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.
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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.
Alexander, F. (1950). Psychosomatic medicine. New York: Norton.
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.
Blanchard, E. B. (2001). Irritable bowel syndrome. Psychosocial assessment and treatment (pp. 101–113). Washington: American Psychological Association.
Camilleri, M. (2001). Management of the irritable bowel syndrome. Gastroenterology, 120, 652–668. doi:10.1053/gast.2001.21908.
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.
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.
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.
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.
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.
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.
Derogatis, L. R. (1977). SCL-90-R, administration, scoring and procedures manual for the revised version. Baltimore: John Hopkins University, School of Medicine.
Drossman, D. A. (1994a). The functional gastrointestinal disorders: Diagnosis, pathophysiology, and treatment (pp. 12–13). Boston: Little, Brown and Company.
Drossman, D. A. (1994b). Irritable bowel syndrome: The role of psychosocial factors. Stress Medicine, 10, 49–55. doi:10.1002/smi.2460100109.
Drossman, D. A. (1996). Gastrointestinal illness and the biopsychosocial model. Journal of Clinical Gastroenterology, 22, 252–254. doi:10.1097/00004836-199606000-00002.
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.
Drossman, D. A., Creed, F. H., & Olden, K. W. (1999). Psychosocial aspects of the functional gastrointestinal disorders. Gut, 45, 25–30.
Drossman, D. A., Leserman, J., & Zhiming, L. (2000). Effects of coping on health outcome among women with gastrointestinal disorders. Psychosomatic Medicine, 62, 309–317.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Lea, R., & Whorwell, P. J. (2001). Quality of life in irritable bowel syndrome. PharmacoEconomics, 19, 643–653. doi:10.2165/00019053-200119060-00003.
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.
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.
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.
Lydiard, R. B. (2001). Irritable bowel syndrome, anxiety and depression: What are the links? The Journal of Clinical Psychiatry, 62, 38–45.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Talley, N. J. (2006). Irritable bowel syndrome. Internal Medicine Journal, 36, 724–728. doi:10.1111/j.1445-5994.2006.01217.x.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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Seres, G., Kovács, Z., Kovács, Á. et al. 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. J Clin Psychol Med Settings 15, 287–295 (2008). https://doi.org/10.1007/s10880-008-9132-9
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DOI: https://doi.org/10.1007/s10880-008-9132-9