title: Psychological treatment may reduce the need for healthcare in patients with Crohn's disease.
abstract: BACKGROUND
  Few published studies examine the influence of psychological treatment on health care utilization in Crohn's disease.
  
  
  METHODS
  The present substudy of a prospective, randomized, multicenter trial conducted in 69 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the way in which healthcare utilization is influenced by psychotherapy and relaxation in addition to standardized glucocorticoid therapy. Before and after a 1-year period of standardized somatic treatment the psychotherapy and control groups were compared with regard to hospital and sick-leave days. Predictors of healthcare utilization were analyzed.
  
  
  RESULTS
  The comparison between groups before and after psychological treatment showed a significantly higher decrease of mean hospital days (P < 0.03) and sick-leave days in the treatment group compared with the controls. When a covariate analysis was applied to compare the data at randomization, the difference in hospital days remained statistically a trend (P < 0.1). Multivariate regression analysis detected a significant gender and depression effect for hospital days (cor r(2) = 0.114) and a significant gender and age effect for sick-leave days (cor r(2) = 0.112).
  
  
  CONCLUSIONS
  A significant drop in healthcare utilization after psychological treatment demonstrates a clear benefit of this additional therapy. This is important, since the study failed to demonstrate significant changes in the psychosocial status or somatic course of study patients. Clinical and psychological factors influencing these outcomes are discussed.
authors.affiliation: Department of Psychosomatics and Psychotherapy, Charité Campus Benjamin Franklin, Berlin, Germany. deter@charite.de
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Deter
authors.forename: Wolfram
authors.initials: W
authors.lastname: Keller
authors.forename: Jörn
authors.initials: J
authors.lastname: von Wietersheim
authors.forename: Günther
authors.initials: G
authors.lastname: Jantschek
authors.forename: Rainer
authors.initials: R
authors.lastname: Duchmann
authors.forename: Martin
authors.initials: M
authors.lastname: Zeitz
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids