title: The causal representation of outpatients with Crohn's disease: is there a link between psychological distress and clinical disease activity?
abstract: OBJECTIVE
  Because of the fluctuating and occasional character of Crohn's disease (CD), patients have to cope with a changeable condition of health. Personal perceived control is known to be an important element of adaptation to their medical condition. The objectives of this work are to determine if perceived personal control is predictive of the clinical activity of the disease and of psychological distress (depression, anxiety).
  
  
  METHODS
  The Hospital Anxiety Depression Scale (HADS), the causal dimension scale and the Clinical Global Impression (CGI; assessing perceived severity) were administered to 160 patients affected by Crohn's disease. Indicators of inflammation (CRP), disease duration and clinical activity of the disease were also asessed.
  
  
  RESULTS
  Globally, CD patients perceive their disease as being personally neither controllable nor uncontrollable. Whereas psychological distress is significantly higher when the disease is active, the relationship between the variables appears complex. The feeling of personal control is explained by the clinical activity of the disease (p=.0001) and by the perception that CD is unstable (p<.00001) and globally impacts the life of patients (p=.001). Nevertheless perception of personal control does not explain the clinical activity of the disease. Finally, psychological distress is explained by the perception that the medical team is unable to control the disease (p=.00001) and by the global consequences of the disease on life (p<.005).
  
  
  CONCLUSIONS
  Psychological treatments should take these dimensions into account so as to improve the well-being and medical conditions of patients.
authors.affiliation: Laboratoire IPSé (EA 4432), Paris Ouest-Nanterre-La Défense, Université de Bourgogne, Pôle AAFE, Dijon, France.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Banovic
authors.affiliation: Interpsy (EA 4432), Université de Lorraine, Nancy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gilibert
authors.affiliation: Laboratoire IPSé (EA 4432), Paris Ouest-Nanterre-La Défense, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Andronikof
authors.affiliation: Institut Mathématiques de Bourgogne (IMB), UMR du CNRS, Université de Bourgogne, Dijon, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Jebrane
authors.affiliation: SPMS (EA 4180), Université de Bourgogne, Pôle AAFE, Dijon, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Ajdukovic
authors.affiliation: Service de Gastroentérologie et Nutrition, CHU Saint-Antoine, Université Pierre et Marie Curie, Paris VI, France.
authors.forename: Jaques
authors.initials: J
authors.lastname: Cosnes
keywords: IBD; anxiety; causal attributions; depression; disease activity; perceived severity