Stone James K, Shafer Leigh Anne, Graff Lesley A, Witges Kelcie, Sexton Kathryn, Lix Lisa M, Haviva Clove, Targownik Laura E, Bernstein Charles N
Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada.
University of Manitoba IBD Clinical and Research Centre, Winnipeg, MB, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
J Psychosom Res. 2022 Mar;154:110719. doi: 10.1016/j.jpsychores.2022.110719. Epub 2022 Jan 10.
Positive and negative psychological attributes have been shown to influence disease outcomes in many chronic health conditions. We aimed to evaluate the association between self-efficacy, optimism, health anxiety and intolerance of uncertainty and disease activity in inflammatory bowel disease (IBD).
Adults with confirmed and recently active IBD enrolled in a prospective cohort study. Demographics, disease information, validated measures of psychological functioning related to general self-efficacy, optimism, health anxiety and intolerance of uncertainty were collected at baseline, week 26 and week 52. Clinical disease activity was assessed using the Inflammatory Bowel Disease Symptom Inventory (IBDSI), self-reported flares, and intestinal inflammation using fecal calprotectin (FCAL), collected at baseline, weeks 26 and 52. Generalized estimating equations were used to test the association between psychological functioning and disease activity.
Participants' (n = 154) mean age was 43.4 years (SD 12.5), 69.5% were women and 64.1% had Crohn's disease. Adjusting for demographic variables, higher self-efficacy was associated with lower likelihood of flare by self-report (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.71, 0.91) and IBDSI (OR 0.89, 95% CI 0.80, 0.99), while higher health anxiety was associated with greater likelihood of flare by self-report (OR 1.07, 95% CI 1.01, 1.18) and higher symptomatic disease activity (IBDSI; OR 1.14, 95% CI 1.05, 1.24). The psychological attributes were not significantly associated with active disease as measured by inflammation (FCAL).
General self-efficacy and health anxiety are relevant in understanding patient experience with disease activity, and may be appropriate targets for psychological intervention in the care of individuals with IBD.
在许多慢性健康状况中，积极和消极的心理特质已被证明会影响疾病预后。我们旨在评估自我效能感、乐观主义、健康焦虑以及对不确定性的不耐受与炎症性肠病（IBD）患者疾病活动度之间的关联。
确诊且近期病情活动的成年IBD患者参与了一项前瞻性队列研究。在基线、第26周和第52周收集人口统计学信息、疾病信息以及与一般自我效能感、乐观主义、健康焦虑和对不确定性的不耐受相关的心理功能有效测量指标。使用炎症性肠病症状量表（IBDSI）、自我报告的病情发作情况以及在基线、第26周和第52周收集的粪便钙卫蛋白（FCAL）来评估肠道炎症，以此评估临床疾病活动度。采用广义估计方程来检验心理功能与疾病活动度之间的关联。
参与者（n = 154）的平均年龄为43.4岁（标准差12.5），69.5%为女性，64.1%患有克罗恩病。在对人口统计学变量进行校正后，较高的自我效能感与自我报告的病情发作可能性较低相关（优势比[OR] 0.80，95%置信区间[CI] 0.71，0.91）以及与IBDSI评分较低相关（OR 0.89，95% CI 0.80，0.99），而较高的健康焦虑与自我报告的病情发作可能性较高相关（OR 1.07，95% CI 1.01，1.18）以及与较高的症状性疾病活动度（IBDSI评分；OR 1.14，95% CI 1.05，1.24）相关。这些心理特质与通过炎症指标（FCAL）测量的活动性疾病无显著关联。
一般自我效能感和健康焦虑在理解患者疾病活动体验方面具有相关性，可能是IBD患者护理中心理干预的合适目标。
