Depressive Symptoms in Youth with Inflammatory Bowel Disease Compared with a Community Sample

摘要: Crohn's disease and ulcerative colitis, collectively known as inflammatory bowel diseases (IBD), are chronic, immune-mediated of the gastrointestinal tract. Incidence IBD is increasing among youth in United States; 25 to 30% patients with have onset symptoms before age 18 years 1. characterized by unpredictable remissions activity followed relapses including abdominal pain, diarrhea, rectal bleeding, weight loss, growth pubertal delay, fever, fatigue, arthritis 2. Managing requires attention complicated medication regimens, side effects, symptoms, nutritional modifications or supplementation. In addition, require frequent medical appointments, may be faced recurrent school absences needing answer potentially embarrassing questions from friends relatives 3. Youth higher rates compared healthy peers 1, 4, up 35% experience permanent failure 5. They appear younger than their chronological age, thereby risk peer teasing difficulty developing age-appropriate relationships. Given these challenges, prevalence emotional difficulties depression has been a topic ongoing interest 6, 7. An accurate understanding nature mood disturbance important clinical research implications. Decisions on how best allocate resources guided based perceived need, documentation base depressive one indication need. Further, better compare somatic needed delineate potential role physical illness elevating for those reporting difficulties. both levels barriers adherence well anxiety/depressive reported lower adherence, suggesting that presence implications management 8. Depressive particular because association steroid treatments processes involved 9, 10. Findings regarding mixed, however. Mackner Crandall 11 that, parents adolescents, adolescents rated experiencing greater anxiety and/or Child Behavior Checklist, standard questionnaire assessing global behavior functioning. Adolescents at least one-year post diagnosis, however, self-reported functioning comparable 12. early study, limited small sample size 20 IBD, found parent-reported internalizing control group 13. A recent meta-analytic review psychosocial adjustment differentiated versus disorders 6. formal diagnosis sufficient number chronicity typically derived via diagnostic interview whereas exist isolation another commonly measured patient report checklists questionnaires. When using self-report Children's Depression Inventory 14, standardized did not elevations when other chronic illnesses. However, were illnesses (odds ratio = 5.80) psychiatric considered most reliable valid methodology diagnosing highest sensitivity specificity. practice, assessed report, majority self parent-report questionnaires 6. There mixed findings relationship between activity, factors need addition related predicting outcomes 15. Maternal depression, stressful life events, family dysfunction, usage shown relate 16, 17. Though specific socioeconomic status an additional factor 18. Given disproportionately relatively advantaged backgrounds 19, associated SES less relevant this population. Ambiguity literature whether elevated led could accounted 10, 21. overlap changes eating patterns, sleep 11. Consequently, scores parent proxy-reports conflating producing some partially due activity. Recently, structure was evaluated results yielding 3-factor mood, behavioral/motivational, complaint Items comprising complaints assess reduced appetite, tiredness, worry about aches pains, problems. Interestingly, only predicted severity above beyond current dose, highlighting symptomatology. Conversely, items CDI, items, following cognitive-behavioral therapy depression10. Decreases independent part, responsive psychological treatment regardless activity. The first aim study community similar geographic region symptoms. The second examine measures Interpretation sought (1) provide evidence (2) differentiate attributable order gain clearer experienced IBD.