Stressful life events and psychosocial correlates of pediatric inflammatory bowel disease activity

Abstract

AIMTo investigate the association of psychiatric and psychosocial correlates with inflammatory bowel disease (IBD) activity in children and adolescents.METHODSA total of 85 pediatric IBD patients (in remission or active state of the disease) and their parents completed a series of questionnaires and semi-structured interviews measuring life events, depression, anxiety, family dysfunction, and parent mental health. Differences between the remission and the IBD active group and the association of any significant variable with the disease activity state were examined.RESULTSParents of children being in active state of the disease reported more life events (P = 0.005) and stressful life events (P = 0.048) during the past year and more mental health symptoms (P < 0.001), while the children themselves reported higher levels of anxiety symptoms (P = 0.017) compared to the remission group. In the logistic regression multivariate analysis, the only predictor which had a significant positive effect on the probability of the patients being in active state was parent mental health symptoms (OR = 4.8; 95%CI: 1.2-25.8).CONCLUSIONLife events, child anxiety and parent mental health symptoms may be important correlates of pediatric IBD activity and targets of thorough assessment and treatment.

Systematic review with meta‐analysis: anxiety and depression in children and adolescents with inflammatory bowel disease

“…Three studies included healthy adolescents, the other 6 included patients with other chronic diseases (eg Cystic fibrosis, Diabetes, Juvenile Idiopathic Arthritis) . With respect to geography, 20 studies were from the USA, seven studies were from Europe, and one study from Asia . See Table for an overview of the study characteristics.…”

“…Finally, in 23 out of 28 studies, clinical disease activity was measured for CD, with the following indices: Paediatric Crohn's Disease Activity Index (PCDAI), short‐PCDAI abbreviated PCDAI, Harvey Bradshaw Index, Physician Global Assessment (PGA), (part of) Children's Somatisation Inventory, IBD‐symptom questionnaire, and Short‐Crohn's Disease Activity Index . Twenty‐five studies included UC patients and in 21 disease activity was measured using the following indices; Paediatric Ulcerative Colitis Activity Index (PUCAI), Physician Global Assessment, (part of) Children's Somatisation Inventory, IBD‐symptom questionnaire, Clinical score of Kozarek, Lichtiger Colitis Activity index, and PCDAI . Of the 17 studies that reported percentage active disease, 35.9% of patients had active disease and 64.1% was in remission.…”

“…Twenty‐two studies reported on depressive symptoms (including 2911 participants), using nine different instruments, including three versions of the Child Depression Inventory (CDI). The pooled estimate of prevalence of depressive symptoms was 15.0% (95% CI 6.4%‐24.8%), with a high level of heterogeneity ( I 2 = 95.0%, P < 0.001).…”

“…Bramer for his assistance in executing the systematic literature search, which contributed to the realisation of this study. In addition, we thank the authors of 13 of the included studies that provided extra data for the meta‐analysis. We also would like to thank B. Dierckx for his help with the statistical analyses.…”

Parent IMPACT‐III

“…Healthrelated quality of life (HRQOL) refers to how a child's illness affects his/her functioning across social, emotional, and physical functioning domains (7). Lower HRQOL has been associated with worse disease-related variables and psychosocial functioning, including greater disease severity (8), more pain interference (9), and worse internalizing symptoms (10,11).…”