Longitudinal study of quality of life and psychological functioning for active, fluctuating, and inactive disease patterns in inflammatory bowel disease.
BACKGROUND
The aim was to assess quality of life (QOL) and psychological functioning in inflammatory bowel disease (IBD) as related to patterns of disease activity over time.


METHODS
Study participants were 388 recently diagnosed individuals from the population-based Manitoba IBD Cohort Study. They completed mail-out surveys at 6-month intervals and clinical interviews annually. Based on their 2-year pattern of self-reported disease activity, participants were assigned to 1 of 3 groups: consistently active, fluctuating, or consistently inactive disease. Disease type (Crohn's disease [CD] or ulcerative colitis [UC]) was confirmed through chart review. Change over time was modeled for measures of QOL and positive and negative psychological functioning using mixed-effects regression analyses.


RESULTS
Half of the participants had fluctuating disease activity, while almost one-third of participants reported consistent active disease. Participants with the fluctuating activity pattern showed significant improvement in disease-specific QOL compared to participants with consistent activity. Perceived stress, health anxiety, and pain anxiety decreased while pain catastrophizing and mastery increased over time, although the amount of change was not significantly different among disease activity patterns. However, when the data were averaged over time there were significant differences among disease activity patterns on most outcomes. Significant effects of CD versus UC were observed only for the pain measures.


CONCLUSIONS
Change in IBD QOL is influenced by one's longitudinal profile of disease activity, but change in psychological functioning is not. Effects of disease activity on psychological functioning were modest, suggesting that disease has an impact even when patients are not experiencing active symptoms.
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
Lisa M
LM
Lix
Lesley A
LA
Graff
John R
JR
Walker
Ian
I
Clara
Patricia
P
Rawsthorne
Linda
L
Rogala
Norine
N
Miller
Jason
J
Ediger
Thea
T
Pretorius
Charles N
CN
Bernstein
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000523:psychology; D003424:Crohn Disease / Q000503:physiopathology / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000503:physiopathology* / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D012044:Regression Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018434:Sickness Impact Profile; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult