title: Effects of social support on the clinical course of Crohn's disease.
abstract: BACKGROUND
  Social support has been found to be protective from adverse health effects of psychological stress. We hypothesized that higher social support would predict a more favorable course of Crohn's disease (CD) directly (main effect hypothesis) and via moderating other prognostic factors (buffer hypothesis).
  
  
  METHODS
  Within a multicenter cohort study we observed 597 adults with CD for 18 months. We assessed social support using the ENRICHD Social Support Inventory. Flares, nonresponse to therapy, complications, and extraintestinal manifestations were recorded as a combined endpoint indicating disease deterioration. We controlled for several demographic, psychosocial, and clinical variables of potential prognostic importance. We used multivariate binary logistic regression to estimate the overall effect of social support on the odds of disease deterioration and to explore main and moderator effects of social support by probing interactions with other predictors.
  
  
  RESULTS
  The odds of disease deterioration decreased by 1.5 times (95% confidence interval [CI]: 1.2-1.9) for an increase of one standard deviation (SD) of social support. In case of low body mass index (BMI) (i.e., 1 SD below the mean or <19 kg/m(2) ), the odds decreased by 1.8 times for an increase of 1 SD of social support. In case of low social support, the odds increased by 2.1 times for a decrease of 1 SD of BMI. Low BMI was not predictive under high social support.
  
  
  CONCLUSIONS
  The findings suggest that elevated social support may favorably affect the clinical course of CD, particularly in patients with low BMI.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland. roland.vonkaenel@insel.ch
authors.forename: Rafael J A
authors.initials: RJ
authors.lastname: Cámara
authors.forename: Paul S
authors.initials: PS
authors.lastname: Lukas
authors.forename: Stefan
authors.initials: S
authors.lastname: Begré
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D012944:Social Support; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome