Perceived distress, personality characteristics, coping strategies and psychosocial impairments in a national German multicenter cohort of patients with Crohn’s disease and ulcerative colitis

Abstract

Background and aims This study examined differences in personality, psychological distress, and stress coping in inflammatory bowel disease (IBD) depending on type of disease and disease activity. We compared patients suffering from Crohn’s disease (CD) and ulcerative colitis (UC) with controls. While the literature is replete with distinctive features of the pathogenesis of IBD, the specific differences in psychological impairments are not well studied. Methods In this German national multicenter study, participants were recruited from 32 centers. Two hundred ninety-seven questionnaires were included, delivering vast information on disease status and psychological well-being based on validated instruments with a total of 285 variables. Results CD patients were more affected by psychological impairments than patients suffering from UC or controls. Importantly, patients with active CD scored higher in neuroticism (p < 0.01), psychological distress (p < 0.001) and maladaptive stress coping (escape, p = 0.03; rumination, p < 0.03), but less need for social support (p = 0.001) than controls. In contrast, patients suffering from active UC showed psychological distress (p < 0.04) and maladaptive coping (avoidance, p < 0.03; escape, p = 0.01). Patients in remission seemed to be less affected. In particular, patients with UC in remission were not inflicted by psychological impairments. The group of CD patients in remission however, showed insecurity (p < 0.01) and paranoid ideation (p = 0.04). Conclusions We identified specific aspects of psychological impairment in IBD depending on disease and disease activity. Our results underscore the need for psychological support and treatment particularly in active CD.

Higher Levels of Psychological Burden and Alterations in Personality Functioning in Crohn’s Disease and Ulcerative Colitis

“…Specifically, an avoidant attachment style in UC is a moderator between negative childhood experiences and disease activity, while this association could not be shown in CD ( Caplan et al, 2014 ). UC patients seem to have more attachment-related anxiety than HC and therefore experience more perceived stress, while another study found especially CD to be associated with higher levels of emotional distress than UC or HC ( Agostini et al, 2016 ; Petruo et al, 2019 ). Deficits in mentalization and attachment insecurity may lead, via a decreased medical adherence and a decreased social support, to a worsening of the IBD course and afterward to more IBD-related stress and further deficits in a vicious circle ( Colonnello and Agostini, 2020 ).…”

Exploring joint patterns of brain structure and function in inflammatory bowel diseases using multimodal data fusion

“…Some medical therapies are effective in both diseases; other therapies work well in one, but not the other 21 . There is also evidence of different prevalence of affective symptoms and different strategies of coping with psychosocial stress 22,23 . In this regard, a study using near infrared spectroscopy (NIRS) provided preliminary evidence for neural differences between CD and UC in terms of a decreased activity in the frontal lobe of UC patients compared to CD, 24 but topologically more distinct evidence, such as high‐resolution MRI data, is lacking.…”

Integrated Bioinformatics Analysis Identifies ELAVL1 and APP as Candidate Crucial Genes for Crohn’s Disease

“…The adaptive immune system is considered the key regulator of the pathogenesis of CD [ 3 ]. When the intestinal barrier is broken, pattern recognition receptors, such as TLR [ 52 ] and NLR [ 53 ], recognize the microbe-associated molecular patterns, thus promoting the activation and differentiation of T cells [ 54 ].…”

“…Although the pathogenesis is complex, the decades of studies have illustrated that CD is caused by environmental factors that broke the mucosal barrier and increased the luminal antigens into the lamina propria [ 2 ]. Different innate immune cells, like dendritic cells, recognize the antigens via pattern recognition receptors, such as Toll-like receptors (TLR) and NLR, and then regulate the activation of T cells [ 3 ].…”