Stigma, deviance and morality in young adults' accounts of inflammatory bowel disease

Construction of identity in individuals with inflammatory bowel disease across the lifespan

Inflammatory bowel disease (IBD) is a chronic illness that affects 10 million individuals worldwide; however, Canada has the highest rates of IBD per capita in the world. Presently, 0.7% of Canadians are diagnosed with IBD, which is expected to rise to 1% by 2030. Disease onset is typically between the ages of 15-45 years old. This is a crucial period for identity development and growth; however, IBD symptoms often disrupt these processes and cause individuals to abandon or reconstruct parts of their identity. As a result, changes in individuals' life plans and health status may cause them to grieve their former pre-IBD identities. In this qualitative narrative study, we captured the lived experiences of IBD, with a focus on what individuals have lost, gained, or accomplished across various avenues (e.g. relationships, education, and future scripts). Thirteen participants constructed IBD narratives using a holistic-form narrative approach, a method that captures various plot formulations and discourses that emerge through storytelling. We found three main plotlines: The 'journey to acceptance', which detailed a route to acceptance wherein individuals integrated IBD into their identity, 'the ambivalent story', which exemplified individuals who were unsure of IBD and the resulting impacts of the diagnosis on their identity, and 'the grief story', which outlined grief and loss surrounding one's pre-IBD self. These results illuminate the role of narrative in shaping meaning-making and identity processes over the life course. We urge future researchers to explore narrative inquiry as a route to further understand the integration of IBD into one's life story/identity.

Stigma and its correlates among patients with Crohn's disease: A cross-sectional study in China

Objectives

Crohn's disease is an incurable disease characterized by unpredictable intestinal symptoms, which unavoidably affect patients' lives and contribute to feelings of stigma. This study aimed to explore the status and its correlates of stigma among patients with Crohn's disease.

Methods

Using a convenience sampling, 146 hospitalized patients with Crohn's disease were recruited in a tertiary hospital in Southern China from October 2020 to March 2021. The participants were assessed by demographic and disease-related questionnaires, the Social Impact Scale (SIS), Inflammatory Bowel Disease-Self-Efficacy Scale (IBD-SES), and Social Support Rating Scale (SSRS). Multivariate linear regression analysis was conducted to explore the influencing factors of stigma among patients with Crohn's disease.

Results

The mean SIS score was 58.14 ± 10.74, representing a moderate effect of stigma, and 85.6% (125/146) of the patients experienced moderate to high levels of stigma. The multiple linear regression analysis showed that perceived public awareness of the disease, family income, age, and self-efficacy were the main influencing factors of stigma, which could explain 52% of the total variation of stigma among patients with Crohn's disease.

Conclusion

Stigma among patients with Crohn's disease is influenced by perceived public awareness of the disease, family income, age, and self-efficacy. Interventions aimed at improving self-efficacy and public awareness should be considered to alleviate the level of stigma, especially for those aged 40 years or older or low-income patients.

Perceived effect of pediatric inflammatory bowel diseases on academics, college planning, and college adjustment

ObjectiveTo examine the relationship between perceived effect of inflammatory bowel diseases (IBD) on high school academics and college planning on college adjustment. Participants: Participants (N = 97) were college students with IBD. Methods: Participants completed an online survey including the Student Adaptation to College Questionnaire and study-developed questions assessing the perceived impact of their diagnosis on their high school academics and college planning. Results: Most participants reported average college adjustment across domains, except personal-emotional adjustment with 47% of participants falling within the very low to low ranges. Nearly half reported IBD impacted their choice of college (49%). The impact of IBD on college planning was most consistently associated with domains of college adjustment. Conclusions: IBD severely impacts college planning, decision-making, and adjustment in college-bound youth. Perceiving that having a chronic illness impacts college planning may result in greater difficulty with academic adjustment, attachment to the institution, and social adjustment during college.

Systematic Review and Meta-analysis on the Incidence, Prevalence and Determinants of Discomfort in Inflammatory Bowel Disease

Background

The symptom burden in inflammatory bowel disease (IBD) has a significant negative impact on the health-related quality of life (HRQOL). Patients with IBD report physical, psychological and social discomfort even during remission.

Aim

To synthesize the best available evidence to determine the worldwide incidence, prevalence and determinants of discomfort in adults with inflammatory bowel disease (IBD).

Methods

Following PRISMA recommendations, we searched the Medline, CINAHL, PsycInfo, Embase, Cochrane, Campbell and JBI Evidence Synthesis databases for studies on either incidence or prevalence of discomfort in English until January 2021. Data were extracted using the Joanna Briggs Institute’s standardized extraction tools. Data that directly reported or could be used to calculate the incidence and prevalence of discomfort were extracted. Ten studies were eligible for inclusion in this review. Overall, the methodological quality of the included studies was considered moderate. Data measuring the incidence of discomfort in 6 out of 10 identified studies using the same measurement tool (EQ-5D) were pooled in a meta-analysis. Additional results have been presented in a narrative form, including tables.

Results

There is no standardized definition or tool utilized to describe or measure discomfort in IBD. Synthesized findings demonstrate that discomfort is prevalent among adults living with IBD. Determinants of discomfort included health literacy, disease activity, hospitalization/surgery, age and gender, delayed diagnosis, local practice standards and quality of IBD care.

Conclusions

More research is needed to identify the impact of discomfort on health-related outcomes for people with IBD and consequently appraise discomfort interventions for their efficacy.

"The Rest of my Childhood was Lost": Canadian Children and Adolescents' Experiences Navigating Inflammatory Bowel Disease

Children and adolescents with Inflammatory Bowel Disease (IBD) face significant and unique challenges related to their condition. The aim of this study was to better understand some of these challenges, and to explore how Canadian youth respond to them. We interviewed 25 pediatric patients with IBD, ranging in age from 10-17, to find out about their illness experiences. Using a thematic analysis, we discerned three themes: challenges related to diagnosis, making sense of change, and navigating sociability. Taken together, they paint a picture of young people facing great uncertainty prior to diagnosis, pronounced changes to selfhood as they make lifestyle adjustments, and facing difficulties with the implications of reduced sociability because of their disease. We conclude by providing recommendations for the development of resources aimed at helping newly diagnosed pediatric patients navigate these issues.

Impact of eHealth technologies on patient outcomes: a meta-analysis of chronic gastrointestinal illness interventions

Gastrointestinal (GI) illness interventions are increasingly utilizing eHealth technologies, yet little is currently known about the extent of their impact on patient outcomes. The purpose of this study was to conduct a meta-analysis of the GI eHealth intervention literature. We used a comprehensive search strategy to locate studies. To be included, studies had to be a randomized controlled trial comparing an eHealth intervention condition against a no-treatment or waitlist control condition. Studies had to report data on at least one of the following patient outcomes: medication adherence, quality of life (QoL), psychological distress, illness-related knowledge, or number of patient visits to the clinic/hospital. Analyses weighted effect sizes (d) by their inverse variance and combined them using random effects meta-analytic procedures. K = 19 studies conducted in eight countries with a cumulative sample size of N = 3,193 were meta-analyzed. Findings indicated that GI eHealth interventions improved patients' QoL (d = .25, p = .008), psychological distress (d = .24, p = .017), medication adherence (d = .17, p = .014), and illness-related knowledge (d = .19, p = .002). GI eHealth interventions also significantly reduced the number of patient visits to the clinic/hospital (d = .78, p = .005). Our findings suggest that eHealth interventions hold promise in improving patient outcomes for those with GI illnesses. We suggest the next generation of GI interventions continue developing and evaluating the impact of technology using randomized controlled trial designs, and perhaps consider adapting existing efficacious interventions for burgeoning platforms, such as smartphones and tablets.

A Feeling of Otherness: A Qualitative Research Synthesis Exploring the Lived Experiences of Stigma in Individuals with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) consists of Crohn’s disease and ulcerative colitis, chronic conditions involving inflammation and ulceration of the gastrointestinal tract. Individuals with IBD may be susceptible to experiencing health-related stigma: experienced, perceived, or internalised social exclusion, rejection, blame, or devaluation resulting from negative social judgements based on the disease. This qualitative research synthesis draws together findings from 38 studies describing lived experiences to develop a unified interpretative account of the experience of stigma in IBD. Analysis developed two categories: ‘The IBD journey’ explores the dynamic ways in which having IBD impacted on individuals’ self-identity and ‘a need to be understood’ examines the tension between wanting to be understood whilst feeling their true experiences needed to be hidden from or were misjudged by the social sphere. The overarching concept ‘feeling of otherness’ highlights that, rather than a static, binary experience, individuals moved across a continuum ranging from the excluding experience of feeling stigmatised and othered, to the inclusive experience of integration. Individuals fluctuated along this continuum across different physical, social, and health contexts. Psychological adjustment to IBD, drawing on experience of adaptive coping, and reconnecting with valued others through illness disclosure strengthened stigma resistance during more challenging times.

Topics Analysis of Reddit and Twitter Posts Discussing Inflammatory Bowel Disease and Distress From 2017 to 2019

Background

Social media platforms are popular tools for people with inflammatory bowel disease (IBD) to seek support. In the current study, we sought to examine and characterize IBD and distress discourse on public social media platforms. Our goal was to identify topics associated with these online discussions.

Methods

We collected public social media posts about IBD and distress from Reddit (N = 40 625) and Twitter (N = 40 306) published between September 2017 and August 2019. We created a term-based dictionary to characterize posts based on 8 different, nonmutually exclusive topics: (1) symptoms, (2) medication, (3) nutrition, (4) procedures, (5) marijuana, (6) stigma, (7) ostomy, and (8) intimacy. We used descriptive statistics to characterize the frequency and order the prevalence of the topics on the 2 platforms, and to assess topic co-occurrences among posts.

Results

Most Reddit (79%) and Twitter (56%) posts mentioned at least 1 IBD topic. The order of topic prevalence was the same for the 2 platforms. Symptoms was the most mentioned topic (Reddit: 57%, Twitter 36%), followed by medication (Reddit: 30%, Twitter 11%), and nutrition (Reddit: 27%, Twitter 9%). Intimacy was the least mentioned topic (Reddit: 2%, Twitter: <1%). Topic co-occurrences varied by platform. Most Reddit posts (57%) mentioned at least 2 IBD topics, whereas only 27% of tweets mentioned multiple IBD topics.

Conclusions

This study contributes to a growing literature examining how IBD is discussed on social media-specifically, in distress-related contexts on Reddit and Twitter. These cross-platform findings highlight important areas potentially associated with IBD-related distress, which could help facilitate future support.

Glycaemic control mediates the relationships of employment status and self-stigma with self-care behaviours in young adults with type 2 diabetes

AIMS AND OBJECTIVES

To investigate the relationships of sociodemographic factors, self-stigma, glycaemic control (measured by glycated haemoglobin (A1C)) and self-care behaviours in young adults with type 2 diabetes.

