Thematic analysis of physical illness perceptions in depressed adolescents with inflammatory bowel disease (IBD).

Abstract

OBJECTIVE: The focus of this study is to examine illness perception in 50 depressed youths with inflammatory bowel disease (IBD) and to 1) probe for themes of contingency, coping, and overall optimism and pessimism within the child's illness narrative; 2) explore the relationship between illness perception, depressive severity, and IBD severity; and to 3) compare children's illness narratives with a validated measure of illness perception (Brief Illness Perception Questionnaire, BIPQ).1 Little is known about children's perceptions of chronic illness and its relationship to current depressive and IBD severity. It was hypothesized that the frequency of illness narrative responses coded as pessimistic would show positive correlation to selfand clinician-rated depressive severity, IBD severity, and age. METHODS: A semi-structured illness interview that explores the responses of clinically depressed youth with IBD to questions about their physical illness was developed based on the five dimensions of cognitive representation of illness (identity, cause, cure/control, timeline, and consequences).2 Two independent raters coded the interview responses according to themes of interest with input from a third rater when coding discrepancies arose. Statistical analysis was performed to determine the relationship between response frequency of most common themes and measures including age, sex, depressive severity, and IBD severity. RESULTS: Participants were 11-17 years old; 56% were male; 82% had Crohn's disease; and 32.6% had severe IBD activity. There was a significant inverse relationship between the frequency of responses coded positive contingency and IBD severity (r =-0.405, p<0.05). There were inverse relationships between self-rated depressive severity and the themes of optimism (r =-0.276, p<0.1) and positive self-competence (r =-0.204, p<0.1), as well as a positive relationship between self-rated depressive severity and negative self-competence (Kendall-Tau coefficient = 0.211, p<0.1). There were no significant correlations between depressive severity and the themes of pessimism or negative contingency. Total frequency of optimistic responses showed a negative trend with BIPQ score that approached significance (r =-0.236, p<0.15). Frequency of pessimistic responses for an illness narrative question regarding sense of control over IBD showed a positive trend with participants' scores for the BIPQ question that also asked about sense of control (Kendall-Tau coefficient =-0.248, p<0.1). CONCLUSIONS: Overall, illness themes and their negative or positive emotional valence are independent of depressive severity, IBD severity, sex, or age. Also, illness narrative theme frequencies show trends with a validated instrument of illness perception that are hypothesized to strengthen with increased sample size. These results suggest that illness perception is important to probe as an independent predictor of coping with IBD, particularly during adolescence.