Advertisement

Different Associations of Health Related Quality of Life with Pain, Psychological Distress and Coping Strategies in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disorder

  • Gabriella SeresEmail author
  • Zoltán Kovács
  • Ágota Kovács
  • Olga Kerékgyártó
  • Krisztina Sárdi
  • Pál Demeter
  • Eszter Mészáros
  • Ferenc Túry
Article

Abstract

The primary aim of this study was to measure psychological distress, pain severity, health related quality of life (QOL) and pain coping strategies in patients with irritable bowel syndrome (IBS) and ulcerative colitis (UC). A second aim was to determine the influence of somatic and psychological variables on health related QOL. Eighty-eight IBS and 66 UC patients completed the Irritable Bowel Syndrome Quality of Life Questionnaire (IBSQOL), Pain Severity Scale of West Haven Yale Multidimensional Pain Inventory (WHYMPY), Symptom Checklist-90-R (SCL-90-R) and Coping Strategies Questionnaire (CSQ). T-tests and GLM Analysis of Covariance were used for statistical analysis. IBS patients had significantly higher levels of psychological distress, pain severity and maladaptive pain coping strategies (catastrophization), and lower QOL than UC patients. Variance of QOL in IBS was explained for the most part by catastrophization (15%), then by psychological distress (8%), and for the less part by pain severity (5%). In UC, pain severity explained 21%, psychological distress 8%, and catastrophization 3% of the variance of QOL. These results suggest there are differences between IBS and UC patients in the role of physical and psychological factors in QOL and emphasize the importance of cognitive processes in IBS.

Keywords

Irritable bowel syndrome Ulcerative colitis Quality of life Psychological distress Catastrophization Pain severity 

References

  1. Akehurst, R. L., Brazier, J. E., Mathers, N., O’Keefe, C., Kaltenthaler, E., Morgan, A., et al. (2002). Health-related quality of life and cost impact of irritable bowel syndrome in a UK primary care setting. PharmacoEconomics, 20, 455–462. doi: 10.2165/00019053-200220070-00003.PubMedCrossRefGoogle Scholar
  2. Alexander, F. (1950). Psychosomatic medicine. New York: Norton.Google Scholar
  3. Bernklev, T., Jahnsen, J., Lygren, I., Henriksen, M., Vatn, M., & Moum, B. (2005). Health-related quality of life in patients with inflammatory bowel diseases measured with the Short Form-36: Psychometric assessments and a comparison with general population norms. Inflammatory Bowel Diseases, 11, 909–918. doi: 10.1097/01.mib.0000179467.01748.99.PubMedCrossRefGoogle Scholar
  4. Blanchard, E. B. (2001). Irritable bowel syndrome. Psychosocial assessment and treatment (pp. 101–113). Washington: American Psychological Association.CrossRefGoogle Scholar
  5. Camilleri, M. (2001). Management of the irritable bowel syndrome. Gastroenterology, 120, 652–668. doi: 10.1053/gast.2001.21908.PubMedCrossRefGoogle Scholar
  6. Casellas, F., Arenas, J. I., Baudet, J. S., Fabregas, S., Garcia, N., Gelabert, J., et al. (2005). Impairment of health-related quality of life in patients with inflammatory bowel disease: A Spanish multicenter study. Inflammatory Bowel Diseases, 11, 488–496. doi: 10.1097/01.MIB.0000159661.55028.56.PubMedCrossRefGoogle Scholar
  7. Casellas, F., Lopez-Vivancos, J., & Malagelada, J. R. (2002). Factors affecting health related quality of life of patients with inflammatory bowel disease. Quality of Life Research, 11, 775–781. doi: 10.1023/A:1020841601110.PubMedCrossRefGoogle Scholar
  8. Crane, C., & Martin, M. (2002). Perceived vulnerability to illness in individuals with irritable bowel syndrome. Journal of Psychosomatic Research, 53, 1115–1122. doi: 10.1016/S0022-3999(02)00351-3.PubMedCrossRefGoogle Scholar
  9. Crane, C., & Martin, M. (2004). Social learning, affective state and passive coping in irritable bowel syndrome and inflammatory bowel disease. General Hospital Psychiatry, 26, 50–58. doi: 10.1016/j.genhosppsych.2003.07.005.PubMedCrossRefGoogle Scholar
  10. Cser, T., & Túry, F. (2001). Irritábilis bél szindróma életminőség kérdőív. In L. Újszászy, M. Udvardy, & P. Kupcsulik (Eds.), Életminőség és vizsgálata a gasztroenterológiában (Hungarian—Quality of life and measurements in gastroenterology) (pp. 227–258). Budapest: Mediszter.Google Scholar
  11. Dancey, C. P., Taghavi, M., & Fox, R. J. (1998). The relationship between daily stress and symptoms of irritable bowel: A time-series approach. Journal of Psychosomatic Research, 44, 537–545. doi: 10.1016/S0022-3999(97)00255-9.PubMedCrossRefGoogle Scholar
  12. Derogatis, L. R. (1977). SCL-90-R, administration, scoring and procedures manual for the revised version. Baltimore: John Hopkins University, School of Medicine.Google Scholar
  13. Drossman, D. A. (1994a). The functional gastrointestinal disorders: Diagnosis, pathophysiology, and treatment (pp. 12–13). Boston: Little, Brown and Company.Google Scholar
  14. Drossman, D. A. (1994b). Irritable bowel syndrome: The role of psychosocial factors. Stress Medicine, 10, 49–55. doi: 10.1002/smi.2460100109.CrossRefGoogle Scholar
  15. Drossman, D. A. (1996). Gastrointestinal illness and the biopsychosocial model. Journal of Clinical Gastroenterology, 22, 252–254. doi: 10.1097/00004836-199606000-00002.PubMedCrossRefGoogle Scholar
  16. Drossman, D. A. (1999). Do psychosocial factors define symptom severity and patient status in irritable bowel syndrome? The American Journal of Medicine, 107, 42–50. doi: 10.1016/S0002-9343(99)00081-9.CrossRefGoogle Scholar
  17. Drossman, D. A., Creed, F. H., & Olden, K. W. (1999). Psychosocial aspects of the functional gastrointestinal disorders. Gut, 45, 25–30.Google Scholar
  18. Drossman, D. A., Leserman, J., & Zhiming, L. (2000). Effects of coping on health outcome among women with gastrointestinal disorders. Psychosomatic Medicine, 62, 309–317.PubMedGoogle Scholar
  19. Drossman, D. A., Thompson, W. G., Talley, N. J., Funch-Jensen, P., Janssens, J., & Whitehead, W. E. (1990). Identification of sub-groups of functional gastrointestinal disorders. Gastroenterology International, 3, 159–172.Google Scholar
  20. Drossman, D. A., Whitehead, W. E., & Camilleri, M. (1997). Irritable bowel syndrome: A technical review for practice guideline development. Gastroenterology, 112, 2120–2137. doi: 10.1053/gast.1997.v112.agast972120.PubMedCrossRefGoogle Scholar
  21. Fowlie, S., Eastwood, M. A., & Ford, M. J. (1992). Irritable bowel syndrome: The influence of psychological factors on the symptom complex. Journal of Psychosomatic Research, 36, 169–173. doi: 10.1016/0022-3999(92)90025-W.PubMedCrossRefGoogle Scholar
  22. Gomborone, J., Dewsnap, P., Libby, G., & Farthing, M. (1995). Abnormal illness attitudes in patients with irritable bowel syndrome. Journal of Psychosomatic Research, 39, 227–230. doi: 10.1016/0022-3999(94)00126-P.PubMedCrossRefGoogle Scholar
  23. Guthrie, E., Jackson, J., Shaffer, J., Thompson, D., Tomenson, B., & Creed, F. (2002). Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn’s disease. The American Journal of Gastroenterology, 97, 1994–1999. doi: 10.1111/j.1572-0241.2002.05842.x.PubMedCrossRefGoogle Scholar
  24. Hahn, B., Kirchdoerfer, L. J., Fullerton, S., & Mayer, E. (1997). Evaluation of a new quality of life questionnaire for patients with irritable bowel syndrome. Alimentary Pharmacology and Therapeutics, 11, 547–552. doi: 10.1046/j.1365-2036.1997.00168.x.PubMedCrossRefGoogle Scholar
  25. Han, S. W., McCall, E., Barton, J. R., James, P., Steen, I. N., & Welfare, M. R. (2005). Predictors of quality of life in ulcerative colitis: The importance of symptoms and illness representations. Inflammatory Bowel Diseases, 11, 24–34. doi: 10.1097/00054725-200501000-00004.PubMedCrossRefGoogle Scholar
  26. Hauser, W. (2004). Anxiety and depression in ulcerative colitis and ileal pouch anal anastomosis. Journal of Psychosomatic Research, 56, 640–641. doi: 10.1016/j.jpsychores.2004.04.256.CrossRefGoogle Scholar
  27. Haythornthwaite, J. A., Menefee, L. A., Heinberg, L. J., & Clark, M. R. (1998). Pain coping strategies predict perceived control over pain. Pain, 77, 33–39. doi: 10.1016/S0304-3959(98)00078-5.PubMedCrossRefGoogle Scholar
  28. Irwin, C., Falsetti, S. A., Lydiard, R. B., Ballenger, J. C., Brock, C. D., & Brener, W. (1996). Comorbidity of posttraumatic stress disorder and irritable bowel syndrome. The Journal of Clinical Psychiatry, 57, 576–578.PubMedGoogle Scholar
  29. Jensen, M. P., & Karoly, P. (1991). Control beliefs, coping efforts, and adjustment to chronic pain. Consulting Clinical Psychology, 59, 431–438. doi: 10.1037/0022-006X.59.3.431.CrossRefGoogle Scholar
  30. Jones, M. P., Wessinger, S., & Crowell, M. D. (2006). Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease. Clinical Gastroenterology and Hepatology, 4, 474–481. doi: 10.1016/j.cgh.2005.12.012.PubMedCrossRefGoogle Scholar
  31. Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The West Haven Yale Multidimensional Pain Inventory (WHYMPI). Pain, 20, 345–356. doi: 10.1016/0304-3959(85)90004-1.CrossRefGoogle Scholar
  32. Koloski, N. A., Talley, N. J., & Boyce, P. M. (2001). Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: A critical review of the literature on symptom and psychosocial factors. The American Journal of Gastroenterology, 96, 1340–1349. doi: 10.1111/j.1572-0241.2001.03789.x.PubMedCrossRefGoogle Scholar
  33. Lackner, J. M., Gellman, R., Gudleski, G., Sanders, K., Krasner, S., Katz, L., et al. (2005). Dysfunctional attitudes, gender, and psychopathology as predictors of pain affect in patients with irritable bowel syndrome. Journal of Cognitive Psychotherapy, 19, 151–161. doi: 10.1891/jcop.19.2.151.66790.CrossRefGoogle Scholar
  34. Lackner, J. M., Quigley, B. M., & Blanchard, E. B. (2004). Depression and abdominal pain in IBS patients: The mediating role of catastrophising. Psychosomatic Medicine, 66, 435–441. doi: 10.1097/01.psy.0000126195.82317.46.PubMedCrossRefGoogle Scholar
  35. Lakner, J. M., & Quigley, B. M. (2005). Pain catastrophising mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Behaviour Research and Therapy, 43, 943–957. doi: 10.1016/j.brat.2004.06.018.CrossRefGoogle Scholar
  36. Lea, R., & Whorwell, P. J. (2001). Quality of life in irritable bowel syndrome. PharmacoEconomics, 19, 643–653. doi: 10.2165/00019053-200119060-00003.PubMedCrossRefGoogle Scholar
  37. Levenstein, S. (2004). Embracing complexity: What determines quality of life in inflammatory bowel disease. European Journal of Gastroenterology and Hepatology, 16, 1273–1280. doi: 10.1097/00042737-200412000-00002.CrossRefGoogle Scholar
