Illness Perceptions and Outcomes in Patients with Inflammatory Bowel Disease: Is Coping a Mediator?

Abstract

Purpose

Patients with inflammatory bowel disease (IBD) often experience severe impairment in different life domains. Psychological factors, such as illness perceptions and coping, may play a role in the adjustment to IBD as indicated by mental and physical health, activity, and work impairment. The present study aimed at examining the assumption of the Common Sense Model (CSM) that coping mediates the relationship between illness perceptions and adjustment in patients with IBD.

Method

In a cross-sectional design, 211 IBD patients (73 % Crohn’s disease, 40 % male, mean age 42.9 ± 12.9 years) attending an outpatient clinic completed questionnaires assessing illness perceptions (IPQ-R), coping (CORS), mental and physical health (SF-36), as well as activity and work impairment (WPAI). Multiple mediation analyses were applied that allow estimating the total and direct effects of all illness perception dimensions and the indirect effects through all coping strategies on the illness outcomes simultaneously.

Results

The analyses yielded significant direct effects of perceptions regarding the cyclical course, the chronic course, the severity of the consequences, the comprehensibility, and the emotional impact of IBD on study outcomes. Additionally, significant indirect effects were found for the perceptions regarding the severity of the consequences, the possibility of personal control, and the comprehensibility of IBD on mental and physical health as well as activity impairment through the use of one specific coping strategy, i.e., reduction of activity.

Conclusion

The results provide evidence for the assumptions of the CSM and suggest the importance of addressing illness perceptions and activity stimulation in quality health care for IBD patients.

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References

  1. 1.

    Olivieri I, Cantini F, Castiglione F, Chionchetti P, Orlando A, Salvarani C, Vecchi M, Armuzzi A. Italian expert panel on the management of patients with coexisting spondyloarthritis and inflammatory bowel disease. Autoimmun Rev. 2014;13:822–30.

    Article  PubMed  Google Scholar 

  2. 2.

    De Vlam K, Mielants H, Cuvelier C, de Keyser F, Veys EM, de Vos M. Spondyloarthropathy is underestimated in inflammatory bowel disease: prevalence and HLA association. J Rheumatol. 2000;27:2860–5.

    CAS  PubMed  Google Scholar 

  3. 3.

    Van der Have M, Minderhoud IM, Kaptein AA, Leenders M, Siersema PD, Fidder HH, Oldenburg B. Substantial impact of illness perceptions on quality of life in patients with Crohn’s disease. J Crohns Colitis. 2012;7:292–301.

    Article  Google Scholar 

  4. 4.

    Fuller-Thomson E, Lateef R, Sulman J. Robust association between inflammatory bowel disease and generalized anxiety disorder: findings from a nationally representative Canadian study. Inflamm Bowel Dis. 2015. doi:10.1097/MIB.0000000000000518.

    Google Scholar 

  5. 5.

    Parekh NK, McMaster K, Nguyen DL, Shah S, Speziale A, Miller J, Melmed G. Coping strategies used by adult patients with inflammatory bowel disease. South Med J. 2015;108:337–42.

    PubMed  Google Scholar 

  6. 6.

    Casati J, Toner BB. Psychosocial aspects of inflammatory bowel disease. Biomed Pharmacother. 2000;54:388–93.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Casati J, Toner BB, de Rooy EC, Drossmann DA, Maunder RG. Concerns of patients with inflammatory bowel disease. Dig Dis Sci. 2000;45:26–31.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Bernklev T, Jahnsen J, Henriksen M, Lygren I, Aadland E, Sauar J, Schulz T, Stray N, Vatn M, Moum B. Relationship between sick leave, unemployment, disability, and health-related quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2006;12:402–12.

    Article  PubMed  Google Scholar 

  9. 9.

    Feagan BG, Bala M, Yan S, Olson A, Hanauer S. Unemployment and disability in patients with moderately to severely active Crohn’s disease. J Clin Gastroenterol. 2005;39:390–5.

    Article  PubMed  Google Scholar 

  10. 10.

