations than did men. Expectations were not associated with psychosocial measures, except those related to disease recognition, and most of them were highly associated with increased concerns on disease constraints and uncertainty.

CONCLUSIONS

Patients have high expectations for information and communication among caregivers, the levels varying by gender and region. Patients also appear to request more active participation in their disease management.