Health-related quality of life in adolescents with inflammatory bowel disease depends on disease activity and psychiatric comorbidity

Adolescent patients with inflammatory bowel disease (IBD) show an increased risk for behavioral and emotional dysfunction. Health-related quality of life (HRQoL) is influenced by medical illnesses, as well as by psychiatric disorders, but for adolescents with IBD, the extent to which HRQoL is influenced by these two factors is unclear. For 47 adolescent IBD patients, we analyzed disease activity, HRQoL and whether or not a psychiatric disorder was present. Disease activity was estimated using pediatric Ulcerative Colitis Activity Index and pediatric Crohn's Disease Activity Index. The IMPACT-III and the EQ-5D were used to measure HRQoL and QoL, respectively. In addition, patient and parent diagnostic interviews were performed. 55.3 % patients fulfilled DSM-IV criteria for one or more psychiatric disorders. In all patients, psychiatric comorbidity together with disease activity contributed to a reduction in quality of life. Adolescents with IBD are at a high risk for clinically relevant emotional or behavioral problems resulting in significantly lower HRQoL. We conclude that accessible, optimally structured psychotherapeutic and/or psychiatric help is needed in adolescent patients with IBD.

[Therapy of functional abdominal pain in childhood. Concept, acceptance and preliminary results of a short hypnotherapeutic-behavioural intervention]

OBJECTIVE

Recurrent abdominal pain is one of the most frequent pain syndromes in childhood and is accompanied by notable functional impairment and unfavourable long-term outcome. Psychotherapeutic approaches are promising, but not widely used in Germany. The concept of a multimodal short-term intervention and its acceptance are described and preliminary results are reported.

METHOD

A total of 21 children aged 6-12 years and their parents participated in a hypnotherapeutic-behavioural short intervention program. Preliminary results on efficacy up to 3 months are reported.

RESULTS

Participating children showed a decrease in pain frequency and daily impairment. Health-related quality of life also increased and associated mental problems could be reduced. Content and conditions of the intervention were rated as helpful by children and parents.

CONCLUSION

Preliminary results indicate that even short psychotherapeutic interventions might help affected children effectively and lower the burden felt by parents. Further investigations using a randomized controlled trial design and focussing on children suffering more severely should follow to allow major conclusions.