Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma, USA.
Baylor College of Medicine - Texas Children's Hospital, Houston, Texas, USA.
J Pediatr Gastroenterol Nutr. 2024 Jan;78(1):77-84. doi: 10.1002/jpn3.12056. Epub 2023 Dec 10.
Clinical disease activity associated with inflammatory bowel disease (IBD) can place physical limitations on youths' activities of daily living. In turn, functional limitations potentially contribute to youths' heightened experience of IBD-induced intrusions on a wide range of routine and valued activities (i.e., illness intrusiveness), which can increase their risk for depressive symptoms. The present study examined the contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in youth with IBD.
Youth (N = 180) completed the Functional Disability Inventory (FDI), Illness Intrusiveness Scale-Child (IIS-C), and Children's Depression Inventory-2 (CDI-2). Physicians completed the Physicians Global Assessment of disease activity (PGA).
Results revealed a mediating effect for functional disability in the association between disease activity and depressive symptoms (PGA → FDI → CDI-2); illness intrusiveness mediated the association between functional disability and depressive symptoms (i.e., FDI → IIS-C → CDI-2). Serial mediation revealed that clinical disease activity conferred an indirect effect on youth depressive symptoms through the sequential effects of functional disability and illness intrusiveness (i.e., PGA → FDI → IIS-C → CDI-2).
Taken together, these findings indicate that youth who encounter more physical limitations as a function of clinical disease activity are more likely to experience an amplified sense of IBD-related intrusions on their ability to participate in meaningful activities. In turn, heightened illness intrusiveness increases the likelihood of depressive symptoms. Clinical interventions that help youth maintain adequate functional ability in the face of IBD disease activity and encourage involvement in positively valued activities could decrease the negative impact of IBD on youths' emotional adjustment.
与炎症性肠病（IBD）相关的临床疾病活动会限制青少年的日常生活活动能力。反过来，功能障碍可能会导致青少年对广泛的日常和有价值的活动（即疾病入侵）的体验加剧，从而增加他们患抑郁症状的风险。本研究探讨了临床疾病活动、功能障碍和疾病入侵对青少年 IBD 患者抑郁症状的影响。
共 180 名青少年完成了功能障碍量表（FDI）、疾病入侵量表儿童版（IIS-C）和儿童抑郁量表-2（CDI-2）的评估。医生完成了疾病活动的总体评估（PGA）。
结果显示，在疾病活动与抑郁症状之间，功能障碍具有中介作用（PGA→FDI→CDI-2）；疾病入侵在功能障碍与抑郁症状之间具有中介作用（即 FDI→IIS-C→CDI-2）。序列中介显示，临床疾病活动通过功能障碍和疾病入侵的连续效应，对青少年的抑郁症状产生间接影响（即 PGA→FDI→IIS-C→CDI-2）。
综上所述，这些发现表明，由于临床疾病活动而导致更多身体限制的青少年更有可能体验到与 IBD 相关的活动参与能力的增强入侵感。反过来，疾病入侵感的增强增加了抑郁症状的可能性。有助于青少年在面对 IBD 疾病活动时保持足够的功能能力，并鼓励参与有价值的活动的临床干预措施，可能会降低 IBD 对青少年情绪调节的负面影响。
