Coping with Stress in Patients with Inflammatory Bowel Disease and Its Relationship with Disease Activity, Psychological Disorders, and Quality of Life

Authors

  • Manizheh Danesh Medical Student, Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Ali Gholamrezaei Medical Student, Research Center, School of Medicine, Isfahan University of Medical Sciences AND Gastrointestinal Disease Research Centre, Poursina Hakim Research Institute, Isfahan, Iran
  • Farnaz Torkzadeh Medical Student, Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Leila Mirbagher Medical Student, Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Reaza Soluki Gastrointestinal Disease Research Centre, Poursina Hakim Research Institute, Isfahan, Iran
  • Mohammad Hassan Emami Department of Internal Medicine, Isfahan University of Medical Sciences AND Gastrointestinal Disease Research Centre, Poursina Hakim Research Institute, Isfahan, Iran

DOI:

https://doi.org/10.22122/ijbmc.v2i2.29

Keywords:

Anxiety, Crohn's disease, Depression, Inflammatory bowel disease, Quality of life, Stress, Ulcerative colitis

Abstract

Background: Inflammatory bowel diseases (IBD) are chronic diseases with significant impact on patients' well-being. The aim of this study was to determine stress coping strategies in IBD patients and their association with disease activity, psychological health, and quality of life (QOL).

Methods: This cross-sectional study was conducted on IBD patients referred to a gastroenterology clinic in Isfahan city (Iran). Disease activity, severity of anxiety and depression symptoms, stress coping strategies, and QOL were assessed using self-administered questionnaires. Coping strategies in IBD patients were compared to an unaffected control group.

Results: In the present study, 80 patients with mean age of 52.9 years (57.5% female) and mean disease duration of 6.5 years were studied. Compared to the controls, IBD patients had higher scores in the maladaptive coping styles (evasive and palliative) (P < 0.05). Association between coping strategies and disease activity was not significant. Severity of anxiety and depression was directly correlated with the maladaptive strategies (fatalistic and emotional) (r = 0.283 to 0.468) and inversely correlated with the adaptive strategies (confrontive, optimistic, and self-reliant) (r = -0.320 to -0.534). In addition, QOL was inversely correlated with the maladaptive strategies (fatalistic and emotional) (r = -0.278 to -0.327) and directly correlated with the adaptive strategies (confrontive and optimistic) (r = 0.262 to 0.355).

Conclusion: Patients with IBD use more maladaptive and less adaptive stress coping strategies which are associated with their psychological health and QOL. Larger and prospective studies on the dynamic and interactive network of biopsychosocial factors in IBD patients are required.

References

Bagherian Sararoud,i R., Mahmmodi, M., & Ahmadzadeh, G. h. (2009). Coping styles among diabetic patients. J Arak Univ Med Sci, 12(1), 9-17.

Bernstein, C. N., Singh, S., Graff, L. A., Walker, J. R., Miller, N., & Cheang, M. (2010). A prospective population-based study of triggers of symptomatic flares in IBD. Am J Gastroenterol, 105(9), 1994-2002. doi:ajg2010140 [pii];10.1038/ajg.2010.140 [doi]. Retrieved from PM:20372115

Best, W. R., Becktel, J. M., Singleton, J. W., & Kern, F., Jr. (1976). Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology, 70(3), 439-444. doi:S0016508576000504 [pii]. Retrieved from PM:1248701

Bitton, A., Dobkin, P. L., Edwardes, M. D., Sewitch, M. J., Meddings, J. B., Rawal, S. et al. (2008). Predicting relapse in Crohn's disease: a biopsychosocial model. Gut, 57(10), 1386-1392. doi:gut.2007.134817 [pii];10.1136/gut.2007.134817 [doi]. Retrieved from PM:18390994

Casellas, F., Alcala, M. J., Prieto, L., Miro, J. R., & Malagelada, J. R. (2004). Assessment of the influence of disease activity on the quality of life of patients with inflammatory bowel disease using a short questionnaire. Am J Gastroenterol, 99(3), 457-461. doi:10.1111/j.1572-0241.2004.04071.x [doi];AJG4071 [pii]. Retrieved from PM:15056085

Dorrian, A., Dempster, M., & Adair, P. (2009). Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping. Inflamm.Bowel.Dis., 15(1), 47-55. doi:10.1002/ibd.20583 [doi]. Retrieved from PM:18626980

