Illness stigma, body image dissatisfaction, thwarted belongingness and depressive symptoms in youth with inflammatory bowel disease

Abstract

Background Elevated depressive symptoms are observed in a significant number of youth with inflammatory bowel disease (IBD) and have been linked to illness stigma and social isolation. Body image dissatisfaction is an understudied variable in the pediatric IBD literature that may be related to both stigma and social difficulties. It is suspected that, due to the stigmatizing nature of IBD, some youth may feel self-conscious about their body image, which contributes to decreased feelings of social belongingness and ultimately depressive symptoms. The current study tested an illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptoms serial mediation model, in which IBD stigma was hypothesized to indirectly influence youth depressive symptoms through the sequential effects of stigma on body image dissatisfaction and thwarted social belongingness. Methods Youth with IBD (N = 75) between 10 and 18 years old were recruited from a pediatric gastroenterology clinic and completed psychosocial measures. Disease severity was assessed by a physician global assessment. Current medications and BMI data were collected. Results Analyses revealed significant direct effects among the modeled variables and a significant serial indirect path for illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptoms, controlling for sex, BMI and prednisone medication. Conclusions: Youth who perceive greater IBD stigma are more likely to experience increased body image dissatisfaction due to their IBD, which may engender feelings of social estrangement and ultimately elevated depressive symptoms. Depressive symptoms and the psychosocial challenges faced by youth should be routinely monitored as part of comprehensive IBD management.

Body image dissatisfaction during the first year of pediatric inflammatory bowel disease diagnosis

“…The existing body image dissatisfaction literature within IBD has largely focused on adults, finding that greater body image dissatisfaction is associated with identifying as female, greater disease activity, and elevated psychosocial concerns 4,6 . Studies with pediatric samples have similarly found that body image dissatisfaction is associated with female sex, older age at diagnosis and assessment, greater body mass index (BMI), more active disease, greater illness stigma, and more depression and anxiety 8,9 . Our cross‐sectional work used a body image‐specific questionnaire and found that increased dissatisfaction was associated with older age and greater patient‐reported disease symptoms but, notably, depressive symptoms were the only significantly associated psychosocial factor within a regression model 10 .…”

“…4,6 Studies with pediatric samples have similarly found that body image dissatisfaction is associated with female sex, older age at diagnosis and assessment, greater body mass index (BMI), more active disease, greater illness stigma, and more depression and anxiety. 8,9 Our cross-sectional work used a body image-specific questionnaire and found that increased dissatisfaction was associated with older age and greater patient-reported disease symptoms but, notably, depressive symptoms were the only significantly associated psychosocial factor within a regression model. 10 However, the cross-sectional literature has precluded determining if and how dissatisfaction with one's body changes over time, and whether depressive symptoms are related to changes.…”

Psychological distress in individuals with irritable bowel syndrome: the roles of body image and self-criticism

“…Research also shows a strong link between body image concerns and PD in individuals coping with a variety of chronic illnesses, such as fibromyalgia (Berk et al, 2020 ; Geller et al, 2022 ), endometriosis (Geller et al, 2021 ; Sullivan-Myers et al, 2023 ), IBD (McDermott et al, 2015 ; Roberts et al, 2022 ; Wabich et al, 2020 ), breast cancer (Campbell-Enns & Woodgate, 2015 ; Trindade et al, 2018 ), type 1 diabetes (Salah et al, 2022 ), psoriasis (Gündüz et al, 2020 ), and systemic lupus erythematosus (Rodrigues et al, 2021 ). Building on these findings and informed by research that connects body image in IBS with health-related quality of life (Jones et al, 2006 ; Kopczyńska et al, 2018 ), we propose that the increased risk of PD in patients with IBS could be partially attributed to a decline in their quality of life due to heightened body dissatisfaction.…”

The Influence of Social Exclusion on High School Students’ Depression: A Moderated Mediation Model

“…Second, thwarted belongingness is positively correlated with depression. 46 When a person is deprived of a sense of belonging, it may lead to elevated levels of stress, anxiety, depression, and other negative emotions. Previous studies have found that a sense of belonging plays a role in how interpersonal relationships influence individual mental health.…”