Intervening for IBD

Psychological interventions for adolescents with inflammatory bowel disease (IBD) may help to improve adherence to treatments and healthrelated quality of life (HRQoL) says research published in Behavioral Medicine by Le Bonheur Gastroenterologists Mark R. Corkins, MD, and John R. Whitworth, MD. The research was conducted in conjunction with Psychologist Kimberly L. Klages and colleagues from the department of Psychology at the University of Memphis. Their study of adolescents with IBD showed that psychosocial problems, disease severity and identifying as Black led to lower HRQoL scores.

“Youth with IBD typically experience disruptions to their health-related quality of life,” said
Whitworth. “The findings of our study show that a psychological approach to coping with psychosocial problems and IBD symptoms may influence patients better adhering to their treatment plan and improving their quality of life.

HRQoL of youth is influenced by three interacting factors — sociodemographic and disease characteristics, psychosocial problems and health-related behaviors. This is the first time that research has looked at the impact of these factors on HRQoL of adolescents with IBD, with the study aiming to better understand the relationship among these factors and their influence on HRQoL.

Data was collected from 107 adolescent-caregiver pairs in Le Bonheur’s outpatient gastroenterology clinic. Patients were between 12 and 20 years old with a diagnosis of ulcerative colitis or Crohn’s disease. The patient and caregiver each independently completed the following questionnaires and measurements:

• The Medication Adherence Questionnaire (MAM)
• Self-Care Inventory-Revised (SCI-R-IBD)
• A visual analog scale to measure medication adherence
• The Pediatric Symptom Checklist-17 (PSC-17)
• PedsQL™ Gastrointestinal Symptoms Scales
The results of the study showed:
• Psychosocial problems were associated with worse HRQoL
and adherence behaviors.
• HRQoL scores were lower for youth who were Black, had
more severe disease or had greater psychosocial problems.
• Those with more severe disease had better adherence
behaviors.

• Those with nonpublic insurance were associated with
greater adherence behaviors and lower psychosocial
problems.
• Age, disease duration, disease activity and gender did not
predict psychosocial problems, adherence behaviors or
HRQoL.

“Out of all of our study findings, we found the effect of psychosocial problems on HRQoL and adherence to be quite large,” said Corkins. “Our findings indicate factors by which youth with IBD can be quickly and cost-effectively screened to identify those at risk for lower HRQoL.

The results of the study have clinical and economic significance for patients and clinicians treating IBD. By screening patients for risk factors such as insurance status, disease severity, psychosocial problems, race and adherence behaviors interventions can take place quickly to prevent decline in quality of life. Implementing psychological interventions focused on psychosocial problems, symptom coping and medication adherence may help enhance adherence behaviors and HRQoL while also preventing the treatment cost for longterm medical and psychological complications that can occur among adolescents with IBD. Le Bonheur gastroenterologists plan to use the data to demonstrate the need for psychologists in the care of pediatric patients with IBD.