Psychological Distress and Quality of Life in Pediatric Crohn Disease

Abstract

Objectives For patients with Crohn's disease (CD), symptom reporting may not coincide with disease state; patients in remission may continue to report symptoms and pain, while other patients may be symptom-free despite a flare. This phenomenon has been documented in adults but only recently assessed in pediatric patients. This study assessed the role of pain reporting and disease state in pediatric patients with CD in understanding psychological distress and quality of life. Methods Participants included 116 children and adolescents ages 8-18 with CD who completed self-report questionnaires assessing pain, disease symptoms, depression, anxiety, functional disability, and quality of life. Physicians completed the Pediatric Crohn's Disease Activity Index to assess disease activity (scores ≤10 =remission, scores >10=flare). Results Approximately two-thirds of participants reported pain concordant with disease state. For patients in remission, those with pain experienced significantly increased disability and decreased quality of life compared to patients in remission without pain. For patients in a flare, those without pain experienced significantly decreased disability and depressive symptoms, as well as improved quality of life compared to patients in a flare with pain. Conclusions For pediatric patients with CD, report of pain, while in remission or a flare, is associated with increased disability and reduced quality of life. While levels of depression did not differ by disease state, depressive symptoms did differ by pain report (presence or absence) for those in a flare. Pain reporting in CD appears to be associated with both physical and psychological state and should be assessed regardless of disease activity.

Experiências vividas por famílias e crianças com sintomas urinários e intestinais: revisão sistemática de métodos mistos

“…This data was corroborated by other studies described in the literature, among them a study carried out with school children without a specific disease 28 and another study that investigated children with Crohn's disease. 29 In both cases, pain had a negative impact on the various dimensions that make up the concept of QL.…”

Biopsychosocial Correlates of Presence and Intensity of Pain in Adolescents With Inflammatory Bowel Disease

“…Psychological interventions for pediatric pain management exist and trials have demonstrated efficacy for reduction of pain and disability in both disease-related pain and idiopathic pain conditions (10). Given the increased psychological and physical health burden associated with pain in pediatric IBD (2,4,5), an important next step is tailoring these pain management interventions for youth with IBD. The results from this study suggest that adolescent internalizing symptoms and parent behavior may both be important targets.…”

“…Pain is a common symptom of inflammatory bowel disease, with the majority of patients reporting pain at initial diagnosis and during recurrence (1). Pain is associated with impaired psychological and physical health outcomes and greater healthcare expenses in youth with IBD, over and above the influence of disease severity (2)(3)(4)(5). While medical intervention in pediatric IBD is focused on disease management (i.e., the escalation of pharmacological intervention), there is increasing concern that pain management has been neglected (6, 7).…”

Psychogastroenterology: A Cure, Band-Aid, or Prevention?

“…Inflammatory Bowel Disease is an interesting disease model as patients wax and wane between flares (gut inflammation) and remission (no gut inflammation). While many children become symptomatic as their disease flares, some children are asymptomatic while in a disease flare, while others report symptoms during remission [ 13 ]. The biomedical model explains this as follows [ 14 ].…”