Duffy, L. C., Zielezny, M. A., Marshall, J. R., Byers, T. E., Weiser, M. M., Phillips, J. F. et al. (1991). Relevance of major stress events as an indicator of disease activity prevalence in inflammatory bowel disease. Behav Med, 17(3), 101-110. doi:10.1080/08964289.1991.9937553 [doi]. Retrieved from PM:1932843

Folkman, S., & Lazarus, R. S. (1980). An analysis of coping in a middle-aged community sample. J Health Soc Behav, 21(3), 219-239. Retrieved from PM:7410799

Folkman, S., & Lazarus, R. S. (1985). If it changes it must be a process: study of emotion and coping during three stages of a college examination. J Pers.Soc Psychol, 48(1), 150-170. Retrieved from PM:2980281

Gandhi, S., Jedel, S., Hood, M. M., Mutlu, E., Swanson, G., & Keshavarzian, A. (2014). The relationship between coping, health competence and patient participation among patients with inactive inflammatory bowel disease. J Crohns.Colitis., 8(5), 401-408. doi:S1873-9946(13)00356-5 [pii];10.1016/j.crohns.2013.10.005 [doi]. Retrieved from PM:24230968

Gholamrezaei, A., Haghdani, S., Shemshaki, H., Tavakoli, H., & Emami, M. H. (2011). Linguistic validation of the Inflammatory Bowel Disease Questionnaire-short form (IBDQ-9) in Iranian population. J Isfahan Med Sch, 28(123), 1850-1859.

Goodhand, J., & Rampton, D. (2008). Psychological stress and coping in IBD. Gut, 57(10), 1345-1347. doi:57/10/1345 [pii];10.1136/gut.2008.154229 [doi]. Retrieved from PM:18791113

Goodhand, J. R., Wahed, M., Mawdsley, J. E., Farmer, A. D., Aziz, Q., & Rampton, D. S. (2012). Mood disorders in inflammatory bowel disease: relation to diagnosis, disease activity, perceived stress, and other factors. Inflamm.Bowel.Dis., 18(12), 2301-2309. doi:10.1002/ibd.22916 [doi]. Retrieved from PM:22359369

Graff, L. A., Walker, J. R., & Bernstein, C. N. (2009a). Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm.Bowel.Dis., 15(7), 1105-1118. doi:10.1002/ibd.20873 [doi]. Retrieved from PM:19161177

Graff, L. A., Walker, J. R., Clara, I., Lix, L., Miller, N., Rogala, L. et al. (2009b). Stress coping, distress, and health perceptions in inflammatory bowel disease and community controls. Am J Gastroenterol, 104(12), 2959-2969. doi:ajg2009529 [pii];10.1038/ajg.2009.529 [doi]. Retrieved from PM:19755973

Guthrie, E., Jackson, J., Shaffer, J., Thompson, D., Tomenson, B., & Creed, F. (2002). Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn's disease. Am J Gastroenterol, 97(8), 1994-1999. doi:10.1111/j.1572-0241.2002.05842.x [doi]. Retrieved from PM:12190166

Iglesias-Rey, M., Barreiro-de, A. M., Caamano-Isorna, F., Rodriguez, I. V., Gonzalez, A. L., Lindkvist, B. et al. (2013). How do psychological variables influence coping strategies in inflammatory bowel disease? J Crohns.Colitis., 7(6), e219-e226. doi:S1873-9946(12)00418-7 [pii];10.1016/j.crohns.2012.09.017 [doi]. Retrieved from PM:23083699

Iglesias-Rey, M., Barreiro-de, A. M., Caamano-Isorna, F., Rodriguez, I. V., Ferreiro, R., Lindkvist, B. et al. (2014). Psychological factors are associated with changes in the health-related quality of life in inflammatory bowel disease. Inflamm.Bowel.Dis., 20(1), 92-102. doi:10.1097/01.MIB.0000436955.78220.bc [doi]. Retrieved from PM:24193152

Jalowiec, A., Murphy, S. P., & Powers, M. J. (1984). Psychometric assessment of the Jalowiec Coping Scale. Nurs Res, 33(3), 157-161. Retrieved from PM:6563533