  38. Levy, R. L., Cain, K. C., Jarrett, M., & Heitkemper, M. M. (1997). The relationship between daily life stress and gastrointestinal symptoms in women with irritable bowel syndrome. Journal of Behavioral Medicine, 20, 177–193. doi: 10.1023/A:1025582728271.PubMedCrossRefGoogle Scholar
  39. Levy, R. L., Olden, K. W., Naliboff, B. D., Bradley, L. A., Francisconi, C., Drossman, D. A., et al. (2006). Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology, 130, 1447–1458. doi: 10.1053/j.gastro.2005.11.057.PubMedCrossRefGoogle Scholar
  40. Lydiard, R. B. (2001). Irritable bowel syndrome, anxiety and depression: What are the links? The Journal of Clinical Psychiatry, 62, 38–45.PubMedGoogle Scholar
  41. Magni, G., Bernasconi, G., Mauro, P., D’Odorico, A., Sturniolo, G. C., Canton, G., et al. (1991). Psychiatric diagnosis in ulcerative colitis. A controlled study. British Journal of Psychiatry: Journal of Mental Sciences, 158, 413–415.CrossRefGoogle Scholar
  42. Masand, P. S., Kaplan, D. S., Gupta, S., & Bhandary, A. N. (1997). Irritable bowel syndrome and dysthymia: Is there a relationship? Psychosomatics, 38, 63–69.PubMedGoogle Scholar
  43. Minderhoud, I. M., Oldenburg, B., Wismeijer, A., Henegouwen, B., & Smout, A. (2004). IBS-like symptoms in patients with inflammatory bowel disease in remission; relationships with quality of life and coping behavior. Digestive Diseases and Sciences, 49, 469–474. doi: 10.1023/B:DDAS.0000020506.84248.f9.PubMedCrossRefGoogle Scholar
  44. Mitchell, A., Guyatt, G., Singer, J., Irvine, E. J., Goodacre, R., Tompkins, C., et al. (1988). Quality of life in patients with inflammatory bowel disease. Journal of Clinical Gastroenterology, 10, 306–310. doi: 10.1097/00004836-198806000-00014.PubMedCrossRefGoogle Scholar
  45. Pallis, A. G., Vlachonikolis, I. G., & Mouzas, I. A. (2002). Assessing health-related quality of life in patients with inflammatory bowel disease, in Crete, Greece. BMC Gastroenterology, 2. doi: 10.1186/1471-230X-2-1.
  46. Petrak, F., Hardt, J., Clement, T., Borner, N., Egle, U. T., & Hoffmann, S. O. (2001). Impaired health-related quality of life in inflammatory bowel diseases: Psychosocial impact and coping styles in a national German sample. Scandinavian Gastroenterology, 36, 375–382.CrossRefGoogle Scholar
  47. Pinto, C., Lele, M. V., Joglekar, A. S., Panwar, V. S., & Dhavale, H. S. (2000). Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome. The Journal of the Association of Physicians of India, 48, 589–593.PubMedGoogle Scholar
  48. Pizzi, L. T., Weston, C. M., Goldfarb, N. I., Moretti, D., Cobb, N., Howell, J. B., et al. (2006). Impact of chronic condition on quality of life in patients with inflammatory bowel disease. Inflammatory Bowel Diseases, 12, 47–52. doi: 10.1097/01.MIB.0000191670.04605.e7.PubMedCrossRefGoogle Scholar
  49. Porcelli, P., Leoci, C., & Guerra, V. (1996a). A prospective study of the relationship between disease activity and psychologic distress in patients with inflammatory bowel disease. Scandinavian Journal of Gastroenterology, 31, 792–796. doi: 10.3109/00365529609010354.PubMedCrossRefGoogle Scholar
  50. Porcelli, P., Leoci, C., Guerra, V., Taylor, G. J., & Bagby, R. M. (1996b). A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease. Journal of Psychosomatic Research, 41, 569–573. doi: 10.1016/S0022-3999(96)00221-8.PubMedCrossRefGoogle Scholar
  51. Ringel, Y., Sperber, A. D., & Drossman, D. A. (2001). Irritable bowel syndrome. Annual Review of Medicine, 52, 319–338. doi: 10.1146/annurev.med.52.1.319.PubMedCrossRefGoogle Scholar
  52. Rosenstiel, A. K., & Keefe, J. F. (1983). The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain, 17, 33–44. doi: 10.1016/0304-3959(83)90125-2.PubMedCrossRefGoogle Scholar
  53. Rubin, G. P., Hungin, A. P., Chinn, D. J., & Dwarakanath, D. (2004). Quality of life in patients with established inflammatory bowel disease: A UK general practice survey. Alimentary Pharmacology and Therapeutics, 1, 529–535. doi: 10.1111/j.1365-2036.2004.1873.x.CrossRefGoogle Scholar
  54. Sainsbury, A., & Heatley, R. V. (2005). Psychosocial factors in the quality of life of patients with inflammatory bowel disease. Alimentary Pharmacology, 21, 499–508. doi: 10.1111/j.1365-2036.2005.02380.x.CrossRefGoogle Scholar
  55. Schmulson, M. J., Ortiz-Garrido, O. M., Hinojosa, C., & Arcila, D. (2006). A single session of reassurance can acutely improve the self-perception of impairment in patient with IBS. Journal of Psychosomatic Research, 61, 461–467. doi: 10.1016/j.jpsychores.2006.02.011.PubMedCrossRefGoogle Scholar
