A cross-cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome

BACKGROUND

Little information exists regarding whether psychosocial variables in irritable bowel syndrome (IBS) vary by geographic location. Adult attachment is an important psychological concept rooted in childhood relationship experience that has not been previously studied in IBS. Catastrophizing and negative pain beliefs have been described in IBS and may be affected by attachment.

AIMS

In this cross-cultural study, we determined: (i) whether attachment differs between IBS patients and controls, (ii) whether geographic location has a significant effect on attachment style, catastrophizing and negative pain beliefs, and (iii) how all three variables correlate with IBS symptom severity.

METHODS

463 IBS patients, with moderate to severe symptom scores, and 192 healthy controls completed validated questionnaires about attachment, catastrophizing, negative pain beliefs and IBS-SSS in nine locations, USA (New York, Los Angeles), Mexico, Italy (Rome, Bari), Romania, Iran, India, and China.

KEY RESULTS

Attachment anxiety and avoidance scores were significantly higher in IBS patients than in controls (p < 0.001). This was particularly true for the fearful-avoidant attachment category, especially in China and Romania. Path analysis showed that attachment anxiety and avoidance had indirect effects on IBS-SSS through catastrophizing (p < 0.0001) and negative pain beliefs (p = 0.005). All three psychosocial measures varied significantly depending on location.

CONCLUSIONS & INFERENCES

In the IBS population studied, attachment style was significantly different in IBS compared to a control population. Geographic differences in attachment, catastrophizing and negative pain beliefs were documented and their correlation with symptom severity and thus, research of psychosocial variables in IBS should take into account the location of the population studied.

Conducting multinational, cross-cultural research in the functional gastrointestinal disorders: issues and recommendations. A Rome Foundation working team report

BACKGROUND

Cross-cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross-cultural comparative research can make a significant contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra-intestinal co-morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health-related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race.

AIMS

To identify methodological challenges for cross-cultural, multinational research, and suggest possible solutions.

METHODS

This report, which summarises the full report of a working team established by the Rome Foundation that is available on the Internet, reflects an effort by an international committee of FGID clinicians and researchers. It is based on comprehensive literature reviews and expert opinion.

RESULTS

Cross-cultural, multinational research is important and feasible, but has barriers to successful implementation. This report contains recommendations for future research relating to study design, subject recruitment, availability of appropriate study instruments, translation and validation of study instruments, documenting confounders, statistical analyses and reporting of results.

CONCLUSIONS

Advances in study design and methodology, as well as cross-cultural research competence, have not matched technological advancements. The development of multinational research networks and cross-cultural research collaboration is still in its early stages. This report is intended to be aspirational rather than prescriptive, so we present recommendations, not guidelines. We aim to raise awareness of these issues and to pose higher standards, but not to discourage investigators from doing what is feasible in any particular setting.

Technical report: an ePRO patient reported outcome program for the evaluation of patients with irritable bowel syndrome

BACKGROUND

Patient reported outcome (PRO) is an important healthcare concept that describes patient's participation in their care by self-evaluation, usually in the form of questionnaires. This report describes an unique computerized technique, electronic PRO (ePRO), for following the progress of patients with irritable bowel syndrome (IBS).

METHODS

Patients first completed a series of questionnaires, including questions about their illness history, symptom severity, and, in this application, psychological and relationship issues. The symptom severity and psychological questionnaires were then completed at intervals by the patients on their own computers. The ePRO was constructed to allow scores to be automatically summed and placed on a time-line graph for review at the time of the next office visit.

KEY RESULTS

Of the 32 patients who completed the initial set of questionnaires, 20 maintained participation in the program for a 6-month period. Of those 20 patients, median number of submissions was 7.0; median interval between questionnaire submissions was 3.0 weeks, whereas median interval between office visits was 5.9 weeks. On average, questionnaire completion took less than 5 min and was positively experienced by the patients.

CONCLUSIONS & INFERENCES

The ePRO program proved to be technically feasible, clinically useful, and positively experienced by the patients. It provides a focus on a collaborative conversation between physician and patient. It has significant potential as a technique for evaluating outcome in response to various therapies.

The importance of the family context in inflammatory bowel disease

BACKGROUND

This study examines psychological correlates of inflammatory bowel disease (IBD) to answer these questions: What is the association between individual and family stress levels and the patient's coping ability and severity of illness? How does the level of family functioning correlate with individual coping and illness severity? To what extent are patient and family beliefs about IBD related to symptomatology?

METHODS

Seventeen patients and 44 of their family members were studied intensively in an exploration of the psychological response to IBD. They completed a comprehensive battery of self-report questionnaires assessing stressful life events, coping related to the illness, and beliefs regarding IBD. Ratings of family functioning were made from videotaped family discussions about IBD. Treating physicians made independent ratings of past and current disease severity.

RESULTS

Surprisingly, recent disease activity was negatively correlated with family stress level (r = -0.794), but was not associated with patient stress level. However, impaired coping with IBD by affected individuals was directly correlated with both individual (r = 0.595) and family-wide (r = 0.724) reported stress levels. Disease severity was also found to be responsive to family communication style (r = 0.431) and to level of family agreement (r = 0.531) regarding the etiology and management of IBD.

CONCLUSIONS

These findings suggest that individual stress affects coping with IBD, whereas family-wide stress, communication style, and agreement about disease etiology and management are related to disease activity. The interrelationship of family and patient as well as individual coping with IBD should be evaluated in future studies.

Psychosocial growth retardation in adolescence. A reversible condition secondary to severe stress

Two cases of psychosocial growth retardation in adolescents are presented, along with a brief review of the literature. Both cases were females, aged 12-13 years, who showed marked deceleration of growth and development when placed in an emotionally stressful situation. A normal pattern of growth and development ensued when the stressful situation was at least partially alleviated. To facilitate proper management, it is important to recognize those adolescents with psychosocial growth retardation. The increased availability of human growth hormone (hGH) may place more pressure on physicians to use exogenous hGH in adolescents who exhibit growth retardation. It appears that the administration of exogenous hGH is not indicated in the treatment of children with psychosocial growth retardation.