BACKGROUND

Young adults aged 25-44 years are in their most productive period. Once diagnosed with diabetes, this population tends to experience poor glycaemic control and perform poorly in self-care activities. Such patterns may raise perceptions of self-stigma and further decrease motivations to engage in self-care behaviours in patients with diabetes.

DESIGN

A cross-sectional, correlational research design.

METHODS

The STROBE guidelines for cross-sectional studies were followed. A convenience sample of 115 participants was recruited from a medical centre in southern Taiwan. Instruments included the Self-Stigma Scale-Chinese version and the Diabetes Self-Care Behaviours Scale. Data were analysed using a three-step hierarchical regression analysis and the Sobel test.

RESULTS

The average age of the participants was 36.7 years. Marital status, employment status, self-stigma and A1C were significantly associated with self-care behaviours, and these four variables explained 43.6% of the variance in self-care behaviours. However, A1C (β = -.58, p < .001) was found to be the only determinant of self-care behaviours in the last regression model. The Sobel test showed that A1C had mediating effects on self-stigma and self-care behaviours as well as employment status and self-care behaviours.

CONCLUSION

This study supports the interactive relationship among self-stigma, employment status, glycaemic control and self-care behaviours in young adults with type 2 diabetes. Strategies aimed at optimising glycaemic control can help reduce the effects of self-stigma perceptions and employment status on the self-care behaviours of such patients.

RELEVANCE TO CLINICAL PRACTICE

More effective educational programmes should be designed to improve glycaemic control, lower the effects of employment and decrease perceptions of self-stigma to further motivate young adults to engage in better diabetes self-care behaviours.

A delicate balance between control and flexibility: Experiences of care and support among pre-teenage children with type 1 diabetes and their families

For children with type 1 diabetes, the period of adolescence is associated with higher blood glucose levels and increased psychological distress compared to other age groups. Focusing on pre-teens (9-12 years) with type 1 diabetes and their families has been suggested as key to understanding and reducing these challenges. The aim of this study was to explore: 1, how diabetes affects family life, 2, experiences of and needs for support and 3, how care responsibilities are negotiated among pre-teens with type 1 diabetes and their families. Data were obtained from four interactive workshops with pre-teens (n = 17), their parents (n = 26) and their siblings (n = 14). Dialogue tools, for example quotes and picture cards, were used to facilitate discussion and reflection concerning family life with type 1 diabetes. Data analysis resulted in three themes: 1, diabetes takes up 'a lot of space', 2, giving and receiving support and 3, balancing control and flexibility. While diabetes took up significant space in the families, family members protected each other from their respective frustrations. The findings point to the significance of considering all key family members and their interactions in diabetes interventions. This includes balancing control and flexibility, negotiating responsibilities and building trust.

Mindfulness-based cognitive therapy experiences in youth with inflammatory bowel disease and depression: findings from a mixed methods qualitative study

OBJECTIVES

Mindfulness-based cognitive therapy (MBCT) is effective in treating psychosocial comorbidities in inflammatory bowel disease (IBD); however, there have been no qualitative studies of MBCT experiences among youth with IBD. We aimed to examine the experiences of youth with IBD and depression who completed an adapted MBCT group programme, and the impact of common psychotherapy and group factors.

DESIGN

This mixed method qualitative study, nested within a randomised controlled trial (RCT) of MBCT for youth with IBD, employed thematic analysis of qualitative data from three focus groups and open-ended survey questions.

SETTING

The study was conducted in the outpatient department of a tertiary hospital for young adults in Brisbane, Australia.

PARTICIPANTS

Out of sixty-four adolescents and young adults recruited to the RCT of MBCT for youth with IBD and depression, 29 completed the MBCT evaluation survey and 19 attended the focus groups.

RESULTS

Four key themes emerged: 'connectedness and shared understanding', 'growing in wisdom', 'therapeutic alliance' and 'barriers to mindfulness practice'. Participants described MBCT experiences as healing and transformative with the themes of connectedness, growing in wisdom and therapeutic alliance laying the foundation for therapeutic change. Main barriers included fatigue, depression, time and travel constraints.

CONCLUSIONS

The study identified key themes facilitating the process of therapeutic change within the MBCT programme for youth with IBD and elucidated common and group psychotherapy factors underlying the key themes. Participants perceived connecting with peers as essential for learning mindfulness skills which in turn strengthened the connection. Study findings will facilitate interpretation of the results of the RCT of MBCT in youth with IBD and inform the design of future studies of MBCT in this cohort.

TRIAL REGISTRATION NUMBER

ACTRN12617000876392; Results.

Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity, age of onset, and embarrassment of the condition

Purpose

Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity and abdominal pain being important factors. In the current study, building on what young people had told us in our previous work, we examined whether embarrassment of the condition, social self-efficacy, and friendship quality mediated the relationship between abdominal pain and disease severity, and mental health/well-being. We also included loneliness as a component of well-being.

Methods

Data on depression, anxiety, loneliness, friendship quality, social self-efficacy, and disease embarrassment were collected from 130 AYA with IBD ages 14–25 years; data on disease severity and abdominal pain were taken from their medical records. Structural Equation Modeling (SEM) was used to test the relationships between the variables.

Results

Using SEM, we established that higher IBD disease activity negatively impacted how AYA felt about their friendships and how embarrassed they were about their condition; embarrassment then influenced reports of mental health, including loneliness. Abdominal pain, disease onset, and social self-efficacy directly predicted internalising problems.

