Departments of *Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), †Internal Medicine VI (Psychosomatic Medicine and Psychotherapy), and ‡Surgery, University Hospital Tübingen, Tübingen, Germany.
Inflamm Bowel Dis. 2017 Oct;23(10):1796-1802. doi: 10.1097/MIB.0000000000001216.
The relative contribution of psychological factors to the onset and course of inflammatory bowel diseases (IBD) is a matter of constant debate since its beginning, as is the clinical need and the efficacy of psychotherapeutic interventions. However, the perspective of patients with IBD has largely been ignored in this debate.
Psychometric tests including the Short-Form IBD Questionnaire (SIBDQ), the ADAP test measuring demand for psychotherapy, and the Fear-of-Progression Questionnaire Short Form as well as disease-related questions were positioned on the internet between December 2014 and January 2016. The study was advertised through DCCV (German branch of the European Federation of Crohn's and Ulcerative Colitis Associations).
n = 631 patients responded, and complete data from n = 578 (356 Crohn's disease, 219 ulcerative colitis, 3 unclear) were available for analysis. n = 296 had previous experiences with psychotherapy, whereas n = 282 had not. This distribution clearly determined the factor "demand for psychotherapy" (chi-square = 23.7, P < 0.001). When all available data were entered into a (stepwise-forward) regression model, psychotherapy demand was dependent on previous experience (P < 0.001), fear of progression (P < 0.001), quality of life (P = 0.001), smoking (P = 0.003), and previous surgery (P = 0.005) with the total model explaining 29.7% of the variance. The total explained variance of this model was higher in ulcerative colitis (37.6%) than in Crohn's disease alone (25.4%).
The demand for psychotherapy as additional therapy in IBD depends on previous experience with psychotherapy, fear for disease progression but also other disease or social characteristics and quality of life.
自炎症性肠病 (IBD) 出现以来，心理因素对其发病和病程的影响一直是争论的焦点，心理治疗的临床需求和疗效也是如此。然而，在这场争论中，IBD 患者的观点在很大程度上被忽视了。
在 2014 年 12 月至 2016 年 1 月期间，我们在互联网上使用包括短版 IBD 问卷 (SIBDQ)、测量心理治疗需求的 ADAP 测试、恐惧进展问卷短版以及与疾病相关的问题在内的心理测试。该研究通过德国克罗恩病和溃疡性结肠炎协会的分支机构 DCCV 进行宣传。
共有 631 名患者做出回应，其中 578 名（356 名克罗恩病、219 名溃疡性结肠炎、3 名未明确）患者提供了完整的数据用于分析。296 名患者有过心理治疗的经历，而 282 名患者没有。这种分布明显决定了“对心理治疗的需求”这一因素（卡方=23.7，P<0.001）。当所有可用数据输入逐步向前回归模型时，心理治疗需求取决于先前的经验（P<0.001）、对疾病进展的恐惧（P<0.001）、生活质量（P=0.001）、吸烟（P=0.003）和以前的手术（P=0.005），该模型总共解释了 29.7%的方差。该模型在溃疡性结肠炎中的总解释方差（37.6%）高于克罗恩病（25.4%）。
IBD 患者对作为附加治疗的心理治疗的需求取决于他们以前是否接受过心理治疗、对疾病进展的恐惧，以及其他疾病或社会特征和生活质量。