Jones, M. P., Wessinger, S., & Crowell, M. D. (2006). Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease. Clin Gastroenterol Hepatol., 4(4), 474-481. doi:S1542-3565(05)01183-3 [pii];10.1016/j.cgh.2005.12.012 [doi]. Retrieved from PM:16616353

Keefer, L., Kiebles, J. L., Martinovich, Z., Cohen, E., van Denburg, A., & Barrett, T. A. (2011). Behavioral interventions may prolong remission in patients with inflammatory bowel disease. Behav Res Ther, 49(3), 145-150. doi:S0005-7967(10)00254-8 [pii];10.1016/j.brat.2010.12.005 [doi]. Retrieved from PM:21256475

Keegan, D., Byrne, K., Cullen, G., Doherty, G. A., Dooley, B., & Mulcahy, H. E. (2015). The Stressometer: A Simple, Valid, and Responsive Measure of Psychological Stress in Inflammatory Bowel Disease Patients. J Crohns.Colitis.. doi:jjv120 [pii];10.1093/ecco-jcc/jjv120 [doi]. Retrieved from PM:26221000

Knowles, S. R., Wilson, J. L., Connell, W. R., & Kamm, M. A. (2011). Preliminary examination of the relations between disease activity, illness perceptions, coping strategies, and psychological morbidity in Crohn's disease guided by the common sense model of illness. Inflamm.Bowel.Dis., 17(12), 2551-2557. doi:10.1002/ibd.21650 [doi]. Retrieved from PM:21425208

Knowles, S. R., Cook, S. I., & Tribbick, D. (2013a). Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients. J Crohns.Colitis., 7(10), e471-e478. doi:S1873-9946(13)00105-0 [pii];10.1016/j.crohns.2013.02.022 [doi]. Retrieved from PM:23541738

Knowles, S. R., Monshat, K., & Castle, D. J. (2013b). The efficacy and methodological challenges of psychotherapy for adults with inflammatory bowel disease: a review. Inflamm.Bowel.Dis., 19(12), 2704-2715. doi:10.1097/MIB.0b013e318296ae5a [doi]. Retrieved from PM:23846488

Maunder, R. G., & Levenstein, S. (2008). The role of stress in the development and clinical course of inflammatory bowel disease: epidemiological evidence. Curr Mol Med, 8(4), 247-252. Retrieved from PM:18537632

Mawdsley, J. E., & Rampton, D. S. (2005). Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut, 54(10), 1481-1491. doi:54/10/1481 [pii];10.1136/gut.2005.064261 [doi]. Retrieved from PM:16162953

McCombie, A. M., Mulder, R. T., & Gearry, R. B. (2013a). How IBD patients cope with IBD: a systematic review. J Crohns.Colitis., 7(2), 89-106. doi:S1873-9946(12)00263-2 [pii];10.1016/j.crohns.2012.05.021 [doi]. Retrieved from PM:22718016

McCombie, A. M., Mulder, R. T., & Gearry, R. B. (2013b). Psychotherapy for inflammatory bowel disease: a review and update. J Crohns.Colitis., 7(12), 935-949. doi:S1873-9946(13)00069-X [pii];10.1016/j.crohns.2013.02.004 [doi]. Retrieved from PM:23466412

McCombie, A. M., Mulder, R. T., & Gearry, R. B. (2015). Coping Strategies and Psychological Outcomes of Patients with Inflammatory Bowel Disease in the First 6 Months After Diagnosis. Inflamm.Bowel.Dis.. doi:10.1097/MIB.0000000000000476 [doi]. Retrieved from PM:26099065

Mittermaier, C., Dejaco, C., Waldhoer, T., Oefferlbauer-Ernst, A., Miehsler, W., Beier, M. et al. (2004). Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom.Med, 66(1), 79-84. Retrieved from PM:14747641

Montazeri, A., Vahdaninia, M., Ebrahimi, M., & Jarvandi, S. (2003). The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual.Life.Outcomes., 1, 14. doi:10.1186/1477-7525-1-14 [doi]. Retrieved from PM:12816545

Moradkhani, A., Beckman, L. J., & Tabibian, J. H. (2013). Health-related quality of life in inflammatory bowel disease: psychosocial, clinical, socioeconomic, and demographic predictors. J Crohns.Colitis., 7(6), 467-473. doi:S1873-9946(12)00323-6 [pii];10.1016/j.crohns.2012.07.012 [doi]. Retrieved from PM:22884758

Moskovitz, D. N., Maunder, R. G., Cohen, Z., McLeod, R. S., & MacRae, H. (2000). Coping behavior and social support contribute independently to quality of life after surgery for inflammatory bowel disease. Dis.Colon.Rectum., 43(4), 517-521. Retrieved from PM:10789749

O'Connor, D. B., & Shimizu, M. (2002). Sense of personal control, stress and coping style: a cross-cultural study. Stress and Health, 18(4), 173-183. Retrieved from http://dx.doi.org/10.1002/smi.939. Retrieved from John Wiley & Sons, Ltd.