Conclusion

In this sample of 14–25-year-old patients with IBD, specifics about the disease (severity and pain) predicted poorer mental health, suggesting discussion of mental health should be part of the clinical dialogue between patient and consultant. In addition, embarrassment about their condition increased depression, anxiety, and loneliness, mediating the relationship between disease severity and well-being. Thus, it is important to consider how perceived stigma affects those with chronic illness, and those issues should be explored in clinic.

Sustaining, Forming, and Letting Go of Friendships for Young People with Inflammatory Bowel Disease (IBD): A Qualitative Interview-Based Study

Inflammatory bowel disease (IBD) is an incurable, chronic, gastrointestinal condition that can constrain young people's social relationships. Few studies have specifically explored friendships of people with IBD. This qualitative, participatory study used interviews, photographs, and friendship maps to explore friendships and friendship networks of young people with IBD. An online Young Person's Advisory Group was actively engaged throughout the study. Thirty-one young people participated (n = 16 males, n = 15 female; n = 24 Crohn's disease, n = 6 ulcerative colitis, n = 1 IBD-unclassified; the mean age at study was 18.7 years; range 14-25 years). Findings present a metatheme “The importance and meaning of friendships” and three interwoven subthemes of “Sustaining friendships,” “Forming new friendships,” and “Letting go of friendships.” Friendship was important to the young people with IBD, providing support, but associated with challenges such as disclosure. Such challenges could be mitigated by clearer conversations with clinicians about friendships and more extensive conversations about friendships and long-term conditions in education settings.

Experiences of Body Image Changes in Chinese Patients Living with Inflammatory Bowel Disease: A Descriptive Qualitative Study

PURPOSE

Body image changes are common among patients living with inflammatory bowel disease (IBD) because of the illness and related treatments. Currently, there is little known about how those patients experience and perceive their altered body image in the literature. The aim of this study was to explore the experiences of body image changes in patients with IBD in China and to describe how those changes influence patients' perception of body and self.

METHODS

This study used a descriptive qualitative approach. A total of 16 participants from three tertiary hospitals in southeast China were recruited through purposive sampling combined with maximum variation strategy. Data were collected through semistructured interviews and analyzed using conventional content analysis method.

RESULTS

The following six themes were extracted: (1) "being a constrained person," (2) "being a flawed person," (3) "being a disliked person," (4) "being an alienated person," (5) "being a reconciled person," and (6) "being a blessed person."

CONCLUSION

With the diagnosis of IBD and its side effects of treatments, patients' life changed significantly and they were struggling to reinterpret their body and self. As a result, negative self-evaluations and/or positive self-evaluations towards themselves generated. Further studies are required to explore the underlying mechanism and related influencing factors about how those different images were produced.

The impact of adolescents' everyday life experiences on their primary hyperhidrosis treatment - a qualitative study

INTRODUCTION

Hyperhidrosis is a disease affecting around 5% of the western population. The qualitative field within hyperhidrosis among adolescents has been sparsely investigated. The aim of this study was to investigate the impact of adolescent hyperhidrosis patients' everyday life experiences on their hyperhidrosis treatment.

METHODS

Qualitative, semi-structured interviews were carried out. In total, 10 adolescents, aged 12-18 years, participated in the study. Data were analyzed using a set of inseparable activities as described by Van Manen.

RESULTS

Three main themes were identified to represent common shared experiences across participants. The first theme was related to the impact of hyperhidrosis on the physical and psychological dimensions of life as it negatively affected both physical abilities and one's self-concept. Having hyperhidrosis was experienced as living a life in secrecy, characterized by individual routines for concealment and isolation in order to protect social identity.

CONCLUSION

The large negative impact of hyperhidrosis on adolescents is a strong justification for treatment of the disease. The substantial emotional distress suggests that treatment may need to include psychological support.

Stigma and Disclosure in Patients With Inflammatory Bowel Disease

Stigma in patients suffering from chronic disease is associated with worse clinical outcomes and secondary medical issues such as depression, anxiety, and decreased quality of life. We believe various forms of stigma can have different clinical significance in patients with inflammatory bowel disease (IBD). With further insight and research, we suggest that these forms of stigma could be identified and targeted by researchers or clinicians to lessen the psychological disease burden in patients and to potentially improve their physical well-being. In the current review, we discuss public perceptions, knowledge, and stigmatization of IBD, the prevalence of various forms of IBD stigma, and the impact of such stigma on patient outcomes. We also discuss IBD disclosure, its association with stigma, and the tendencies and effects of such disclosures among youth and adult patient populations. We finish the review by highlighting possible modalities and research areas for future IBD interventions.

"I Don't Like to Make a Big Thing out of It": A Qualitative Interview-Based Study Exploring Factors Affecting Whether Young People Tell or Do Not Tell Their Friends about Their IBD

