Slonim-Nevo Vered, Sarid Orly, Friger Michael, Schwartz Doron, Chernin Elena, Shahar Ilana, Sergienko Ruslan, Vardi Hillel, Rosenthal Alexander, Mushkalo Alexander, Dizengof Vitaly, Ben-Yakov Gil, Abu-Freha Naim, Munteanu Daniella, Gaspar Nava, Eidelman Leslie, Segal Arik, Fich Alexander, Greenberg Dan, Odes Shmuel
aSpitzer Department of Social Work Departments of bPublic Health cHealth Systems Management dFaculty of Health Sciences, Ben-Gurion University of the Negev eDepartment of Gastroenterology and Hepatology, Soroka Medical Center, Beer-Sheva, Israel.
Eur J Gastroenterol Hepatol. 2016 Sep;28(9):1073-81. doi: 10.1097/MEG.0000000000000666.
Threatening life experiences and adverse family relations are major psychosocial stressors affecting mental and physical health in chronic illnesses, but their influence in Crohn's disease (CD) is unclear. We assessed whether these stressors would predict the psychological and medical condition of CD patients.
Consecutive adult CD patients completed a series of instruments including demography, Patient Harvey-Bradshaw Index (P-HBI), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), short-form survey instrument (SF-36), brief symptom inventory (BSI), family assessment device (FAD), and list of threatening life experiences (LTE). Associations of FAD and LTE with P-HBI, SIBDQ, SF-36, and BSI were examined by multiple linear and quantile regression analyses.
The cohort included 391 patients, mean age 38.38±13.95 years, 59.6% women, with intermediate economic status. The median scores were as follows: P-HBI 4 (2-8), FAD 1.67 (1.3-2.1), LTE 1 (0-3), SF-36 physical health 43.75 (33.7-51.0), SF-36 mental health 42.99 (34.1-51.9), and BSI-Global Severity Index 0.81 (0.4-1.4). The SIBDQ was 47.27±13.9. LTE was associated with increased P-HBI in all quantiles and FAD in the 50% quantile. FAD and LTE were associated with reduced SIBDQ (P<0.001). Higher LTE was associated with lower SF-36 physical and mental health (P<0.001); FAD was associated with reduced mental health (P<0.001). FAD and LTE were associated positively with GSI in all quantiles; age was associated negatively.
CD patients with more threatening life experiences and adverse family relations were less healthy both physically and mentally. Physicians offering patients sociopsychological therapy should relate to threatening life experiences and family relations.
危及生命的经历和不良的家庭关系是影响慢性病患者身心健康的主要社会心理应激源，但它们在克罗恩病（CD）中的影响尚不清楚。我们评估了这些应激源是否能预测CD患者的心理和身体状况。
连续纳入成年CD患者，他们完成了一系列问卷，包括人口统计学、患者哈维 - 布拉德肖指数（P - HBI）、简短炎症性肠病问卷（SIBDQ）、简短健康调查量表（SF - 36）、简明症状量表（BSI）、家庭评估量表（FAD）以及危及生命经历清单（LTE）。通过多元线性回归和分位数回归分析检验FAD和LTE与P - HBI、SIBDQ、SF - 36和BSI之间的关联。
该队列包括391名患者，平均年龄38.38±13.95岁，59.6%为女性，经济状况中等。中位数得分如下：P - HBI为4（2 - 8），FAD为1.67（1.3 - 2.1），LTE为1（0 - 3），SF - 36身体健康维度为43.75（33.7 - 51.0），SF - 36心理健康维度为42.99（34.1 - 51.9），BSI - 总体严重程度指数为0.81（0.4 - 1.4）。SIBDQ为47.27±13.9。LTE在所有分位数上均与P - HBI升高相关，在第50百分位数上与FAD相关。FAD和LTE与SIBDQ降低相关（P<0.001）。较高的LTE与较低的SF - 36身体和心理健康相关（P<0.001）；FAD与心理健康降低相关（P<0.001）。FAD和LTE在所有分位数上均与GSI呈正相关；年龄与GSI呈负相关。
有更多危及生命经历和不良家庭关系的CD患者在身体和心理方面健康状况较差。为患者提供社会心理治疗的医生应关注危及生命的经历和家庭关系。
