Impact of Psychological Variables on Health Status Over Time in Adolescents With Inflammatory Bowel Disease
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The relationship between psychological factors and health outcomes over time in adolescents with Inflammatory Bowel Disease (IBD) is complex. The pediatric IBD literature with respect to these relationships is limited, yet the broader IBD and health psychology literatures offer clues as to the negative impact of alexithymia, depressive symptoms, and stress on health status and health care utilization. Studies have revealed higher rates of alexithymia in adult IBD populations, which in turn has been associated with worse emotional functioning and lower quality of life (QOL). Depression has been associated with worse disease status in children with IBD, but this relationship requires additional exploration, as it remains equivocal. In the adult IBD literature, stress has been associated with disease relapse and avoidant coping. Our study sought to understand the relationship between these psychological factors, health status as determined by disease severity, and health care utilization (i.e., outpatient GI visits, ED visits, nights hospitalized, and time to medical care) over the course of 3 months and 12 months after baseline. Our study revealed correlations between disease severity and age, race, and ethnicity. However, no associations emerged between disease severity and our psychological factors of interest. Conversely, significant associations emerged between our health care utilization variables and psychological factors. For instance, stress was predictive of nights hospitalized over the course of 3 months post-baseline while both alexithymia and depressive symptoms emerged as significantly predictive of number of nights hospitalized over the course of 12 months. Additionally, increasing depressive symptoms were associated with shorter time to hospitalization post-baseline. These results highlight the complex and important relationship between psychological factors and markers of health outcome, and the importance of continuing research efforts to elucidate the mechanisms underlying these relationships. Ultimately, clearer understanding of these dynamics has important implications for pediatric IBD patients and the providers who treat them.