Inflammatory Bowel Disease (IBD) describes a group of conditions that includes Crohn's disease and ulcerative colitis. Unlike some chronic conditions, to a greater or lesser extent, IBD is hidden from or invisible to others which enables concealment of the condition, especially when stigma is associated with the condition. Concealment or nondisclosure allows a means of identity management. Disclosure of a chronic condition is not a single event, and it is dependent on many factors. There is little literature that specifically addresses stigma and/or disclosure in relation to children and young people with IBD. An in-depth qualitative study was undertaken, framed by Interpretive Description and using interviews, friendship maps, and photographs within a participatory framework. Public and patient involvement and engagement (PPIE) was undertaken throughout (inception to dissemination) the study. Young people aged 14-25 years with IBD who had participated in the survey phase of the larger study self-selected to participate in interviews that focused broadly on friendship and feelings of social connectedness. Data were analysed using an iterative, interpretive approach. Preliminary themes were developed and these were explored further, and then tentative theoretical connections about friendship were developed. One superordinate theme focused on disclosure. Thirty-one young people (16 males, 15 females, mean age 18.7 years; 24 Crohn's, 7 colitis) participated in the interviews (of these, five created friendship maps and six utilised photographs). Three discrete, but interlinked, themes were generated, revealing young people's experiences of disclosure: to tell or not to tell; controlling the flow: the who, when, what, and how of telling; and reactions and responses to telling: anticipated and actual. Decisions about telling friends about having IBD are challenging for many young people. Having control over disclosure is not always possible, and the potential consequences can feel risky. However, most young people had positive experiences of disclosure and gained support from friends and romantic partners. Most young people downplayed the seriousness of their IBD, revealing some facets of their condition, aiming to sustain their self-identity. Only one young person had been given professional support to disclose. Provision of support and opportunities to discuss whether, when, who, and how to tell friends and what the risks and benefits may be is something that could be woven into an ongoing and wider person-centred dialogue between young people and health professionals within routine clinic visits.

Trait Perfectionism and Psychosocial Outcomes in Adolescents With Inflammatory Bowel Disease

OBJECTIVES

The aim of this prospective cross-sectional study was to examine perfectionism, disease self-management, and psychosocial outcomes in a sample of adolescents with inflammatory bowel disease (IBD).

METHODS

Adolescent patients with IBD and caregivers were enrolled in the study. Patients completed the Child and Adolescent Perfectionism Scale, the Strengths and Difficulties Questionnaire (SDQ), and the TRANSITION-Q. Parents completed the Multidimensional Perfectionism Scale and the parent form of the SDQ. Health care providers reported on disease activity using the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn Disease Activity Index (PCDAI).

RESULTS

Ninety adolescents (mean age 15.17 ± 1.49, range = 12-18) with diagnosed IBD (51 CD, 37 UC, and 2 IBD-U) and 76 primary caregivers participated in the study. Results indicated high rates of self-oriented perfectionism in adolescents with IBD (59% of sample reported elevated rates; 33% of sample in the clinical range). After accounting for age, sex, and disease activity, self-oriented perfectionistic striving was associated with better disease self-management; nonetheless, adolescent and parent perfectionistic strivings were also related to higher adolescent internalizing symptoms (standardized beta = 0.22 and 0.29, respectively). Additionally, perfectionistic concerns (self-critical and socially prescribed perfectionism) were associated with higher rates of adolescent-reported externalizing symptoms (standardized beta 0.30 and 0.24). Further, multilevel mixed modelling found no differences within-dyad in relation to perfectionism, but documented that adolescents report higher levels of externalizing symptoms compared with parents.

CONCLUSIONS

The present study explores the prevalence and presentation of perfectionism in a sample of adolescents with IBD. Results suggest dimensions of perfectionism are differentially associated with psychosocial and disease management outcomes, suggesting further evidence of the relationship between perfectionism, maladaptive coping, and subsequent influences on health outcomes in the context of pediatric chronic illness.

Stigmatisation and resilience in inflammatory bowel disease

Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is an immune-mediated, chronic relapsing disorder characterised by severe gastrointestinal symptoms that dramatically impair patients' quality of life, affecting psychological, physical, sexual, and social functions. As a consequence, patients suffering from this condition may perceive social stigmatisation, which is the identification of negative attributes that distinguish a person as different and worthy of separation from the group. Stigmatisation has been widely studied in different chronic conditions, especially in mental illnesses and HIV-infected patients. There is a growing interest also for patients with inflammatory bowel disease, in which the possibility of disease flare and surgery-related issues seem to be the most important factors determining stigmatisation. Conversely, resilience represents the quality that allows one to adopt a positive attitude and good adjustments despite adverse life events. Likewise, resilience has been studied in different populations, age groups, and chronic conditions, especially mental illnesses and cancer, but little is known about this issue in patients with inflammatory bowel disease, even if this could be an interesting area of research. Resilience can be strengthened through dedicated interventions that could potentially improve the ability to cope with the disease. In this paper, we focus on the current knowledge of stigmatisation and resilience in patients with inflammatory bowel disease.

The agentic Self and uncontrollable body: Young people's management of chronic illness at university

Young people's experiences of living with a long-term health condition have been largely investigated from the perspective of developing autonomy and optimal self-management of treatment regimens. Little existing research explores how young people adjust to the experience of chronic illness within everyday social contexts. Drawing on sociocultural theories of healthism, in this article, we examine the everyday strategies students employed to manage their health condition at university. Data were drawn from a qualitative study with 16 undergraduate students in Australia. Findings from interviews highlight how participants took up discourses of the (hard-working, diligent) Self to discursively position themselves as 'health conscious' and 'in control'. This positioning was maintained through separating the controlled Self from the (uncontrollable) body. The unpredictability of the body posed a threat to young people's abilities to maintain control and denied them opportunities to exercise personal agency. Yet, participants also described a number of subversive strategies in order to take back control and resist the experience of ill health. These potential agentic practices often held unintended consequences, including loss of optimal medical control or (self) exclusion from university life - offering new insights into the differing ways young people concomitantly take-up, rework and resist the pursuit of healthism to 'successfully' manage their health conditions.

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.

Are there also negative effects of social support? A qualitative study of patients with inflammatory bowel disease

OBJECTIVE

Social support is considered an important resource in coping with chronic conditions. By conducting a series of interviews with people who suffer from inflammatory bowel disease (IBD), we received the impression that social support in face-to-face or online communication could also be a source of stress and strain. The aim of our study was to better understand and describe possible negative effects of social support.