    Ramos A, Calvet X, Sicilia B, Vergara M, Figuerola A, Motos J, Sastre A, Villoria A, Gomollon F. IBD-related work disability in the community: prevalence, severity and predictive factors. A cross-sectional study. United European Gastroenterol J. 2015;3(4):335–42.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Leventhal H, Brissette I, Leventhal EA. The Common-Sense Model of self-regulation of health and illness. In: Cameron LD, Leventhal H, editors. The self-regulation of health and illness behaviour, vol. 2003. London: Routledge; 2003. p. 42–65.

    Google Scholar 

  12. 12.

    Dorrian A, Dempster M, Adair P. Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping. Inflamm Bowel Dis. 2009;15:47–55.

    Article  PubMed  Google Scholar 

  13. 13.

    Kiebles JL, Doerfler B, Keefer L. Preliminary evidence supporting a framework of psychological adjustment to inflammatory bowel disease. Inflamm Bowel Dis. 2010;16:1685–95.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Knowles SR, Cook SI, Tribbick D. Relationship between health status, illness perceptions, coping strategies and psychological morbidity: a preliminary study with IBD stoma patients. J Crohns Colitis. 2013;7:471–8.

    Article  Google Scholar 

  15. 15.

    Knowles SR, Grass C, Macrae F. Illness perceptions in IBD influence psychological status, sexual health and satisfaction, body image and relational functioning: a preliminary exploration using structural equation modeling. J Crohns Colitis. 2013;7:344–50.

    Article  Google Scholar 

  16. 16.

    Knowles SR, Wilson JL, Connell WR, Kamm MA. Preliminary examination of the relations between disease activity, illness perceptions, coping strategies, and psychological morbidity in Crohn’s disease guided by the Common Sense Model of illness. Inflamm Bowel Dis. 2011;17:2551–7.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Rochelle TL, Fidler H. The importance of illness perceptions, quality of life and psychological status in patients with ulcerative colitis and Crohn’s disease. J Health Psychol. 2012;18:972–83.

    Article  PubMed  Google Scholar 

  18. 18.

    Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The Revised Illness Perception Questionnaire (IPQ-R). Psychol Health Med. 2002;17:1–16.

    Article  Google Scholar 

  19. 19.

    Van Lankveld W, van’t Pad Bosch P, van de Putte L, Näring G, van der Staak C. Disease-specific stressors in rheumatoid arthritis: coping and well-being. Br J Rheumatol. 1994;33:1067–73.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Haggar SM, Orbell S. A meta-analytic review of the Common-Sense Model of illness representations. Psychol Health. 2003;18(2):141–84.

    Article  Google Scholar 

  21. 21.

    Han SW, McColl E, Barton JR, James P, Steen IN, Walfare MR. Predictors of quality of life in ulcerative colitis. The importance of symptoms and illness representations. Inflamm Bowel Dis. 2005;11:24–34.

    Article  PubMed  Google Scholar 

  22. 22.

    Van der Have M, Brakenhoff LKPM, van Erp SJH, Kaptein AA, Leenders M, Scharloo M, Veenendaal RA, van der Heijde D, van der Meulen-de Jong AE, Hommes DW, Fidder HH. Back/joint pain, illness perceptions and coping are important predictors of quality of life and work productivity in patients with inflammatory bowel disease: a 12-month longitudinal study. J Crohns Colitis. 2015;9:276–83.

    Article  PubMed  Google Scholar 

  23. 23.

    Van der Have M, Fidder HH, Leenders M, Kaptein AA, van der Valk ME, van Bodegraven AA, Dijkstra G, de Jong DJ, Pierik M, Ponsioen CY, van der Meulen-de Jong AE, van der Woude CJ, van de Meeberg PC, Romberg-Camps MJ, Clemens CH, Jansen JM, Mahmmod N, Bolwerk CJ, Vermeijden JR, Siersema PD, Oldenburg B. Self-reported disability in patients with inflammatory bowel disease largely determined by disease activity and illness perceptions. Inflamm Bowel Dis. 2015;21:369–77.

    Article  PubMed  Google Scholar 

  24. 24.

    Netjes JE, Rijken M. Labor participation among IBD patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(1):81–91.

    Article  PubMed  Google Scholar 

  25. 25.

    McCombie AM, Mulder RT, Gearry RB. Coping strategies and psychological outcomes of patients with inflammatory bowel disease in the first 6 months after diagnosis. Inflamm Bowel Dis. 2015;21(10):2272–80.

