Symptoms of Crohn’s disease in children are driven by disease severity and psychological factors, suggesting that physicians should consider incorporating behavioral techniques to manage their patient’s disease, according to data published in Journal of Pediatrics.
“Research reports have been inconsistent regarding the relationship of psychological factors to disease activity in pediatric patients with IBD, with both positive associations as well as no associations reported between anxiety/depression and Crohn’s disease activity,” Miranda A.L. van Tilburg, PhD, from the Center for Functional Gastrointestinal and Motility Disorders at the University of North Carolina, Chapel Hill, and colleagues wrote. “Recognition of the role of psychological factors associated with patient symptom reporting and disability in pediatric Crohn’s disease is … important and needed.”
Miranda A.L. van Tilburg
Researchers recruited 127 children with CD aged 8 to 18 years between 2007 and 2012 to assess whether psychological factors and disease activity would affect self-reported symptoms and disability. Each participant received a questionnaire on symptom severity and disability, as well as psychological measures assessing anxiety, depression pain beliefs and coping. The investigators used the Pediatric Crohn’s Disease Activity Index to measure disease activity, and structural equation modeling to test the effects of disease activity and psychological factors on symptoms and disability.
Van Tilburg and colleagues found that psychological factors (beta = .58; P < .001) were significantly associated with disease symptoms but, there was no association with disease activity (beta = .11; P = .16). After rerunning the model to only include the 60 children who had clinically active disease at the time of testing, they observed the association between disease activity measures and symptoms remained insignificant (P = .08) and psychological factors still significantly predicted outcomes (beta = .7; P < .001). The hypothesized model predicting disability showed significant associations for both psychological factors (beta = .75; P < .001) and disease activity (beta = .61; P < .05). Again, they reran the model to only include the 60 participants with clinically active disease and saw significant association between disability and psychological factors (beta = .8; P < .001), but no association between disability and disease activity (P = .3).
“Psychological distress, such as depression, is increased in a large subset of CD patients and these patients may be at risk for unnecessary exposure to tests and treatments, with potential negative side effects, when being evaluated based on their symptoms,” van Tilburg told Healio Gastroenterology. “When confronted with a pediatric Crohn’s disease patient who has high levels of psychological distress, independent of their inflammatory status, the clinician should consider incorporating behavioral techniques such as education, reassurance, and cognitive behavior therapy into the management plan.” – by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.