TOPLINE:
Baseline psychological distress predicts gastrointestinal symptom severity and mental health-related quality of life (HRQoL) over time in patients newly diagnosed with ulcerative colitis (UC).
METHODOLOGY:
There is limited knowledge about the longitudinal evolution of UC symptoms, the underlying biopsychosocial processes, and the dynamic relationship between symptoms, psychological distress, and systemic inflammation over time.Researchers assessed 98 adult patients with new-onset UC (mean age, 36 years; 69% men) from two outpatient gastroenterology clinics in Sweden.Biopsies, blood samples, and fecal samples were collected from the patients at diagnosis, and various self-report questionnaires were administered at study inclusion and over 3 years to assess severity of gastrointestinal symptoms (abdominal pain and diarrhea), HRQoL, anxiety, depression, and coping resources.The researchers analyzed the data to identify subgroups of patients on the basis of symptom severity evolution, determine the baseline predictors of subgroups, and investigate the directional relationships between gastrointestinal symptoms and psychological functioning over time while controlling for inflammation.
TAKEAWAY:
Patients with higher levels of psychological distress at disease onset were less likely to experience improvements in diarrhea (P=.049) and abdominal pain (P=.009).Higher levels of gastrointestinal symptoms were associated with poorer physical HRQoL.Lower coping resources and higher levels of depression and gastrointestinal symptoms were associated with poorer mental HRQoL outcomes.Abdominal pain positively predicted changes in psychological distress over time (standardized coefficient [β], 0.165-0.238), while diarrhea (β, −0.096 to −0.155) and abdominal pain (β, −0.178 to −0.310) negatively predicted changes in coping resources over time.
IN PRACTICE:
“Baseline psychological distress is predictive of increased [gastrointestinal] symptom severity and reduced mental HRQoL over time, suggesting early assessment of psychological symptoms may identify patients who may have worse disease trajectories,” the authors wrote. “Intervening in abdominal pain may help prevent or reduce future psychological distress.”
SOURCE:
The study, led by Maaike Van Den Houte, PhD, of the Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium, was published online on March 29 in the Journal of Crohn’s and Colitis.
LIMITATIONS:
The sample size was small, which may have prevented discovery of other associations. Patients were recruited before widespread use of biologic therapies, so the disease trajectories in the study may differ from current trajectories. The physical component of the HRQoL questionnaire may not have captured quality of life aspects related to inflammatory bowel disease.
DISCLOSURES:
The study was supported by the Region Västra Götaland, the Swedish Medical Research Council, the Marianne and Marcus Wallenberg Foundation, and the University of Gothenburg. The authors declared no conflict of interest.
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