Illness perceptions and stress: mediators between disease severity and psychological well-being and quality of life among patients with Crohn's disease

Structural brain morphometry differences and similarities between young patients with Crohn's disease in remission and healthy young and old controls

Introduction

Crohn's disease (CD), one of the main phenotypes of inflammatory bowel disease (IBD), can affect any part of the gastrointestinal tract. It can impact the function of gastrointestinal secretions, as well as increasing the intestinal permeability leading to an aberrant immunological response and subsequent intestinal inflammation. Studies have reported anatomical and functional brain changes in Crohn's Disease patients (CDs), possibly due to increased inflammatory markers and microglial cells that play key roles in communicating between the brain, gut, and systemic immune system. To date, no studies have demonstrated similarities between morphological brain changes seen in IBD and brain morphometry observed in older healthy controls..

Methods

For the present study, twelve young CDs in remission (M = 26.08 years, SD = 4.9 years, 7 male) were recruited from an IBD Clinic. Data from 12 young age-matched healthy controls (HCs) (24.5 years, SD = 3.6 years, 8 male) and 12 older HCs (59 years, SD = 8 years, 8 male), previously collected for a different study under a similar MR protocol, were analyzed as controls. T1 weighted images and structural image processing techniques were used to extract surface-based brain measures, to test our hypothesis that young CDs have different brain surface morphometry than their age-matched young HCs and furthermore, appear more similar to older HCs. The phonemic verbal fluency (VF) task (the Controlled Oral Word Association Test, COWAT) (Benton, 1976) was administered to test verbal cognitive ability and executive control.

Results/Discussion

On the whole, CDs had more brain regions with differences in brain morphometry measures when compared to the young HCs as compared to the old HCs, suggesting that CD has an effect on the brain that makes it appear more similar to old HCs. Additionally, our study demonstrates this atypical brain morphometry is associated with function on a cognitive task. These results suggest that even younger CDs may be showing some evidence of structural brain changes that demonstrate increased resemblance to older HC brains rather than their similarly aged healthy counterparts.

The Perceived Meaning of Traumatic Brain Injury for Older Adults: A Longitudinal-Multiple Case Study

PURPOSE

The aim of this study was to explore the perceived meaning of traumatic brain injury (TBI) over the first-year postinjury among older adults and to explore if and how meaning changes.

DESIGN

A longitudinal multiple-case study design was used.

METHODS

Semistructured face-to-face interviews were completed at 1 week and 1, 3, 6, and 12 months postinjury. Transcripts were analyzed using inductive thematic analysis.

RESULTS

Fifty-five interviews were conducted with 12 participants. Four themes were identified: gratitude, vulnerability and dependence, slowing down and being more careful, and a chance for reflecting on life. Most participants' perceptions of their TBI remained either consistently positive or negative over the first-year postinjury.

CLINICAL RELEVANCE

Nurses should elicit and support patients' positive illness perceptions regarding their brain injury, which can contribute to a higher quality of life. For those patients with negative illness perceptions, nurses should provide resources in order to support coping and resilience following brain injury.

CONCLUSIONS

This study is the first study to explore individual perceptions over time of the meaning made from experiencing TBI among older adults. Findings can serve as a foundation for tailored supportive interventions among older adults following TBI to maximize quality of life.

Exploring the Impact of Covid-19-Related Perceptions on Psychological Distress and Quality of Life in an International Gastrointestinal Cohort Over Time Guided by the Common Sense Model

The aim of this longitudinal study was to examine changes in COVID-19 and illness-related perceptions, gastrointestinal symptoms, coping, catastrophising, psychological distress, and QoL during the COVID-19 pandemic. A total of 831 adults with a gastrointestinal condition completed an online questionnaire at baseline (May-October 2020). Of those, 270 (32.5%) participants (85.2% female, mean age = 47.3 years) provided follow-up data (March-May 2021). Repeated-measures multiple analysis of variance and a cross-lagged panel model were used to test the study hypotheses. Gastrointestinal symptoms and COVID-19 perceptions at follow-up were strongly predicted by their baseline values, while illness perceptions were predicted by baseline gastrointestinal symptoms. Cross-lagged relationships indicated a reciprocal relationship between gastrointestinal symptoms and psychological distress. Moreover, gastrointestinal symptoms had substantial predictive utility, strongly predicting future gastrointestinal symptoms, and to a lesser extent, more negative illness perceptions, greater psychological distress, and greater use of adaptive coping strategies across time.

A qualitative investigation into the role of illness perceptions in endometriosis-related quality of life

Endometriosis is related to adverse quality of life (QoL) and wellbeing outcomes. The way in which endometriosis is perceived by individuals experiencing the condition has not been directly considered, yet illness perceptions (IPs) are predictors of QoL in several chronic conditions. This research aims to gain an understanding of the IPs held by individuals experiencing endometriosis and their impact on QoL. Semi-structured, one-to-one interviews with 30 UK-based participants sought to gain an understanding of participant experiences and perceptions linked to endometriosis. Three themes were constructed through reflexive thematic analysis: a life disrupted; lost sense of self; and complex emotional responses. Largely negative IPs were held by individuals experiencing endometriosis which, along with endometriosis-specific symptoms, fuelled fears for the future and reduced QoL. IP-based interventions may support the QoL of those experiencing endometriosis whilst effective treatment is sought.

Perception of coronavirus disease (COVID-19) and its relationship with coping strategies and perceived social support in iranian people: a descriptive correlational study

BACKGROUND

Perception of the threatening disease leads to coping behaviors that can affect the treatment process. Social support can be one of the factors influencing the perception of the disease and coping strategies. Our study aimed to determine the perception of the disease, its relationship with coping strategies and social support in COVID-19 patients in Iran.

METHODS

This cross-sectional study was conducted on 1014 patients who were hospitalized during October 2020 to May 2021 through multi-stage sampling method. The data-gathering instruments consisted a demographic information checklist, and standard questionnaires including disease perception, social support, and coping strategies. Correlation coefficient, multiple linear regression model, and simple linear regression model were used for data analysis.

RESULTS

The mean age of the participants was 40.87 ± 12.42 and the majority of them were female (67.2%(, married (60.1%), and had relatives who had COVID-19 (82.6%). There was a significant inverse relationship between variables (identity, outcomes, emotional expressions etc.) and social support (> 0.01). Also there was a significant direct relationship between variables (self-control, therapeutic susceptibility etc.) and the coping behavior (p < 0.05). There was an inverse relationship between the variables (outcomes, self-blaming, sex, etc.) (P = 0.0001) and a direct one between the variables (education, disease phase, etc.) and perceived social support (P = 0.004).