Parekh, N. K., McMaster, K., Nguyen, D. L., Shah, S., Speziale, A., Miller, J. et al. (2015). Coping Strategies Used by Adult Patients with Inflammatory Bowel Disease. South.Med J, 108(6), 337-342. doi:10.14423/SMJ.0000000000000292 [doi];SMJ50020 [pii]. Retrieved from PM:26079458

Petrak, F., Hardt, J., Clement, T., Borner, N., Egle, U. T., & Hoffmann, S. O. (2001). Impaired health-related quality of life in inflammatory bowel diseases: psychosocial impact and coping styles in a national German sample. Scand.J Gastroenterol, 36(4), 375-382. Retrieved from PM:11336162

Podolsky, D. K. (2002). Inflammatory bowel disease. N Engl J Med, 347(6), 417-429. doi:10.1056/NEJMra020831 [doi];347/6/417 [pii]. Retrieved from PM:12167685

Sainsbury, A., & Heatley, R. V. (2005). Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease. Aliment.Pharmacol.Ther, 21(5), 499-508. doi:APT2380 [pii];10.1111/j.1365-2036.2005.02380.x [doi]. Retrieved from PM:15740531

Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health: psychological, behavioral, and biological determinants. Annu.Rev Clin Psychol, 1, 607-628. doi:10.1146/annurev.clinpsy.1.102803.144141 [doi]. Retrieved from PM:17716101

Smolen, D. M., & Topp, R. O. B. E. (1998). Coping methods of patients with inflammatory bowel disease and prediction of perceived health, functional status, and well-being. Gastroenterology Nursing, 21 (3). Retrieved from http://journals.lww.com/gastroenterologynursing/Fulltext/1998/05000/Coping_Methods_of_Patients_with_Inflammatory_Bowel.3.aspx

Tabibian, A., Tabibian, J. H., Beckman, L. J., Raffals, L. L., Papadakis, K. A., & Kane, S. V. (2015). Predictors of health-related quality of life and adherence in Crohn's disease and ulcerative colitis: implications for clinical management. Dig.Dis.Sci, 60(5), 1366-1374. doi:10.1007/s10620-014-3471-1 [doi]. Retrieved from PM:25559754

Thia, K., Faubion, W. A., Jr., Loftus, E. V., Jr., Persson, T., Persson, A., & Sandborn, W. J. (2011). Short CDAI: development and validation of a shortened and simplified Crohn's disease activity index. Inflamm.Bowel.Dis., 17(1), 105-111. doi:10.1002/ibd.21400 [doi]. Retrieved from PM:20629100

van der Zaag-Loonen HJ, Grootenhuis, M. A., Last, B. F., & Derkx, H. H. (2004). Coping strategies and quality of life of adolescents with inflammatory bowel disease. Qual.Life.Res, 13(5), 1011-1019. Retrieved from PM:15233514

Walmsley, R. S., Ayres, R. C., Pounder, R. E., & Allan, R. N. (1998). A simple clinical colitis activity index. Gut, 43(1), 29-32. Retrieved from PM:9771402

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatr.Scand., 67(6), 361-370. Retrieved from PM:6880820

Downloads

Published

2015-09-15

How to Cite

Danesh, M., Gholamrezaei, A., Torkzadeh, F., Mirbagher, L., Soluki, R., & Emami, M. H. (2015). Coping with Stress in Patients with Inflammatory Bowel Disease and Its Relationship with Disease Activity, Psychological Disorders, and Quality of Life. International Journal of Body, Mind and Culture, 2(2), 95-104. https://doi.org/10.22122/ijbmc.v2i2.29

Issue

Vol 2, No 2 (2015)

Section

Quantitative Study(ies)

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.