DESIGN

This is a secondary analysis of narrative interviews. The interviewees were selected using a maximum-variation sampling approach. Grounded theory and the 'OSOP' (one sheet of paper) method were applied to categorise those parts of the interviews that touched on the negative effects of social support.

SETTING

The open-end interview collection took place throughout Germany from September 2011 to June 2012. Most of the participants were interviewed in their homes, some in the Department of General Practice in Göttingen.

PARTICIPANTS

42 patients with IBD.

RESULTS

Two interrelated categories emerged: (1) unwanted confrontation and (2) undesirable reactions. The interviewees perceived social support as negative, especially if they felt overwhelmed and/or if they had not asked for it. Consequently, some of our interview partners developed strategies to prevent coming into social contact with others or stopped talking entirely about their disease.

CONCLUSION

While social support is usually conceptualised and perceived as a positive resource in chronic disease, it sometimes turns into a negative experience and may end in social isolation and deteriorate health. This process also happens in online support groups and increases anxiety when exchanging with other people on the internet. Before motivating ill people to seek contact with others, they should know about the negative effects of social support.

"I can fight it!": A qualitative study of resilience in people with inflammatory bowel disease

Objectives

This study aimed to understand the resilience experiences in patients with inflammatory bowel disease (IBD) and develop the resilience framework for them.

Methods

Semistructured interviews were conducted with 15 patients with IBD who were purposefully recruited from the gastroenterology department of two hospitals in Jiangsu, China to gain diversity in the demographic and clinical characteristics. The data were analyzed using a directed content analysis approach based on the Kumpfer's resilience framework.

Results

The resilience framework for patients with IBD was formed from the analysis. This framework was composed of four themes, as follows: (1) complicated factors in the environment, (2) change the environment into a protective one, (3) personality traits, and (4) resilience-related coping.

Conclusions

The resilience framework for patients with IBD can effectively characterize the resilience experience of patients during the disease and assist healthcare professionals to understand how patients recover from the disease. More quantitative studies are needed to further explore the influencing factors of resilience and improve resilience in patient with inflammatory Bowel Disease.

Swedish Children's Lived Experience of Ulcerative Colitis

Inflammatory bowel disease (IBD) is increasing in children. When this lifelong illness is diagnosed in childhood, especially during adolescence, it may have a negative impact on children's quality of life. The aim of the present study was to illuminate the meaning of children's lived experience of ulcerative colitis. Seven children aged between 10 and 18 years were recruited from University Hospital South Sweden and interviewed about the phenomenon under scrutiny. Data were analyzed by means of a phenomenological hermeneutical method. The meaning of the children's lived experience of ulcerative colitis was summed up as a main theme. A daily struggle to adapt and be perceived as normal consisted of 4 subthemes: being healthy despite the symptoms, being healthy despite being afraid, being healthy despite a sense of being different, and being healthy despite needing support. The children strove to perceive themselves as healthy, and they needed to be perceived as healthy, especially when experiencing symptoms of inflammatory bowel disease. Children with inflammatory bowel disease confront various problems, such as ambitions and goals that are hard to achieve, due to reduced abilities as a result of the illness or an insufficiently adapted environment.

Impact of Disease Disclosure on Stigma: An Experimental Investigation of College Students' Reactions to Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a serious chronic illness that affects 1 in 200 people in the United States with the majority of new cases of IBD diagnosed in young people under the age of 35. Despite the growing number of people who are diagnosed each year, the consequences of health-related stigma faced by young people grappling with the effects of IBD are understudied. This experimental investigation explored the existence of enacted stigma among college students, a population that faces many social and psychological challenges due to the added emotional stresses brought about by the transition from high school and adolescence to college and adulthood. Results indicate that enacted stigma among college students toward other students with IBD decreases when disclosure of the disease is present. Results also suggest that greater knowledge of the nature and symptoms of IBD positively correlates to decreased stigma.

The experience of stigma in inflammatory bowel disease: An interpretive (hermeneutic) phenomenological study

AIM

To explore experiences of stigma in people with inflammatory bowel disease.

BACKGROUND

Diarrhoea, urgency and incontinence are common symptoms in inflammatory bowel disease. Social rules stipulate full control of bodily functions in adulthood: poor control may lead to stigmatization, affecting patients' adjustment to disease. Disease-related stigma is associated with poorer clinical outcomes, but qualitative evidence is minimal.

DESIGN

An interpretive (hermeneutic) phenomenological study of the lived experience of stigma in inflammatory bowel disease.

METHODS

Forty community-dwelling adults with a self-reported diagnosis of inflammatory bowel disease were recruited purposively. Participants reported feeling stigmatized or not and experiencing faecal incontinence or not. Unstructured interviews took place in participants' homes in the United Kingdom (September 2012 - May 2013). Data were analysed using Diekelmann's interpretive method.

FINDINGS

Three constitutive patterns-Being in and out of control, Relationships and social Support and Mastery and mediation-reveal the experience of disease-related stigma, occurring regardless of continence status and because of name and type of disease. Stigma recedes when mastery over disease is achieved through development of resilience-influenced by humour, perspective, mental well-being and upbringing (childhood socialization about bodily functions). People travel in and out of stigma, dependent on social relationships with others including clinicians and tend to feel less stigmatized over time.

CONCLUSION

Emotional control, social support and mastery over disease are key to stigma reduction. By identifying less resilient patients, clinicians can offer appropriate support, accelerating the patient's path towards disease acceptance and stigma reduction.