CONCLUSIONS

These results show the importance of promoting positive coping strategies and social support in the face of large-scale health crises. The knowledge of nurses about the results of this study, who are responsible for the care and education of the patient, can be effective in the length of hospitalization and reducing costs.

Sexual Dysfunction in People with Multiple Sclerosis: The Role of Disease Severity, Illness Perception, and Depression

Despite being a common issue in people with multiple sclerosis (pwMS), sexual dysfunction is still underinvestigated. This work aims to assess the potential determinants of sexual dysfunction in pwMS by considering its relationship with disease severity (in terms of global disability), illness perception, and depressive symptoms. In this multicenter study, 1010 pwMS responded to an online survey. A serial mediation model considering negative illness perception and depressive symptoms as mediators of the relationship between disease severity and sexual dysfunction was conducted using the SPSS PROCESS Macro with bias-corrected bootstrapping (5000 samples). Disease severity exerts an indirect effect on sexual dysfunction via illness perception, both independently and through depressive symptoms. However, the results indicated that illness perception plays a more crucial role in sexual dysfunction in pwMS with mild disability than in pwMS with moderate-severe disability. This study suggests that higher disability increases its magnitude by enhancing negative illness perception, that, in turn, affects sexual dysfunction both directly and through depressive symptoms, especially in pwMS with mild disability. Modulating the effect of illness perception by favoring adaptive coping strategies might represent a valid approach to mitigate sexual dysfunction symptoms in MS.

Is whole-body magnetic resonance imaging a source of anxiety in oncological patients?

OBJECTIVE

Magnetic resonance often produces feelings of anxiety before, or during, the examination. The aim of this study was to assess anxiety and potential causes of anxiety in cancer patients undergoing whole-body magnetic resonance imaging (WB-MRI).

METHODS

This monocentric study recruited 70 cancer patients who were scheduled to undergo WB-MRI for detection, staging or therapy monitoring. At baseline (prior to the WB-MRI), assessments were performed using the State-Trait Anxiety Inventory (STAI-Y 1), Illness Perception Questionnaire (IPQ-R), Big Five Inventory (BIF-10) and Revised Life Orientation Test (LOT-R), while at the end of the WB-MRI examination the patients repeated the STAI-Y 1 questionnaire and were asked to indicate their preference between WB-MRI and computed tomography.

RESULTS

We found a positive correlation between pre- and post-examination STAI-Y 1 scores (r = 0.536, p < .0001), with no significant difference between them. Pre-examination STAI-Y 1 scores had a negative correlation with the emotional stability in the BIF-10 questionnaire (r = -0.47, p = .001) and a positive correlation with emotional representation (r = 0.57, p = .001) in IPQ-R. The post-examination STAI-Y 1 had a negative correlation with optimistic orientation (r = -0.59, p = .001).

CONCLUSIONS

The anxiety associated with a WB-MRI examination was only in small part associated with the examination itself, and in fact, most patients preferred WB-MRI to computed tomography. Concern with the outcome of the examination was likely a greater source of anxiety.

Representations of depression and schizophrenia in the community: The role of illness and risk perceptions on help-seeking intentions

Objective

Illness perceptions (IPs) are important in understanding human reactions to illnesses, including mental health disorders. They influence risk perceptions and several variables relevant to the adjustment to a disorder, treatment seeking, and health outcomes. This study sought to compare IP, risk perception, and help-seeking intention for depression and schizophrenia in a community sample and to assess the mediating role of risk perception in the relationship between IP and help-seeking intention.

Materials and methods

A total of 380 adults participated in this study and filled out self-report measures of IPs, risk perceptions, and help-seeking intention. The previous diagnosis of depression was used to control the comparisons between the two disorders. A structural equation model (SEM) was used to test the mediation relationship.

Results

Perceived consequences, expected timeline, lack of personal control, and symptom identity were higher for schizophrenia, while lack of treatment control and concern were higher for depression. An interaction occurred with a previous diagnosis of depression for several dimensions of IP. Concerning the SEM, a valid model was obtained for depression, explaining 15.5% of help-seeking intentions, but not for schizophrenia.

Conclusion

The results show that the general population represents depression and schizophrenia differently. These representations are influenced by having experienced depression, and that illness and risk perceptions contribute to explaining the intention to seek help. Considering these illness representations makes it possible to understand the general population's emotional and cognitive reactions to mental health disorders.

Extending the Common Sense Model to Explore the Impact of the Fear of COVID-19 on Quality of Life in an International Inflammatory Bowel Disease Cohort

The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (χ2 (9) = 17.06, p = .05, χ2/N = 1.90, RMSEA = 0.05, SRMR = 0.04, CFI = .99, TLI = .97, GFI = 0.99), indicating the influence of gastrointestinal symptoms on QoL was mediated by illness perceptions, fear of COVID-19, adaptive and maladaptive coping, and psychological distress. Interventions targeting the fear of COVID-19 in the context of an individual's perceptions will likely enhance QoL during the pandemic.

Health-related quality of life among Chinese patients with Crohn's disease: a cross-sectional survey using the EQ-5D-5L

BACKGROUND

Crohn's disease (CD) is a chronic disease that may have an adverse impact on health-related quality of life (HRQoL). This study aimed to describe the HRQoL of CD patients and assess correlating factors using the EQ-5D-5L in China.

METHODS

We recruited CD patients at Shanghai Renji Hospital from October 2018 to May 2019. The data collected included demographic and clinical information, medical expenditures, and EQ-5D-5L questionnaire responses. The chi-square test or Fisher's exact test was applied to analyse the proportion of patients in subgroups at each level. After the selection of correlating variables by univariate analysis, multivariate regression analyses were used to explore the correlating factors of HRQoL in CD patients.

RESULTS

A total of 202 CD inpatients with a mean disease duration of 3.3 years were enrolled in the study. A total of 71.8% of patients were males, and 49.5% of patients were aged between 30 and 49 years. The average EQ-5D-5L utility score was 0.85, with a standard deviation (SD) of 0.12. Males, ileum lesions, remission status, and lower expenditure predicted higher EQ-5D-5L scores. In each EQ-5D-5L dimension, the proportion of patients differed significantly by gender, disease activity and location subgroup. In the multivariate regression models, being in an active CD state and using antibiotics had significantly adverse impacts on HRQoL (p < 0.05).

