Z Gastroenterol 2012; 50 - K196
DOI: 10.1055/s-0032-1324131

Psychosocial stress as an indicator for disease severity, impairments in mental health, medication and health care utilization in patients with Crohn's disease (CD) or ulcerative colitis (UC). Evaluation of a short scale of perceived stress in inflammatory bowel diseases (IBD)

J Hardt 1, 2, S Conrad 1, 3, B Bokemeyer 4, 5, H Raspe 1, 6
  • 1Universität zu Lübeck, Institut für Sozialmedizin, Lübeck, Germany
  • 2Bergische Universität Wuppertal, FB D, Institut für Sicherheitstechnik, Wuppertal, Germany
  • 3Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Evidenzbasierte Medizin und Leitlinien, Berlin, Germany
  • 4Gastroenterologische Gemeinschaftspraxis Minden, Minden (Westf.), Germany
  • 5University Medical Center Schleswig-Holstein, Campus Kiel, Clinic of General Internal Medicine I, Kiel, Germany
  • 6Universität zu Lübeck, Seniorprofessur für Bevölkerungsmedizin, Lübeck, Germany

Introduction: IBD are chronic relapsing diseases. Recent studies show associations of stress exposures and active disease [1–3]. This study investigates associations of perceived stress with disease activity, mental health and health care utilization (medication, adherence; contacts with professionals; utilization of psychotherapy) and evaluated an indicator scale for psychosocial impairments [4,5] and health care issues.

Methods: German health care survey data [6] of 1018 IBD patients (65% female, 58% CD) were analyzed. The questionnaire referred to perceived stress, disease activity (GIBDI-Score [5,7]), anxiety and depression (HADS [8]), medication and utilization of health care. A short scale with 3 items was constructed (psychometric scale properties [4,9]). Three groups with low, moderate, high stress were compared with chi2 tests and ANOVA.

Results: Patients with high stress were younger, more often female and working. They more often reported suffering from IBD, impairments of sexuality, substantial disease activity (GIBDI), anxiety and depression. They reported higher medication rates with 5-ASA and analgesics (CD, UC), but also more nonadherence, inpatient treatment, contacts with IBD specialists and psychotherapists. They stated more subjective importance and utilization of psychosocial healthcare.

Discussion: Our results describe chronic patients with high stress levels as a group especially relevant for health care [10]. The high prevalences of psychosocial problems, disease activity and considerable health problems makes the short scale attractive to identify patients with increased risks of psychosocial comorbidities early with diagnosis.

References:

[1] Van Assche G et al. JCC 2010;4:63–101.

[2] Biancone L et al. JCC 2008;2:63–92.

[3] Bokemeyer B*, Hardt J* et al. JCC 2012 (in press). doi:10.1016/j.crohns.2012.02.014.

[4] Hardt J et al. Eur Psychiat 2011;26:2217–8.

[5] Hardt J et al. Zbl Arbmed 2010;60:318–9.

[6] Hardt J et al. ZGastro 2010;48:381–91

[7] Scherer M et al. ZGastro 2011;49(7):820–6.

[8] Herrmann C et al. [HADS-D Hospital Anxiety and Depression Scale – German Version]. Bern: Huber, 1995.

[9] Hardt J et al. Psychosocial impairments in patients with IBD... German Med Sci 2011: Doc11gmds317.

[10] Raspe H et al. ZGastro 2009;47:541–62