'It seems like you're going around in circles': recurrent biographical disruption constructed through the past, present and anticipated future in the narratives of young adults with inflammatory bowel disease

Biographical disruption and related concepts continue to be widely drawn upon in explaining how individuals experience chronic illness. Through in-depth examination of the narrative experiences of two young adults with inflammatory bowel disease (IBD), this article aims to contribute to the continuing theoretical elaboration of biographical disruption, and in turn offer new insights into how young adults experience this condition. The cases are analysed from an interaction-based, constructionist perspective, through which it is argued that the relapse-remission nature of IBD can give rise to a particular form of recurrent biographical disruption, constructed in narrative through a complex configuration of past, present and anticipated future experiences. The two young adults are found to give different meaning to this recurrent disruption in terms of its significance and consequences - whilst Samuel represents an ongoing cycle of profound disruption and biographical reinstatement, Edith normalises the cycle of disruption and its role in her ongoing biography. Therefore, moving beyond the notion of 'normal illness' observed in previous research literature, the concept of 'normal recurrent disruption' is proposed. Finally, it is argued that this recurrent biographical disruption may be experienced particularly severely in young adulthood owing to the unique pressures and expectations of this lifestage.

The patient's experience of primary ciliary dyskinesia: a systematic review

Background

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by progressive sinopulmonary disease, with symptoms starting soon after birth. The aim of this study is to critically review, analyse, and synthesise the literature in order to understand the experiences of patients with primary ciliary dyskinesia (PCD) and the impact on health-related quality of life.

Method

MEDLINE, EBSCO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE were searched according to the inclusion criteria. A qualitative analysis of 14 studies was conducted.

Results

Fourteen studies were included in the review, five with qualitative methodologies. Studies originated from the UK, USA, Italy, Denmark and Belgium, one study included a survey distributed internationally. Significant relationships were found between age and worsening of respiratory symptoms, physical, and mental domains of health-related quality of life, with a greater decline compared with reference populations. Variations between the UK and Italy were found for health-related quality of life and its correlation with time since diagnosis. PCD was found to have a physical impact in all age groups: patients found it difficult to keep up with others, and found energy levels were easily depleted compared to family or peers. In terms of social impact, symptoms lead to embarrassment and a sense of isolation, with patients concealing symptoms and/or their diagnosis. In turn, isolation was also linked with the lack of public and medical knowledge. In relation to emotional impact, anxiety was reported in a number of qualitative studies; patients were anxious about getting sick or when thinking about their future health. The burden of treatment and factors influencing adherence were also discussed in depth.

Conclusion

Health-related quality of life decreases with age in patients with PCD. For all age groups, PCD was found to greatly impact physical, emotional, social functioning, and treatment burden. More research is needed on the psychosocial impact of the illness, disease burden and its effect on quality of life.

Living a secret: Disclosure among adolescents and young adults with chronic illnesses

Objectives This qualitative study examines how and why adolescents living with visible and invisible chronic illnesses choose to share their condition with individuals within their social environments. Methods A sample of 25 adolescents were recruited from five subspecialty services: Spina bifida, rheumatology, cardiology, cystic fibrosis, and renal transplant/dialysis. Recruits completed a semi-structured interview designed to explore: (1) to whom adolescents disclose their conditions, (2) motivation and conditions under which they disclose, (3) content of disclosure, and (4) barriers to disclosure. Results Family members closely connected to treatment or management are most likely to be primary targets of disclosure. Regardless of social network size, respondents disclosed their illness to few peers. Common reasons for disclosure were perceived trust and shared experience with illness and disability. Reasons for withholding disclosure include perceived fear of rejection, pity, and perceptions of being seen as vulnerable or different. Discussion Disclosure was found to be influenced by (a) the visibility of a condition, (b) the anticipated response from the recipient, (c) practical needs, and (d) a decision that disclosure is justified. These findings inform clinical practice, warrant the need for further study, and insinuate practical solutions to combat the socio-emotional impact of nondisclosure among adolescents.

Stigmatization toward irritable bowel syndrome and inflammatory bowel disease in an online cohort

BACKGROUND

Stigma is associated with many negative health outcomes. Research has examined perceived and internalized stigma in individuals with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), but less has been done to evaluate levels of enacted stigma associated with these conditions. The aim of this study was to evaluate the presence of enacted stigma toward IBS and IBD in the general population compared to an adult-onset asthma (AOA) control group.

METHODS

Participants were recruited via social media and a research-dedicated website and completed all measures online. Participants were randomized to one of six clinical vignettes: (i) IBD male, (ii) IBD female, (iii) IBS male, (iv) IBS female, (v) AOA male, or (vi) AOA female. Participants read the assigned vignette and then completed measures of emotional empathy, level of familiarity, and enacted stigma.

KEY RESULTS

Participants reported higher levels of enacted stigma toward IBS compared to both IBD and AOA. No differences in stigma were found between IBD and AOA. Higher levels of familiarity were most strongly correlated with reduced IBD-related stigma, with weaker but still significant correlations between level of familiarity and IBS and AOA. Higher levels of emotional empathy were associated with reduced stigma for IBD, IBS, and AOA.

CONCLUSIONS & INFERENCES

Individuals with IBS experience greater levels of enacted stigma compared to IBD and AOA. This finding is consistent with previous research that has shown greater levels of perceived and internalized stigma in IBS compared to IBD.