CONCLUSIONS

CD may have a significant negative impact on HRQoL in Chinese CD patients. Being in an active phase of the disease and using antibiotics were identified as affecting HRQoL.

Understanding Perceived Stress in Adolescent Inflammatory Bowel Disease

Background

Inflammatory bowel disease (IBD) is a chronic and debilitating illness associated with psychosocial comorbidities. Adolescents are vulnerable to the additive stress of managing IBD and navigating developmental milestones. Psychosocial factors, such as catastrophizing, illness stigma, illness uncertainty, and illness-related shame, often contribute to perceived stress in chronic illnesses. However, the combination of these variables on perceived stress in adolescents with IBD has not been examined.

Methods

Participants completed a cross-sectional online self-report survey. Model 4 of PROCESS Macro in SPSS was used to test the parallel mediation model of the relationship between disease severity and perceived stress using catastrophizing, stigma, uncertainty, and shame as mediators using 10,000 bootstrap samples. T-tests were run to assess systematic differences in the dependent variable between subjects.

Results

One hundred and thirty-one adolescents (Mage = 18.95 years; 100 females) completed the survey. Females had higher stress scores than males (P =0.002), and there were no difference in stress between younger and older participants (P = 0.085), location (P = 0.484), or IBD type (P = 0.515). The total effect of disease stress on perceived stress operating through the mediators was significant, b = 0.168, SE = 0.028, 95% CI [0.112, 0.224]. Helplessness catastrophizing, illness uncertainty, and illness-related shame, but not illness stigma, were equally strong, positive mediators.

Conclusions

The present results suggest that helplessness catastrophizing, illness uncertainty, and illness-related shame are central elements to target in stress interventions for adolescents with IBD.

Longitudinal assessment of the common sense model before and during the COVID-19 pandemic: A large coeliac disease cohort study

OBJECTIVE

Psychosocial factors likely play a substantial role in the well-being of those living with coeliac disease, especially during the COVID-19 pandemic, however, little research has examined well-being in this cohort using an integrated socio-cognitive model. This study had two aims: (1) Examine changes in gastrointestinal symptoms, psychosocial factors, and well-being outcomes (i.e., psychological distress, quality of life [QoL]) associated with the pandemic, (2) Examine the interrelationship of these variables across timepoints using the Common Sense Model (CSM).

METHODS

1697 adults with coeliac disease (Time 1, pre-pandemic; 83.1% female, mean age = 55.8, SD = 15.0 years) and 674 follow-up participants (Time 2, pandemic; 82.8% female, mean age = 57.0, SD = 14.4 years) completed an online questionnaire. Hypotheses were tested using repeated measures MANOVA and cross-lagged panel model analyses.

RESULTS

Participants reported improved QoL, and reduced gastrointestinal symptoms, negative illness perceptions and maladaptive coping from pre-pandemic to during the pandemic. There was no significant change in pain catastrophising or psychological distress. Cross-lagged effects showed gastrointestinal symptoms to predict negative illness perceptions, which in turn were predictive of poorer outcomes across all variables except pain catastrophising. Consistent with the CSM, there was a reciprocal relationship between illness perceptions and QoL over time. Maladaptive coping and pain catastrophising demonstrated limited predictive utility.

CONCLUSION

The COVID-19 pandemic appears to have had a small beneficial effect across several indices of well-being among adults with coeliac disease. Cross-lagged relationships highlight illness perceptions as a predictor of well-being outcomes and a potential target for psychosocial interventions.

The Impact of Illness Perceptions on Depressive Symptoms Among Benign Prostatic Hyperplasia Patients with Lower Urinary Tract Symptom

Objective

This study aimed at exploring whether illness perceptions may mediate the relationship between depressive symptoms and lower urinary tract symptoms (LUTS) among benign prostatic hyperplasia (BPH) patients.

Methods

The Patient Health Questionnaire (PHQ-9) for depression, the International Prostate Symptom Score (IPSS) for the severity of LUTS and the brief Illness Perception Questionnaire (B-IPQ) for illness perceptions (IPs) were used among the 157 BPH patients with LUTS. Pearson’s correlation test and hierarchical regression analyses were used to assess the correlations between LUTS, depressive symptoms and IPs.

Results

Our study found that the severity of LUTS was associated with depressive symptoms and subscales of illness perception; meanwhile, IPs were associated with the level of education. A positive relationship was found between the scores of PHQ9 and the B-IPQ subscales of illness consequences, identity, timeline, concern and emotion; thus, a negative correlation was found between scores of PHQ9 and the B-IPQ subscales of illness coherence, personal control and treatment control. The hierarchical regression analysis showed IPSS and the B-IPQ subscales of illness consequences, concern and emotion were significantly associated with depression, and explained 85.1% of the variance in depressive symptoms (R² = 0.851, p < 0.05).

Conclusion

The relationship between LUTS and depressive symptoms may be mediated by the negative IPs, including consequences, concern and emotions. Clinicians should not only focus on the LUTS but also on the IPs to improve depressive symptoms among BPH patients.

Quality of life in coeliac disease: relationship between psychosocial processes and quality of life in a sample of 1697 adults living with coeliac disease

BACKGROUND

Coeliac disease is a chronic gastrointestinal condition associated with an increased risk of psychiatric comorbidity, and diminished quality of life. Ongoing gastrointestinal symptomatology is frequently reported post-diagnosis, despite undertaking a gluten-free diet.

PURPOSE

To examine the role of psychosocial factors in mediating the relationship between gastrointestinal symptoms and quality of life, using a cross-sectional structural equation modelling mediation analysis guided by the Common-Sense Model.

METHODS

1697 adults with coeliac disease (83.1% female, mean age = 55.79, SD = 14.98 years) completed an online questionnaire. Measures included gluten-free diet adherence, gastrointestinal symptoms, illness perceptions, coping, gastrointestinal-specific anxiety, pain catastrophising, psychological flexibility, psychological distress, and quality of life.

RESULTS

A structural equation model was developed explaining 50.6% of the variation in quality of life and demonstrating good fit (χ2 (2) = 8.54, p = .014, χ2/N = 4.27, RMSEA = 0.04, SRMR = 0.01, CFI = 0.999, TLI = 0.98, GFI = 0.999). Gastrointestinal symptoms directly affected quality of life, and indirectly, via negative illness perceptions, maladaptive coping, pain catastrophising, and psychological distress.

