title: Psychosocial functioning and health-related quality of life in paediatric inflammatory bowel disease.
abstract: OBJECTIVE
  The present systematic review examined the literature focusing on psychosocial functioning and health-related quality of life (HRQOL) in young people with inflammatory bowel disease (IBD). It aimed to critique the methodological quality of the identified studies, discuss the implications of their findings, and make recommendations for future research.
  
  
  METHODS
  Relevant articles (January 1990-December 2009) were subject to strict inclusion and exclusion criteria. Identified papers were rated for methodological quality using SIGN 50 and Critical Appraisal Skills Programme guidelines before data extraction.
  
  
  RESULTS
  Of 2141 articles initially identified, 278 were screened in detail, leaving 12 articles for inclusion in the review: 3 having "acceptable" and 9 having "good" quality rating scores. These 12 studies yielded a combined total of 5330 participants including 790 with IBD and 4540 controls (ages 4-18 years). Five main outcomes--self--esteem, HRQOL, anxiety and depression, social competence, and behavioural functioning-were examined. Three of the 4 controlled studies addressing self-reported HRQOL found it to be significantly lower in the participants with IBD. The evidence for lowered self-esteem, self-reported symptoms of depression and anxiety, impaired social competence, and behavioural problems were conflicting. Methodological heterogeneity was noted in terms of areas of functioning addressed, measures used, sample size, and use of control groups.
  
  
  CONCLUSIONS
  HRQOL is lower in patients with IBD, but conflicting results and methodological flaws limit conclusions on other aspects of psychosocial functioning. Future research should present data on effect sizes, avoid confounding findings by not combining across age groups or disease severity indices, and consider investigating body image disturbance.
authors.affiliation: Academic Unit for Mental Health and Wellbeing, School of Medicine, University of Glasgow, Glasgow, UK.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Ross
authors.forename: Julie
authors.initials: J
authors.lastname: Strachan
authors.forename: Richard K
authors.initials: RK
authors.lastname: Russell
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003866:Depressive Disorder / Q000523:psychology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000473:pathology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D012919:Social Behavior