ANXIETY AND QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE PATIENTS

Background. Health of a person is defined as a physical, mental and social well-being. Chronic diseases threaten people’s quality of life, decrease physical and emotional health, functional activity in society and self-esteem.  One of such diseases is inflammatory bowel diseases (IBD).  IBD, comprising Crohn’s disease and ulcerative colitis, is a chronic immunologically mediated disease at the intersection of complex interactions between genetics, environment and gut microbiota [1, P. 205–217]. The predominant symptoms of IBD are diarrhea, abdominal pain, gastrointestinal bleeding, weight loss, malnutrition and fatigue. These symptoms can have substantial psychosocial implications and cause sufferers to limit their lifestyles.

Emotional stress may influence the course of inflammatory bowel disease, as body and mind are so closely related. Although people before the exacerbation of disease sometimes had emotional problems, it does not mean that emotional stress causes IBD. It is possible that emotional stress and anxiety, that the patients sometimes feel, is a reaction to the disease symptoms. It is not surprising, as people believe that it is difficult to cope with chronic diseases. Such diseases decrease quality of life, reduce physical and emotional well-being, social functioning and a sense of self-esteem [9, P.11].

Inflammatory bowel disease patients could be depressed, nervous, anxious and suffer from other organs functional disorders. They visit the doctor more frequently and the prevalence of panic disorder, depression, anxiety, post-traumatic stress disorder and somatization among this group of patient is higher than in population. These disorders often occur before or at the same time with inflammatory bowel disease, clearly indicating that the psycho-emotional interference cannot be measured simply in response to the disease [7, P.106–111].

Nevertheless, inflammatory bowel disease is a serious chronic disease, it does not belong to fatal diseases. Most people, even if they periodically are hospitalized or need to use medication, could continue to be socially active and lead a productive life. During the remission many patients feel good. However, each patient needs to receive appropriate treatment, which depends on the patient and the doctor [2, P.136-138; 4, P.661 – 679].

The aim of this study was to define the quality of life and anxiety for patients with IBD as well as to distinguish the quality of life and anxiety of Crohn’s disease and Ulcerative colitis, who receive treatment in hospital or in outpatient department.

Methods.

The result was gathered by a quantitative method. The study was conducted in gastroenterological departments and in outpatient department in Latvia.

Participants were recruited from patients hospitalized due to relapse of their existing IBD and from outpatient department, when the patients come to visit theirs doctors in a regular way. The recruitment took place in the gastroenterology, hepatology and nutrition treatment center and in the outpatient department of Paul Stradins Clinical University hospital in Riga, in 2015.

We screened adult patients aged between 18 and 40 years who have IBD, Crohn’s disease or Ulcerative colitis diagnosis over one year.

Eligible patients were informed about the study aim and the procedures and those, who agreed to participate and signed informed consent, were enrolled into the study. The study was conducted according to the Declaration of Helsinki and was approved by the Ethics Committee of Riga Stradins University with the protocol number 93/29.01.2015.

During the screening periods the researcher fill in the protocol of analysis of medical documentation and after screening the patients completed three questionnaires: Inflammatory Bowel Disease Questionnaire (IBDQ), State-Trait Anxiety Inventory (STAI) self-evaluation questionnaire, Demographic Survey questionnaire.

The data from hospital medical history and outpatient medical records about sex, age, living place, diagnosis, received treatment and duration of the disease was fixed in the protocol of analysis of medical documentation.

We used the IBDQ to assess the quality of life. This disease-specific questionnaire comprises 32 questions divided into four health subscales: bowel symptoms (10 questions); systemic symptoms, including sleep disorders and fatigue (5 questions); emotional function such as depression, aggression and irritation (12 questions); and social function, meaning the ability to participate in social activities and to work (5 questions). The participant was invited to choose one of seven graded responses. Consequently, the total score ranges from 32 to 224 points, with lower scores reflecting worse quality of life.

The STAI form consists of two 20-items questionnaires. The first questionnaire measures state anxiety, i.e. how the respondent “feels right now” meaning the time of completion. The second questionnaire measures trait anxiety, i.e. how the respondent generally feels. For each questionnaire, the scores range is 20–80. The cut-point for clinically significant anxiety is 39–40, scores > 54 are considered indicative of a mental disorder [6, P.629–634]. STAI measures anxiety at both poles of the normal affect curve (state vs. trait). State anxiety (A-State) can be defined as fear, nervousness, discomfort, and the arousal of the autonomic nervous system induced temporarily by situations perceived as dangerous (i.e., how a person is feeling at the time of a perceived threat). Trait anxiety (A-Trait) can be defined as a relatively enduring disposition to feel stress, worry, and discomfort [11, P. 292-321]. The IBDQ and the STAI have been double translated into Latvian language.

The Demographic Survey questionnaire, filled by patients, consists of the questions about education, occupational status, duration of the IBD, frequency of the exacerbation of IBD and amount of hospitalizations due to IBD.

Data analyses were performed using IBM SPSS Statistics 21 for Windows. P values lower than 0.005 were considered statistically significant. Results are reported as percentages, median and range. Descriptive statistics were used for demographic and clinical characteristics. Based on the psychometric scale cut-offs, we distinguished between three levels of anxiety: low, moderate and high in subscale groups: trait anxiety and state anxiety. Pearson chi-square was used for the comparison of anxiety levels in patients with Crohn’s disease and ulcerative colitis, as well as the anxiety levels for females and males, outpatients and inpatients. Wilcoxon W test and Mann–Whitney test was used for comparisons of means in the scales used, between the group of outpatient and inpatients.

Result. 82 patients participated in the research: 45% of male, 55% of female; 50% of patients with Crohn’s disease and 50% with ulcerative colitis; 70% of inpatients and 30% of outpatients. The mean age was 26,25 years (SD=5.91). The mean duration of illness was 4.39 years (SD=2.37).

Using the Inflammatory Bowel Disease Questionnaire (IBDQ) for evaluating the quality of life we received the following results, the middle score of IBDQ was 125.17 points (N = 82, SD = 23.72). This score corresponds to the middle level of the quality of life. The minimum score was 71, which corresponds to poor quality of life, and the maximum score was 177 points, which corresponds to good quality of life. Not one of the respondents did not gain more than 200 points, which shows that not one of the Inflammatory bowel disease patients do not assess their quality of life to excellent.

We compare the quality of life of Latvian IBD respondents with the similar data from other studies in other countries. The research data show that the average quality of life score of IBD patients in Latvia was 125 points, while in Portugal this score was 159.5 points, in Greece — 186 points, in China — 156 points [3, P.10-20; 5, P.243–248; 8, P.192-197]. Comparing these data, it demonstrates that the Latvian patients with inflammatory bowel disease had a lower level of quality of life than in other countries.

IBDQ consists of 4 subscales: bowel symptoms subscale, systemic symptoms subscale, emotional function subscale and social function subscale.

The standard maximum possible score in bowel symptom subscale is 70, the study data suggest the respondents have a mean score 37.9 points (SD = 11.51) in this subscale group (see Table 1). The standard maximum possible score in social function subscale is 35, but participated patients receive 18.25 points (SD = 4.58) and 22.74 (SD = 4.56) points according to a social symptom score. This suggests a low quality of life in these areas, the social function scale results are higher, suggesting that the respondents are active both at work and leisure. Emotional scale average 43.42 points (SD = 9.66), the standard maximum possible score is 84 points. These data show that the respondents have quite a low level of assessing their emotional state that may be associated with frequent mood swings, fear for their health, uncertainty about future treatment and life.

Table 1.

The rates of quality of life of respondents with inflammatory bowel disease using inflammatory bowel disease questionnaire (n=82)

IBDQ subscales	Standard subscales maximum score	Mean total (range)	Standard deviation
Bowel symptoms	70	37.92 (17-59)	11.51
Systemic symptoms	35	18.25 (8-28)	4.57
Emotional function	84	43.42 (25-65)	9.65
Social function	35	22.74 (14-32)	4.56

Abbreviations: IBDQ — inflammatory bowel disease questionnaire

No statistically significant difference was found in total and dimensional IBDQ scores between patients with Crohn’s disease and Ulcerative colitis (P>0.005).

There was a significant difference of life of quality regarding sex, i.e. the female rate is to 119.6 points (min. 71 – max.153), whilst the male one is even up to 130.8 points (min. 85-max. 177) (total score, P=0.002).

However, a significant correlation on the quality of life was found in groups depending where patients receive treatment: outpatients or inpatients. The quality of life was higher for outpatients in total and for all the subscales of IBDQ except bowel symptoms (total score, P=0.000; bowel symptoms, P=0.178; systemic symptoms, P=0.000; emotional function, P=0.000 and social function, P=0.000).

Using the State-Trait Anxiety Inventory we found, the respondents had a moderate level of State anxiety (mean 40.78 points, min. 31-max.48, SD=5.1) and a moderate level of Trait anxiety (mean 40.83 point, min.29-max.51, SD=6.28).

Table 2.

The anxiety level of patients with inflammatory bowel disease depending of sex, treatment place and disease name using the State-Trait Anxiety Inventory (%)

State anxiety subscale
Level of anxiety	Total N=82	Disease name		Sex		Treatment place
		Crohn’s disease N=41	Ulcerative colitis N=41	Female N=37	Male N=35	Out-patients N=25	In-patients N=47
Low	20.7	14.6	26.8	13.5	26.7	60.0	3.5
Moderate	53.7	65.9	41.5	45.9	60.0	36.0	61.4
High	25.6	19.5	31.7	40.5	13.3	4.0	35.1
Pearson chi-square		0.085		0.011		0.000
Trait anxiety subscale
Low	26.8	31.7	22.0	5.4	44.4	52.0	15.8
Moderate	52.4	61.0	43.9	56.8	48.9	36.0	59.6
High	20.7	7.3	34.1	37.8	6.7	12.0	24.6
Pearson chi-square		0.11		0.000		0.003

 There are no differences of anxiety rates (p=0.085) between Crohn’s disease and Ulcerative colitis (see Table 2).

The higher level of State anxiety was found in women 40.5% than in men 13.3% (p=0.011). A low level of State anxiety was for outpatients in 60% and for inpatients in 3.5% of cases (p=0.000).       The moderate State anxiety level for inpatients was 61.4% and 36% of cases for outpatients. A low level of Trait anxiety was for outpatients in 52% and for inpatients in 15.8% of cases (p=0.003).

Conclusion. Anxiety level is higher for women than for men and the quality of life is lower for women with Inflammatory bowel disease. The inpatients with inflammatory bowel disease have a higher level of anxiety and a lower level of quality of life than outpatients.

References.

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11. Spielberger, C.D., Sydeman, S.J. The use of psychological testing for treatment planning and outcome assessment. NJ: Lawrence Erlbaum Associates, 1994. — 292-321 pp.[schema type=»book» name=»ANXIETY AND QUALITY OF LIFE IN INFLAMMATORY BOWEL DISEASE PATIENTS» description=»Background. Health of a person is defined as a physical, mental and social well-being. Chronic diseases threaten people’s quality of life, decrease physical and emotional health, functional activity in society and self-esteem. One of such diseases is inflammatory bowel diseases (IBD). The aim of this study was to define a quality of life and anxiety for patients with IBD who receive treatment in hospital or in outpatient department. Methods. We screened adult patients aged between 18 and 40 years, who have had IBD diagnosis over one year. We used the protocol of analysis of medical documentation, Inflammatory Bowel Disease Questionnaire, State-Trait Anxiety Inventory (STAI) self-evaluation questionnaire, Demographic Survey questionnaire. Result. 82 patients participated in the research. The mean age was 26,25 years (SD=5.91). The quality of life of patients with IBD had middle rates. Patients with IBD have moderate level of trait and state anxiety. There are no differences of anxiety rates (p=0.085) and quality of life (p>0.05) between Crohn’s disease and Ulcerative colitis. The level of state anxiety was higher in women 40.5% than in men 13.3% (p=0.011). Low level of trait anxiety was for outpatients in 52% and for inpatients in 15.8% of cases (p=0.003). The quality of life was higher for outpatients than for inpatients (p=0.000). Conclusion. Anxiety level is higher for women than for men and quality of life is lower for women with Inflammatory bowel disease. The inpatients with IBD have higher level of anxiety and lower level of quality of life than outpatients with IBD.» author=»Renemane Lubova, Vika Pilusenko, Biruta Kupca» publisher=»БАСАРАНОВИЧ ЕКАТЕРИНА» pubdate=»2016-12-28″ edition=»euroasia-science.ru_26-27.02.2016_2(23)» ebook=»yes» ]