CONCLUSION

Psychosocial processes may affect adjustment in coeliac disease by mediating the relationship between gastrointestinal symptoms and quality of life. Individuals living with coeliac disease may benefit from interventions targeting maladaptive psychosocial factors.

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.

Patient Engagement in Health Management as a Mediator Between Perceived Risk and COVID-19 Related Distress in Patients With IBD: A Structural Equation Model

Objective: This study aimed to evaluate the impact of the COVID-19 emergency on patients with IBD's psychological distress, understanding the role of patient engagement as a mediator. Methods: An online questionnaire was created, measuring perceived risk susceptibility toward COVID-19, perceived stress, and patient engagement. The questionnaire was distributed to a purposive sample of IBD patients who belonged to the Italian Association for patients with IBD (AMICI Onlus) in April 2020. Structural equation models were implemented. Results: The effect of the perceived risk susceptibility toward COVID-19 contagion on the perceived stress is fully mediated by patient engagement (β = 0.306, p < 0.001). Moreover, the patient engagement mitigates the perceived stress (β = -0.748, p < 0.001) in our sample of IBD patients, and it is negatively influenced by the perceived risk susceptibility toward COVID-19 (β = -0.410, p < 0.001). Conclusion: Patient engagement is the key factor that explains how the perceived risk susceptibility toward COVID-19 affects the perceived psychological distress in patients with IBD, underlining that the perceived risk of contagion increases their perceived level of stress through a decrease of patient engagement.

Burden of comorbid anxiety and depression in patients with inflammatory bowel disease: a systematic literature review

INTRODUCTION

Patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, often have comorbid anxiety and depression that affects their quality of life (QoL) and management of their IBD.

AREAS COVERED

A systematic literature review (SLR) was conducted to identify articles and conference abstracts on comorbid anxiety and depression in IBD patients using MEDLINE® and Embase® (January 2003 - June 2018). The impact of these psychological comorbidities on QoL and economic burden was examined. Non-pharmacologic interventions and disease-specific unmet clinical needs associated with these comorbidities were also evaluated.

EXPERT OPINION

There is evidence that individual and group-based cognitive behavioral therapy can reduce rates of anxiety and depression in adults and adolescents with IBD. Patients with IBD and anxiety or depression had an increased risk of hospitalization, emergency department visits, readmission, and used outpatient services more often than people without these conditions. Several disease-specific unmet clinical needs for IBD patients were identified. These included lack of reimbursement for mental-health care, inconsistent screening for psychological comorbidities and patients not consulting mental-health professionals when needed. IBD patients may benefit from integrated medical and psychological treatment, and should be considered for behavioral treatment.Plain Language Summary.

BACKGROUND

People with IBD may have mental-health conditions, such as anxiety and depression. These conditions can affect people's quality of life and how they manage their IBD.

WHAT DID THIS REVIEW LOOK AT?

We found 79 publications on anxiety or depression in people with IBD, published between January 2003 and June 2018. In people with IBD and anxiety or depression, researchers looked at: the impact on health-related quality of life and healthcare utilization, including access to and reimbursement for mental-health services how effective interventions that do not involve the use of medicines were (known as non-pharmacologic therapy).

WHAT WERE THE MAIN FINDINGS FROM THIS REVIEW?

People with IBD and anxiety or depression were more likely to be admitted to hospital and visit emergency departments than people without these conditions. Access to mental-health care varied and some people with IBD were not screened for depression.Individual and group-based talking therapy (known as cognitive behavioral therapy) reduced rates of anxiety and depression in some people with IBD.

WHAT WERE THE MAIN CONCLUSIONS FROM THIS REVIEW?

We found evidence that people with IBD and anxiety or depression may benefit from certain non-pharmacologic interventions. However, many people with IBD and anxiety or depression did not have access to mental-health services. Healthcare professionals should address gaps in patient care to improve outcomes in people with IBD and anxiety or depression.See Additional file 1 for an infographic plain language summary.

Cultural Responses to Covid-19 Pandemic: Religions, Illness Perception, and Perceived Stress

Many psychological researchers have proven the deteriorating effects of the coronavirus disease 2019 (Covid-19) pandemic on public mental health. In Malaysia, various Covid-19 clusters were associated with religious gatherings. From a cultural psychology perspective, how ethno-religious groups respond to this crisis originating from their unique rationality and ecological systems. Therefore, this study aimed to explore the illness perceptions of major religious groups (Christian, Muslim, and Buddhist) in Malaysia toward the Covid-19 pandemic, their stress levels, and the relationship between illness perception, stress, and forms of religious expression during the lockdown period. Through an online survey method, 608 Malaysian religious believers were included in this mixed-method empirical study, which adapted standardized instruments [Duke University Religion Index (DUREL), Brief Illness Perception Questionnaire (BIPQ), and Perceived Stress Scale (PSS)]. Statistical analysis showed that all three groups reported moderate levels of stress in average without any significant difference after controlling for age. Both internal and external forms of religious expression had a significant negative relationship with stress levels. Personal control, comprehension, and emotions domains of illness perception accounted for a significant variance in the stress level. Furthermore, religious expression significantly moderated the relationship between some illness perception domains and stress. Qualitative coding revealed that most participants perceived human behavior and attitudes, sociopolitical, and sociological factors as causal factors to the current pandemic. These findings confirmed the relationship between religious expression, illness belief, and stress regulation during the pandemic lockdown. Incidental findings of age as a potential protective factor for Malaysian believers warrants further study. In the conclusion, implications for public health policymakers and religious communities on pandemic prevention and well-being promotion were discussed.

Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work

BACKGROUND

Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work.

OBJECTIVE

The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work.

METHODS

We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups.

RESULTS

Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management.

CONCLUSIONS

This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time.

Psychological problems and intervention studies of patients with inflammatory bowel disease in the "Internet +" era: A review

Inflammatory bowel disease (IBD) is a kind of chronic nonspecific intestinal inflammatory disease. Although its pathogenesis is not yet clear, it has been confirmed that the occurrence, development, and outcome of IBD are closely related to psychological factors. This paper analyzes the psychological problems of patients with IBD and the status on psychological intervention in the "Internet +" era.

