title: Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability.
abstract: To examine the relative contributions of disease activity and psychological factors to self-reported symptoms and disability in children with Crohn's disease.
  
  
  
  Participants (n = 127 children age 8-18 years) completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs and coping. Disease activity was measured by the Pediatric Crohn's Disease Activity Index. Structural equation modeling was used to test the effects of disease activity and psychological factors on symptoms and disability.
  
  
  
  In the hypothesized model predicting symptoms, psychological factors (β = 0.58; P < .001) were significantly associated with disease symptoms but disease activity was not. The model for disability yielded significant associations for both psychological factors (β = 0.75; P < .001) and disease activity (β = 0.61, P < .05).
  
  
  
  Crohn's disease symptoms in children and adolescents are not only driven by disease activity. Coping, anxiety, depression, and cognition of illness are important in the patient-reporting of symptom severity and disability. Physicians need to be aware that symptom self-reporting can be driven by psychological factors and may not always be simply an indicator of disease activity.
  
  
  
  ClinicalTrials.gov: NCT00679003.
authors.affiliation: Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC; Campbell University, College of Pharmacy and Health Sciences, Buies Creek, NC. Electronic address: tilburg@med.unc.edu.
authors.forename: Miranda A L
authors.initials: MAL
authors.lastname: van Tilburg
authors.affiliation: Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC.
authors.forename: Robyn Lewis
authors.initials: RL
authors.lastname: Claar
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Romano
authors.affiliation: School of Social Work, University of Washington, Seattle, WA.
authors.forename: Shelby L
authors.initials: SL
authors.lastname: Langer
authors.affiliation: Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Drossman
authors.affiliation: Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, NC.
authors.forename: William E
authors.initials: WE
authors.lastname: Whitehead
authors.affiliation: Prime Health Clinic, Puyallup, WA.
authors.forename: Bisher
authors.initials: B
authors.lastname: Abdullah
authors.affiliation: School of Social Work, University of Washington, Seattle, WA.
authors.forename: Rona L
authors.initials: RL
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D002658:Developmental Disabilities; D059026:Diagnostic Self Evaluation; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D063189:Symptom Assessment
keywords: Crohn's disease; anxiety; catastrophizing; coping; depression; disease activity