Major depressive disorder, suicidal behaviour, bipolar disorder, and generalised anxiety disorder among emerging adults with and without chronic health conditions

BACKGROUND

Despite the considerable physical, emotional and social change that occurs during emerging adulthood, there is little research that examines the association between having a chronic health condition and mental disorder during this developmental period. The aims of this study were to examine the sex-specific prevalence of lifetime mental disorder in an epidemiological sample of emerging adults aged 15-30 years with and without chronic health conditions; quantify the association between chronic health conditions and mental disorder, adjusting for sociodemographic and health factors; and, examine potential moderating and mediating effects of sex, level of disability and pain.

METHOD

Data come from the Canadian Community Health Survey-Mental Health. Respondents were 15-30 years of age (n = 5947) and self-reported whether they had a chronic health condition. Chronic health conditions were classified as: respiratory, musculoskeletal/connective tissue, cardiovascular, neurological and endocrine/digestive. The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess the presence of mental disorder (major depressive disorder, suicidal behaviour, bipolar disorder and generalised anxiety disorder).

RESULTS

Lifetime prevalence of mental disorder was significantly higher for individuals with chronic health conditions compared with healthy controls. Substantial heterogeneity in the prevalence of mental disorder was found in males, but not in females. Logistic regression models adjusting for several sociodemographic and health factors showed that the individuals with chronic health conditions were at elevated risk for mental disorder. There was no evidence that the level of disability or pain moderated the associations between chronic health conditions and mental disorder. Sex was found to moderate the association between musculoskeletal/connective tissue conditions and bipolar disorder (β = 1.71, p = 0.002). Exploratory analyses suggest that the levels of disability and pain mediate the association between chronic health conditions and mental disorder.

CONCLUSIONS

Physical and mental comorbidity is prevalent among emerging adults and this relationship is not augmented, but may be mediated, by the level of disability or pain. Findings point to the integration and coordination of public sectors - health, education and social services - to facilitate the prevention and reduction of mental disorder among emerging adults with chronic health conditions.

The Stigma Experienced by Terminally Ill Patients: Evidence From a Portuguese Ethnographic Study

The aim of this study was to offer an understanding of the ways in which terminally ill patients may face discrimination due to their visibly altered body. An ethnographic approach was adopted and fieldwork was conducted over 10 months in 2 inpatient hospice units in Portugal. Participant observation was complemented by 50 in-depth interviews with terminally ill patients, family members, and hospice staff. The stigma experienced by terminally ill patients derived mostly from the behavior of peers, extended family members, and friends toward their visibly altered body. There was no evidence that these patients were discredited by their immediate family when they became visibly unwell; unlike what has been reported in previous studies. This finding could be related to the strong familial culture of Portuguese society.

The Fracture of Relational Space in Depression: Predicaments in Primary Care Help Seeking

Primary care clinicians treat the majority of cases of depression in the United States. The primary care clinic is also a site for enactment of a disease-oriented concept of depression that locates disorder within an individual body. Drawing on theories of the self and stigma, this article highlights problematics of primary care depression treatment by examining the lived experience of depression. The data come from individuals who screened positive for depressive symptoms in primary care settings and were followed over ten years. After iterative mixed-methodological exploration of a large dataset, we analyzed interviews from a purposive sample of 46 individuals using grounded and phenomenological approaches. We describe two major results. First, we note that depression is experienced as located within and inextricable from relational space and that the self is experienced as relational, rather than autonomous, in depression. Second, we describe the ways in which the experience of depression contradicts a disease-oriented concept such that help-seeking intensifies rather than alleviates the relational problem of depression. We conclude by highlighting that an understanding of illness experience may be essential to improving primary care depression treatment and by questioning the bracketing of relational concerns in depression within the construct of stigma.

Self-management in patients with inflammatory bowel disease: strategies, outcomes, and integration into clinical care

Self-management, including medication adherence, is associated with improved health and outcomes for patients with inflammatory bowel disease. The concept of self-management is complex, but can be divided into those aspects that involve the individual patient, those that involve the provider–patient relationship, and those that encompass the social environment. At the individual level, enhancing problem-solving skills and self-efficacy have both been shown to improve self-management tasks, particularly adherence to treatment. However, it is critical to consider these domains from a lifespan perspective because these processes by which self-management can be improved are distinct for children, adolescents, young adults, and adults. A particular emphasis is placed on strategies to improve self-management of older adolescents and young adults as they transition from pediatric to adult providers. The review concludes with recommendations for providers, including rationale and techniques for assessing and promoting patient self-efficacy, encouraging the development of problem-solving skills, improving the patient–provider relationship, and enhancing social support. Providers are encouraged to utilize elements of problem-solving skills training, engage in collaborative relationships with their patients, and offer their patients recommendations for how to increase the quality of their social support networks as ways of increasing overall self-management.

A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease

Chronic illness stigma is a global public health issue. Most widely studied in HIV/AIDS and mental illness, stigmatization of patients living with inflammatory bowel disease (IBD), chronic autoimmune conditions affecting the digestive tract, has garnered increasing attention in recent years. In this paper, we systematically review the scientific literature on stigma as it relates to IBD across its three domains: perception, internalization, and discrimination experiences. We aim to document the current state of research, identify gaps in our knowledge, recognize unique challenges that IBD patients may face as they relate to stigmatization, and offer suggestions for future research directions. Based on the current review, patients living with IBD may encounter stigmatization and this may, in turn, impact several patient outcomes including quality of life, psychological functioning, and treatment adherence. Significant gaps exist related to the understanding of IBD stigma, providing opportunity for future studies to address this important public health issue.