Post-traumatic Growth in Inflammatory Bowel Disease Patients: The Role of Illness Cognitions and Physical Quality of Life

BACKGROUND AND AIMS

The symptoms and complications associated with inflammatory bowel disease [IBD] have been found to be associated significantly with impaired health-related quality of life. Nevertheless, there may also be a positive psychological change such as post-traumatic growth, as was noted among patients with other chronic diseases, but this remains understudied in patients with IBD. In this study, we explored associations between post-traumatic growth and illness cognitions (helplessness, acceptance and perceived benefits). In addition, we evaluated whether physical quality of life in IBD patients mediates the link between illness cognitions and post-traumatic growth.

METHODS

The study employed a cross-sectional design. Two hundred patients diagnosed with IBD completed questionnaires assessing illness cognitions, physical quality of life and post-traumatic growth.

RESULTS

There was a negative association between illness cognition of helplessness and post-traumatic growth, and positive associations between illness cognitions of acceptance and illness cognitions of perceived benefits, and post-traumatic growth. In addition, the association between an illness cognition of helplessness and post-traumatic growth was mediated via physical quality of life. Yet, the signs of the direct and the indirect paths of an illness cognition of helplessness on post-traumatic growth were opposite.

CONCLUSIONS

This study extends the literature on the role of illness cognitions as an important component in facilitating the process of post-traumatic growth among IBD patients. Based on the findings, the management of IBD patients should incorporate more interventions aimed at exploring cognitive aspects of the illness in order to improve physical quality of life and enhance personal growth.

Examining the Mediating Effects of Stress on Fear of COVID-19 and Well-being Using Structural Equation Modeling

This study focuses on the effects of fear factor due to COVID-19 on stress and well-being of college students in India. The authors conducted a cross-sectional survey among 625 Indian students across various Indian universities and structural equation modeling (SEM) has been performed for analyzing the data. The findings of the study show a positive effect of fear of COVID-19 on stress with β = .27, p < 0.05, and a negative effect on well-being (β = -.13, p < 0.05). The results also depicted the mediating role of stress between fear of COVID-19 and well-being. Therefore, it is suggested that measures must be taken by individuals, society, and policy makers to include mental health maintenance in the pandemic response activities. Further longitudinal studies in different geographical regions and demographics can provide a more generalized understanding of the relationship between the pandemic and mental health. The limitations, policy implications, and suggestions are discussed.

Illness Perceptions of COVID-19 in Europe: Predictors, Impacts and Temporal Evolution

Objective: Illness perceptions (IP) are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors (within demographics and contact with COVID-19) and examine the impacts of IP on perceived stress and preventive behaviors.

Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors.

Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context.

Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution.

Impact of BMGIM Music Therapy on Emotional State in Patients with Inflammatory Bowel Disease: A Randomized Controlled Trial

BACKGROUND

Patients with inflammatory bowel disease (IBD) have a high prevalence of emotional disturbances which worsen the symptoms of the disease. As a therapeutic alternative that is part of a comprehensive care alongside medication, the Bonny Method of Guided Imagery and Music (BMGIM) music-assisted therapy has achieved promising emotional improvements in patients with chronic diseases. The objective of the study was to determine the impact of a treatment based on a BMGIM group adaptation on patients with inflammatory bowel disease (IBD) and their emotional state, therefore analyzing state of mind, quality of life, anxiety, depression, immunocompetence as a marker of well-being, and levels of acute and chronic stress.

METHODS

Longitudinal, prospective, quantitative, and experimental study including 43 patients with IBD divided into an intervention group (22 patients), who received eight sessions over eight weeks, and a control group (21 patients). A saliva sample was taken from each patient before and after each session in order to determine cortisol and IgA levels. Similarly, a hair sample was taken before the first and after the last session to determine the cumulative cortisol level. All molecules were quantified using the ELISA immunoassay technique. In addition, patients completed several emotional state questionnaires: HADS, MOOD, and CCVEII.

RESULTS

An improvement was observed in the following states of mind: sadness, fear, anger, and depression. No significant effect was observed in state of mind in terms of happiness or anxiety, in the levels of cortisol in hair, and in patients' perceived quality of life. A reduction in cortisol was observed in saliva, although this did not significantly affect the IgA titer.

CONCLUSIONS

BMGIM seems to improve the emotional state of patients with IBD.

The Psychosocial Burden of Food Allergy Among Adults: A US Population-Based Study

BACKGROUND

Food allergy (FA) affects >25 million US adults, resulting in substantial health care utilization. Data suggest that patients with FA suffer impairments in FA-related quality of life (FAQoL); however, little is known regarding psychosocial impacts of FA among US adults.

OBJECTIVE

To characterize FAQoL among a large, nationally representative adult sample, and its determinants, including sociodemographic characteristics, severity, comorbid conditions, allergic symptoms, number and type of allergens, and health care utilization.

METHODS

A survey was administered between October 2015 and September 2016 to a nationally representative sample of US households. Survey constructs included the Food Allergy Independent Measure (FAIM), which was developed to quantify adverse impacts of living with FA on patient quality of life. FAIM responses were analyzed from adults reporting current FA (N = 6207). Linear regression models examined associations with sociodemographic and FA characteristics.

RESULTS

The overall estimated mean FAIM score was 2.87 (95% confidence interval: 2.83-2.90). FAIM scores (range = 1-7) in adjusted models were invariant by race/ethnicity, private/public insurance status, and census division. Significant differences (P < .05) by lower household income, lower age, and greater education emerged, resulting in higher FAIM scores indicating FAQoL impairment. Among major food allergens, wheat, soy, and milk allergies were each associated with the greatest increases in adjusted FAIM scores. Reporting a current epinephrine autoinjector (EAI) prescription, severe allergic reaction history, history of EAI use, FA-related emergency department visits, or more FAs were also associated with significantly higher FAIM scores.

CONCLUSION

The population-level psychosocial burden of adults with FA is substantial, broadly distributed, and differs by demographic and allergic disease characteristics.

Determinants of quality of life and psychosocial adjustment to pediatric inflammatory bowel disease: A systematic review focused on Crohn's disease

BACKGROUND

Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not.

OBJECTIVE

This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease.

METHOD

Four international databases were consulted in March 2020: PubMed, PsychInfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies.

RESULTS

One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes.

CONCLUSIONS

Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.

