Toward Further Understanding of Crohn’s Disease-Related Fatigue: The Role of Depression and Emotional Processing

Abstract

Because the relationship between Crohn's Disease (CD) activity and CD-related fatigue remains poorly understood, this study investigated the role of underlying psychological processes (depression, anxiety, and emotional processing). It was expected that the relationship between CD activity and CD-related fatigue would be mediated by depression and anxiety and also by a deficit in emotional processing. This prediction was tested in 110 CD patients who completed self-reported questionnaires assessing fatigue (FSS), clinical activity of Crohn's Disease (HBAI), psychological suffering (HADS), and emotional processing (EPS-25). A path analysis showed both direct and indirect effects in the relationship between CD activity and CD-related fatigue, accounting for 33% of the variance. One indirect effect on the experience of fatigue was depression, but there was no effect of anxiety. These preliminary results confirmed that disease activity induces an increase in depressive symptoms, which in turn leads to an increase in the level of fatigue. The most novel result of the present study is that emotional processing had an indirect effect on the relationship between CD and CD-related fatigue: when the disease was more active, patients exhibited greater disruption of emotional processing, which in turn led to greater fatigue. These results did not reveal any association between depression and emotional processing. In conclusion, this work highlights the role of emotional processing in CD-related fatigue and the importance of taking this factor into account in order to manage this condition better.

Is It a Gut Feeling? Bodily Sensations Associated With the Experience of Valence and Arousal in Patients With Inflammatory Bowel Disease

“…A more detached bodily experience of emotions may allow patients to avoid confronting overly intense physiological sensations and thereby reduce psychological distress. Consistent with this interpretation, a recent study by Banovic et al (55) found stronger emotional avoidance and emotional suppression among Crohn's disease patients than among healthy controls (55). Moreover, previous studies on attachment and mentalizing in IBD revealed greater avoidance tendencies in this clinical population (38,56).…”

Relationship Between Endoscopic and Clinical Disease Activity With Fatigue in Inflammatory Bowel Disease

“…In the context of the multivariate analysis, clinical disease activity and anxiety were significantly associated with fatigue. Many studies have found a relationship between clinical disease activity and fatigue (Banovic et al, 2020; Frigstad et al, 2018; Huppertz-Hauss et al, 2017; van Langenberg & Gibson, 2014). Endoscopic disease activity was significant in univariate analysis but became nonsignificant in the multivariate analysis.…”

“…The presence of anxiety and depression has been associated with fatigue (Banovic et al, 2020; Borren, Long, et al, 2020; Chavarria et al, 2019; Huppertz-Hauss et al, 2017). Our results found that anxiety, but not depression, was associated with fatigue, although this finding was not maintained in the sensitivity analysis.…”

Relationship between Human herpesvirus 6 infection and inflammatory bowel disease using novel biomarker

“…In a study of 120 outpatients with IBD (57% with CD and 41% with UC), depression was reported in 22% of subjects, and the risk of developing depression in multivariate analysis was independently associated with a lack of social support and an increase in IBD disease activity [19]. CD activity was signi cantly associated with fatigue, depression, and emotional regulation [20]. All these data underline the correlation between IBD and the severity of psychiatric disorder and suggest that active IBD may exacerbate anxiety and depression.…”