  56. Sewitch, M. J., Abrahamowicz, M., Bitton, A., Daly, D., Wild, G. E., Cohen, A., et al. (2001). Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. The American Journal of Gastroenterology, 96, 1470–1479. doi: 10.1111/j.1572-0241.2001.03800.x.PubMedCrossRefGoogle Scholar
  57. Simren, M., Axelsson, J., Gillberg, R., Abrahamsson, H., Svedlund, J., & Bjornsson, E. S. (2002). Quality of life in inflammatory bowel disease in remission: The impact of IBS-like symptoms and associated psychological factors. Inflammatory Bowel Diseases, 8, 373–374. doi: 10.1097/00054725-200209000-00014.CrossRefGoogle Scholar
  58. Sullivan, G., Jenkins, P. L., & Blewett, A. E. (1995). Irritable bowel syndrome and family history of psychiatric disorder: A preliminary study. Psychosomatics, 39, 45–54.Google Scholar
  59. Suls, J., Wan, C. K., & Blanchard, B. (1994). A multi-level data-analytic approach for evaluation of relationship between daily life stressor and symptomatology: Patients with irritable bowel syndrome. Health Psychology, 13, 103–113. doi: 10.1037/0278-6133.13.2.103.PubMedCrossRefGoogle Scholar
  60. Talley, N. J. (2006). Irritable bowel syndrome. Internal Medicine Journal, 36, 724–728. doi: 10.1111/j.1445-5994.2006.01217.x.PubMedCrossRefGoogle Scholar
  61. Talley, N. J., Boyce, P., & Owen, B. K. (1995). Psychosocial distress and seasonal symptom changes in irritable bowel syndrome. The American Journal of Gastroenterology, 90, 2115–2119.PubMedGoogle Scholar
  62. Toner, B. B., Segal, C. V., Emmott, S. D., & Myran, D. (2000). Cognitive-behavioral treatment of irritable bowel syndrome (pp. 72–76). New York: Guilford.Google Scholar
  63. Unoka, Z., Rózsa, S., Kő, N., Kállai, J., Fábián, Á., & Simon, L. A. (2004). Derogatis-féle tünetlista hazai alkalmazásával szerzett tapasztalatok (Hungarian—psychometric properties of the Hungarian version of Derogatis Symptom Checklist). Psychiatria Hungarica, 19, 28–35.Google Scholar
  64. Walker, E., Roy-Bryne, P., Katon, W., Li, L., Amos, D., & Jiranek, G. (1990). Psychiatric illness and irritable bowel syndrome: A comparison with inflammatory bowel disease. The American Journal of Psychiatry, 147, 1656–1661.PubMedGoogle Scholar
  65. Whitehead, W. E., Burnett, C. K., Cook, E. W., & Taub, E. (1996). Impact of irritable bowel syndrome on quality of life. Digestive Diseases and Sciences, 41, 2248–2253. doi: 10.1007/BF02071408.PubMedCrossRefGoogle Scholar
  66. Whitehead, W. E., Crowell, M. D., Robinson, J. C., Heller, B. R., & Schuster, M. M. (1992). Effects of stressful life events on bowel symptoms: Subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut, 33, 825–830. doi: 10.1136/gut.33.6.825.PubMedCrossRefGoogle Scholar
  67. Whitehead, W. E., & Palsson, O. S. (1998). Is rectal pain sensitivity a biological marker for irritable bowel syndrome: Psychological influences on pain perception. Gastroenterology, 115, 263–271. doi: 10.1016/S0016-5085(98)70099-X.CrossRefGoogle Scholar
  68. Wilson, A., Longstreth, G. F., Knight, K., Wong, J., Wade, S., Chiou, C. F., et al. (2004). Quality of life in managed care patients with irritable bowel syndrome. Managed Care Interface, 17, 24–28.PubMedGoogle Scholar
  69. Woodman, C. L., Breen, K., Noyes, R. J., Moss, C., Fagerholm, R., Yagla, S. J., et al. (1998). The relationship between irritable bowel syndrome and family history of psychiatric disorder. General Hospital Psychology, 17, 43–46.Google Scholar
  70. Zaan-Loonen, H. J., Grootenhuis, M. A., Last, B. F., & Derkx, H. H. (2004). Coping strategies and quality of life of adolescents with inflammatory bowel disease. Quality of Life Research, 13, 1011–1019. doi: 10.1023/B:QURE.0000025598.89003.0c.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Gabriella Seres
    • 1
    Email author
  • Zoltán Kovács
    • 2
  • Ágota Kovács
    • 3
  • Olga Kerékgyártó
    • 4
  • Krisztina Sárdi
    • 5
  • Pál Demeter
    • 5
  • Eszter Mészáros
    • 1
  • Ferenc Túry
    • 1
  1. 1.Institute of Behavioural SciencesSemmelweis University of MedicineBudapestHungary
  2. 2.Department of Psychiatry and PsychotherapySemmelweis University of MedicineBudapestHungary
  3. 3.Department of GastroenterologyPéterfy Sándor u. Municipal HospitalBudapestHungary
  4. 4.Department of GastroenterologyJahn Ferenc HospitalBudapestHungary
  5. 5.Department of Internal Medicine IIISzent Margit HospitalBudapestHungary

Personalised recommendations