Risk of Contracting COVID-19, Personal Resources and Subjective Well-Being among Healthcare Workers: The Mediating Role of Stress and Meaning-Making

The latest research suggests that the relationships between the risk of contracting COVID-19, personal resources and subjective well-being have rather an indirect character and can include the occurrence of mediating factors related to meaning-making processes and stress experiences. Protection motivation theory offers a theoretical paradigm that enables these associations to be thoroughly investigated and understood. The current study aimed to examine the mediating roles of meaning-making and stress in the relationship of risk of contracting COVID-19 and personal resources (self-efficacy and meaning in life) with subjective well-being among healthcare workers. A total of 225 healthcare workers from hospitals, medical centres and diagnostic units completed a set of questionnaires during the first few months of the COVID-19 lockdown period (March-May 2020). The results revealed that greater self-efficacy and meaning in life were associated with higher cognitive and affective dimensions of subjective well-being, whereas a lesser risk of contracting COVID-19 was only associated with the higher affective dimension. The central finding demonstrated different mediating roles of stress and meaning-making in the relationship of risk of contracting COVID-19 and personal resources with the cognitive and affective dimensions of subjective well-being. This confirmed the applicability of meaning-oriented and stress management processes for understanding how healthcare workers' well-being is affected during the COVID-19 pandemic.

Symptom Clusters and Quality of Life in Cervical Cancer Patients Receiving Concurrent Chemoradiotherapy: The Mediating Role of Illness Perceptions

OBJECTIVES

Although studies shows that symptom clusters and illness perceptions are negatively associated with quality of life (QoL), it is unclear how these variables of cervical cancer patients who receive concurrent chemoradiotherapy (CCRT) relate to each other. This study aimed to identify the symptom clusters in cervical cancer patients who receive CCRT and evaluate the mediating effect of illness perceptions on the relationship between symptom clusters and QoL.

METHODS

A cross-sectional survey was conducted on 286 cervical cancer patients receiving CCRT from October 2019 to October 2020. M.D. Anderson Symptom Inventory, Brief Illness Perception Questionnaire, and Functional Assessment Cancer Therapy-Cervix were applied to investigate the symptom clusters, illness perceptions and QoL of the participants, respectively. Exploratory factor analysis was conducted to identify symptom clusters. The relationships among symptom clusters, illness perceptions, and QoL were analyzed with the structural equation modeling.

RESULTS

A total of four symptom clusters were identified, including psychological status symptom cluster, therapy side-effect symptom cluster, sickness symptom cluster, and gastrointestinal symptom cluster (χ² = 1,552.282, Df = 78, P < 0.001). Symptom clusters, illness perceptions, and QoL were significantly correlated. Symptom clusters had significant direct (β = -0.38, P < 0.001) and indirect effects (β = -0.21, P < 0.001) on QoL.

CONCLUSION

Illness perceptions played a significant mediating role between symptom clusters and QoL in cervical cancer patients receiving CCRT. Strategies like prompting effective symptom management for the purposes of alleviating illness perceptions may contribute to improving their QoL.

Do Quarantine Experiences and Attitudes Towards COVID-19 Affect the Distribution of Mental Health in China? A Quantile Regression Analysis

While quarantine has become a widely used control strategy during the outbreak of the 2019 novel coronavirus disease (COVID-19), empirical research on whether and to what extent quarantine and attitudes towards COVID-19 affect mental health is scant. Using a cross-sectional online survey, this paper is the first from the Chinese outbreak to investigate how quarantine experiences and attitudes towards COVID-19 are related to mental health, and how these relationships change across the distribution of mental health scores. Using quantile regression analysis, we found that home self-quarantine is associated with a decrease in depression and an increase in happiness, while community-level quarantine is associated with decreased happiness, especially for those in the lower happiness quantile. We also found that favorable attitudes towards COVID-19 regarding the credibility of real-time updates and confidence in the epidemic control are associated with lower levels of depression and higher levels of happiness. These effects are stronger in the upper quantile of depression and the median quantile of happiness.

Application of the common sense model in inflammatory bowel disease: A systematic review

BACKGROUND AND AIMS

The aim of this paper was to undertake a systematic review of the research utilizing the Common Sense Model (CSM) involving IBD cohorts to explain the psychosocial processes, including illness perceptions and coping styles, that underpin patient reported outcomes (PROs) - psychological distress (PD) and quality of life (QoL).

METHODS

Adult studies were identified through systematic searches of 8 bibliographic databases run in August 2020 including Medline, Embase, and PsychINFO. No language or year limits were applied.

RESULTS

Of 848 records identified, 516 were selected with seven studies evaluating the CSM mediating pathways for final review (n = 918 adult participants). Consistent with the CSM, illness perceptions were associated with PD and QoL in six and five studies respectively. Illness perceptions acted as mediators, at least partially, on the relationship between IBD disease activity and PD and/or QoL in all seven studies. Coping styles, predominantly maladaptive-based coping styles, were found to act as mediators between illness perceptions and PD and/or QoL in five studies. Perceived stress was identified in one study as an additional psychosocial process that partially explained the positive influence of illness perceptions on PD, and a negative impact on QoL. Five studies were classified as high quality and two as moderate.

CONCLUSIONS

The CSM can be utilised in IBD cohorts to evaluate key psychosocial processes that influence PROs. Future research should explore additional psychosocial processes within the CSM and evaluate the efficacy of targeting CSM processes to promote psychological well-being and QoL in IBD cohorts.

The effect of illness perception on life quality in psoriasis patients

Psoriasis is a chronic disease that has negative effects on quality of life. Understanding the illness perception of psoriasis is important for effective management of the disease and improving quality of life. The aim of this study was to determine the relationship between illness perception and quality of life in psoriasis patients. This cross-sectional study was performed with 306 patients who applied to a psoriasis outpatient clinic of a university hospital in Istanbul, Turkey. Data were collected using a sociodemographic characteristics and disease information form, the Dermatology Life Quality Index (DLQI), the Revised Illness Perception Questionnaire (IPQ-R) and the Psoriasis Area Severity Index (PASI) score. Data were analyzed using descriptive statistics, Kruskal-Wallis test and Mann-Whitney U test, Spearman correlation analysis, and multiple regression analysis. A positive relationship was found between scores on the DLQI and scores on the IPQ-R subscales of Illness identity, Consequences, Emotional representations, Time (cyclic), Personal attributions, External attributions, and Chance. A negative correlation was determined between DLQI scores and scores on the IPQ-R subscales of Treatment control and Illness coherence. Furthermore, there was a positive correlation between the PASI score and the DLQI scores and scores on the IPQ-R subscales of Consequences and Emotional representation. Multiple regression analysis showed that illness identity, PASI scores, treatment control, illness coherence, consequences, and personal attributions were significantly associated with quality of life (R2 = 0.365, p < 0.01). The quality of life of the psoriasis patients who associated their symptoms with the disease, who had a high PASI score, thought that they were adversely affected by the disease, and who saw personal attributions as the cause of the disease was negatively affected. The quality of life of patients who thought that their disease could be kept under control and who understood their disease was positively affected.

Breast cancer post-surgical impact on women´s quality of life during chemotherapy treatment: A structural equation modelling approach

OBJECTIVE

Breast cancer is an important public health problem that is increasing in incidence, being a stressor with a negative impact on women's quality of life. This study is focused on the evaluation of temporal precursors (one month before) of women's quality of life undergoing chemotherapy, considering post-surgical personal, clinical, cognitive and neuropsychophysiological factors, according to the Transactional Stress and Coping Model.

METHODS

This longitudinal study included 112 patients with breast cancer. Data were collected in two different moments: before and during the adjuvant chemotherapy. Structural equation modelling was used to support a theoretically based model in which some antecedent factors impact patients' long-term quality of life through a set of mediators.

RESULTS

The associations of breast symptoms, body image and sexual functioning with psychological distress and quality of life were totally mediated by illness perceptions, while the associations of working memory with psychological distress and quality of life were totally mediated by self-efficacy for coping. Patients with greater psychological distress showed higher levels of nadir cortisol.

CONCLUSIONS

Results showed the importance of assessing patients' perceptions of their illness, prior to chemotherapy, as well as promoting more self-efficacy for coping, in order to improve women's emotional state and quality of life.

The role of gender as a moderator in the relationship between disease perception and coping with stress strategies among psychiatric patients

Introduction: The perception of disease depends on the patient’s beliefs related to the nature of the illness, the previous personal or family experiences and his/her attitude to them. Patients try to understand and cope with health problems. The purpose of the present study was to answer the question which components of the relationship between the strategies for coping with stress and mental disease perception are moderated by gender.

Material and Methods: The study involved 98 patients with depressive disorders, anxiety disorders, schizophrenia, alcohol related disorders. The research of the variables was carried out using the COPE Inventory and Disease Perception Questionnaire.

Results: It has been noticed that in men, when their perception of the mental disorder as beneficial increases, the religious strategies for coping with stress become more frequent. Furthermore, the opposite sex pattern emerged. In the situation when an individual’s perception of the illness as a threat increased, female patients less frequently employed religious coping and planning. Furthermore, in women, when the perception of the mental disease as a weakness increases, the frequency of using emotional social support and acceptance decreases.

Conclusions: The result indicated that there are opposite patterns of gender specific coping strategy dependent on the mental illness perception.

Illness Perceptions and Depression Are Associated with Health-Related Quality of Life in Youth with Inflammatory Bowel Disease

Background

In youth with inflammatory bowel disease (IBD), health-related quality of life (HRQOL) has been shown to be affected by individual disease factors and specific psychological factors. The innovative aim of this study is to examine the combined impact of psychological factors (illness perceptions, cognitive coping, anxiety, and depression) on HRQOL, over and above the associations of demographic and disease factors with HRQOL in youth with IBD.

Method

Data on clinical disease activity, illness perceptions, cognitive coping, anxiety, depression, and HRQOL were prospectively collected in 262 consecutive youth (age 10–20, 46.6% male) with confirmed IBD. Multiple linear regression analyses tested the associations of demographic, disease, and psychological variables with HRQOL in separate groups for Crohn’s disease (CD; N = 147) and ulcerative colitis and IBD unclassified (UC/IBD-U; N = 115), using age-specific validated instruments.

Results

In both disease groups, more negative illness perceptions (ß = − .412; ß = − .438, p < .001) and more depression (ß = − .454; ß = − .279, p < .001) were related to lower HRQOL. In the UC/IBD-U group, more anxiety was related to lower HRQOL (ß = − .201, p = .001). The model with the psychological variables explained a large and significant amount of variance in both groups: 74% and 83%, respectively (p < .001).

Conclusion

In 10–20-year-old IBD patients, negative illness perceptions and depression were significantly and more strongly associated with lower HRQOL than demographic and disease factors. Thus, it is important to integrate psychological factors in the treatment for IBD patients. To improve HRQOL in young IBD patients, psychological interventions should be targeted at negative illness perceptions and depression.

Disease perception and coping strategies for stress in Polish patients with various mental disorders

Introduction: Nowadays more and more people struggle with mental problems associated with fast pace of life and overpowering stress. Individuals affected by mental disorders frequently apply ineffective methods of coping with stress, and their attitudes towards the disease in fact strengthen the psychopathological symptoms. The purpose of the present study was to compare disease perception and coping strategies for stress in Polish patients with various types of mental disorders.

Material and Methods: The study involved 123 patients with depressive disorders, anxiety disorders, schizophrenia, alcohol related disorders, subjects detained due to psychoactive substance-induced psychotic disorders and amnestic syndromes, staying at Mental Healthcare Centre. Measurements of the variables were carried out using COPE Inventory and Disease Perception Questionnaire.

Results: The type of mental disorder differentiated the group with respect to the use of strategies aimed at seeking instrumental and emotional support, planning, positive reinterpretation, focus on emotions and substance use. There are significant differences between patients in the approach to illness as a task, weakness and threat.

Conclusions: The results show that the type of mental disorder is important in the context of the strategies used for coping with stress and the patients' approach to their condition.

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.

RELATIONSHIP AMONG PSYCHOLOGICAL WELL-BEING, RESILIENCE AND COPING WITH SOCIAL AND CLINICAL FEATURES IN CROHN’S DISEASE PATIENTS