    PubMed  Google Scholar 

  26. 26.

    Van Erp SJH, Brakenhoff LK, van Gaalen FA, van den Berg R, Fidder HH, Verspaget HW, Huizinga TW, Veenendaal RA, Wolterbeek R, van der Heijde D, van der Meulen-de Jong AE, Hommes DW. Classifying back pain and peripheral joint complaints in inflammatory bowel disease patients: a prospective longitudinal follow-up study. J Crohns Colitis. 2015;9(3):276–83. doi:10.1093/ecco-jcc/jju025.

    Article  PubMed  Google Scholar 

  27. 27.

    Harvey RF, Bradshaw JMA. Simple index of Crohn’s disease activity. Lancet. 1980;1(8173):876.

    Google Scholar 

  28. 28.

    Walmsley RS, Ayres RC, Pounder RE, Allan RNA. Simple clinical colitis activity index. Gut. 1998;43:29–32.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  30. 30.

    Zhang W, Bansback N, Boonen A, Young A, Singh A, Anis AH. Validity of the work productivity and activity impairment questionnaire—general health version in patients with rheumatoid arthritis. Arthritis Res Ther. 2010. doi:10.1186/ar3141.

    Google Scholar 

  31. 31.

    Reilly MC, Gerlier L, Brabant Y, Brown M. Validity, reliability, and responsiveness of the work productivity and activity impairment questionnaire in Crohn’s disease. Clin Ther. 2008;30:393–404.

    Article  PubMed  Google Scholar 

  32. 32.

    Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013.

    Google Scholar 

  33. 33.

    Hayes AF, Preacher KJ. Statistical mediation analysis with a multicategorical independent variable. Br J Math Stat Psychol. 2014;67:451–70.

    Article  PubMed  Google Scholar 

  34. 34.

    Tiggelman D, van de Ven MOM, van Schayck OCP, Kleinjan M, Engels RCME. The Common Sense Model in early adolescents with asthma: longitudinal relations between illness perceptions, asthma control and emotional problems mediated by coping. J Psychosom Res. 2014;77(4):309–15.

    Article  PubMed  Google Scholar 

  35. 35.

    McCombie A, Swaminathan A, Mulder R, Frampton C, Kortlever T, Gearry R. The IBD-Cope: a new instrument for measuring coping in inflammatory bowel disease patients. J Crohns Colitis. 2016;10(6):678–86.

    Article  PubMed  Google Scholar 

  36. 36.

    Chilcot H, Moss-Morris R. Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention. Behav Res Ther. 2013;51:690–5.

    Article  PubMed  Google Scholar 

  37. 37.

    Mikocka-Walus A, Bampton P, Hetzel D, Hughes D, Esterman A, Andrews JM. Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot randomized controlled trial. BMC Gastroenterol. 2015. doi:10.1186/s12876-015-0278-2.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Mussell M, Bocker U, Nagel N, Olbrich R, Singer MV. Reducing psychological distress in patients with inflammatory bowel disease by cognitive-behavioural treatment: exploratory study of effectiveness. Scand J Gasteroenterol. 2003;38(7):755–62.

    CAS  Article  Google Scholar 

  39. 39.

    Petrie KJ, Perry K, Broadbent E, Weinman J. A text message programme designed to modify patients’ illness and treatment beliefs improves self-reported adherence to asthma preventer medication. Br J Health Psychol. 2012;17:74–84.

    Article  PubMed  Google Scholar 

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Corresponding author

Correspondence to Andrea E. van der Meulen-de Jong.

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Funding

This study was funded by Abbott (Grant number HUM2011-0279).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

S. J. H. van Erp and L. K. M. P. Brakenhoff contributed equally to this manuscript.

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van Erp, S.J.H., Brakenhoff, L.K.M.P., Vollmann, M. et al. Illness Perceptions and Outcomes in Patients with Inflammatory Bowel Disease: Is Coping a Mediator?. Int.J. Behav. Med. 24, 205–214 (2017). https://doi.org/10.1007/s12529-016-9599-y

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Keywords

  • Inflammatory bowel disease
  • Common Sense Model
  • Illness perceptions
  • Coping
  • Quality of life
  • Work productivity