ABSTRACT BACKGROUND: Crohn’s disease is chronic, requires prolonged treatment, affects the physical and psychosocial health of patients and may alter their routine, quality of life and well-being. Recent studies recommend monitoring the health of these patients considering physical, psychological and psychosocial aspects, because they are directly related to the disease activity. These studies highlight the relevance of patients’ emotional and behavioral conditions and suggest that the identification of the factors that influence the psychological well-being, resilience and Coping in these patients can favor the proper treatment. OBJECTIVE: To relate psychological well-being, resilience and Coping with social and clinical features of Crohn’s disease patients. METHODS: Prospective study including 104 patients with Crohn’s disease, both genders and mean age of 39 years. Standardized scales were used to assess and to relate psychological well-being, resilience and Coping with social and clinical variables. A questionnaire to characterize the sample and standardized scales in data collection (psychological well-being, resilience pillars and Coping strategies inventory - Folkman & Lazarus) were used. Descriptive analysis of data and statistics for comparison of results were performed. RESULTS: There were significant differences (P<0.05) showing better psychological well-being for male patients, those who without children, were not religious, were employed and were doing complementary activities in addition to clinical treatment. More resilience for the male gender, those who without children, were not religious, divorced, separated or widowed, that received some monthly income; who did not undergo surgery, had the first symptoms after 30 years old and who had complementary activity. There were also significant differences in the use of Coping: usually, women used more developed escape and avoidance strategies; single, married or in stable-union patients used more self-control; not religious used positive revaluation strategy; the ones who were employed showed more self-control and positive reassessment; the ones who had lower family income indicated that they used less the self-control; the ones who had higher family income used more positive re-evaluation; patients who were diagnosed with Crohn’s disease between the second decade of life showed to use mores more the positive reassessment strategy than those who were 20 years old or younger. CONCLUSION: Social aspects influenced psychological well-being, resilience and Coping in patients with Crohn’s disease more strongly than clinical aspects. It was possible to identify the profiles with better and worse psychological well-being, resilience and Coping of those who need more support, as well as to know the most used Coping strategies in the studied group.

Inflammatory bowel disease patient perceptions of diagnostic and monitoring tests and procedures

Background

Inflammatory Bowel Disease (IBD) with its high incidence and prevalence rates in Canada generates a heavy burden of tests and procedures. The purpose of this study is to gain a better understanding of the transfer of information from physician to patient, as well as the patient understanding and perceptions about the tests and procedures that are ordered to them in the context of IBD diagnosis and monitoring.

Methods

An online questionnaire was completed by 210 IBD patients in Canada. Information on the five most-often used tests or procedures in IBD diagnosis/monitoring was collected. These include: general blood test, colonoscopy, colon biopsy, medical imaging and stool testing.

Results

The general blood test is both the most ordered and most refused tool. It is also the one with which patients are the least comfortable, the one that generates the least concern and the one about which physicians provide the least information. The stool test is the test/procedure with which patients are the most comfortable. Procedures raise more concerns among patients and physicians provide more information about why they are needed, their impact and the risks they present. Very little information is provided to patients about the risks of having false positives or negative tests.

Conclusions

This study provides an initial understanding of patient perceptions, the transfer of information from a physician to a patient and a patient’s understanding of the tests and procedures that will be required to treat IBD throughout what is a lifelong disease. The present study takes a first step in better understanding the acceptance of the test or procedure by IBD patients, which is essential for them to adhere to the monitoring process.

Electronic supplementary material

The online version of this article (10.1186/s12876-019-0946-8) contains supplementary material, which is available to authorized users.

INFLAMMATORY BOWEL DISEASE: IMPACT ON SCORES OF QUALITY OF LIFE, DEPRESSION AND ANXIETY IN PATIENTS ATTENDING A TERTIARY CARE CENTER IN BRAZIL

BACKGROUND

Inflammatory bowel disease frequently affects patients at working age, compromising their quality of life in several levels: physical, psychological, familial and social. Few studies have evaluated the impact of Inflammatory bowel disease on quality of life, anxiety and depression in Brazilian patients.

OBJECTIVE

Evaluate quality of life and its correlation with psychological aspects of patients with inflammatory bowel disease through the Inflammatory Bowel Disease Questionnaire and Hospital Anxiety and Depression Scale.

METHODS

Cross-sectional study; Inflammatory Bowel Disease Questionnaire, Short Form-36 and Hospital Anxiety and Depression Scale were applied to consecutive outpatients in a tertiary referral center for inflammatory bowel disease. Harvey-Bradshaw Index and Truelove scores were used to evaluate Crohn's disease and ulcerative colitis activity. Sample calculation: 113 patients for a significance level of 5%, power of 90% and a correlation coefficient of at least 0.3 between scales. Statistical analysis: Student-t test, Pearson and Spearman correlations.

RESULTS

One hundred twenty patients participated in the study; mean age: 41.7 years; female: 58.3%; Crohn's Disease: 69 patients. No low scores for quality of life were found across the four Inflammatory Bowel Disease Questionnaire domains; the Short Form-36 showed low scores in physical limitations (47.2±42.4) and emotional aspects (49.8±43.4); Hospital Anxiety and Depression Scale score presented a mean of 9.5±2.7 for anxiety and 8.7±2.0 for depression. Quality of life was decreased and Hospital Anxiety and Depression Scale did show increased indices of anxiety and depression, in both diseases only when clinically active.

CONCLUSION

Inflammatory Bowel Disease Questionnaire and Hospital Anxiety and Depression Scale showed that outpatients of a tertiary care center for inflammatory bowel disease in Brazil presented good quality of life. The worst quality of life was associated with the intensity of the disease activity.

Improvement of psychological status after infliximab treatment in patients with newly diagnosed Crohn's disease

BACKGROUND

Patients with newly diagnosed Crohn's disease (CD) are associated with impaired physical and psychological well-being. These psychological characteristics are dynamic with the course of disease and could be influenced by medical treatment. Infliximab is effective and widely used in moderate-to-severe CD patients. The aim of this study was to evaluate the improvement of psychological status after infliximab treatment in patients with newly diagnosed CD.

METHODS

Newly diagnosed moderate-to-severe CD patients were prospectively enrolled in our study. Infliximab 5 mg/kg was administered at weeks 0, 2, 6, 14, 22, and 30. Outcomes including disease severity, illness perceptions, coping strategies, anxiety, depression, and quality of life (QoL) were measured at baseline, week 14, and week 30.

RESULTS

Eighty-two patients completed our study. The rates of clinical remission at weeks 14 and 30 were 59/82 (72.0%) and 58/82 (70.7%), respectively. Patients who achieved clinical remission at weeks 14 and 30 significantly improved in illness perceptions (P<0.001 and <0.001), maladaptive coping (P=0.005 and 0.004), anxiety (P<0.001 and <0.001), depression (P=0.004 and 0.004), and QoL (P<0.001 and <0.001). However, emotion-focused coping and problem-focused coping remained unchanged. For infliximab nonresponders, no significant changes were seen in illness perceptions, coping strategies, anxiety, depression, or QoL at week 14 or 30.

CONCLUSION

Effective infliximab treatment not only led to clinical remission in patients with newly diagnosed moderate-to-severe CD but also improved their psychological status including illness perceptions, maladaptive coping, anxiety, depression, and QoL.