P749 Impact of psycho-social variables on the activity of inflammatory bowel disease

Abstract

Background: While the medical causes for exacerbation of Inflam-matory Bowel Disease (IBD) are well known, the impact of psycho-social variables on the activity of Crohn's disease (CD) and ulcera-tive colitis (UC) are poorly understood. We determined the impact of psycho-social variables in active CD and UC. Methods: Our ongoing nation-wide psycho-social research in IBD has generated data on 818 patients. UC patients with Simple Clinical Colitis Activity Index >3 and CD patients with Harvey-Bradshaw Index >5 were entered in a cross-sectional study. Patients completed demographics, economic status (ES), medical history, and six psychological questionnaires: Brief Symptom Inventory (GSI, psychological stress measure), List of Threatening Experiences Questionnaire (LTE, exposure to major stress events), Brief COPE Inventory (coping strategies), Satisfaction with Life Scale (SWLS), SF-36 (generic health-related quality-of-life measure yielding Physical Health and Mental Health scores). Data are means (SD) or medians (IQR). Results: The cohort comprised 122 UC patients (age 38.6 (14.0) years, 60.0% women, disease duration 8.0 (3.0-14.0) years, 40.5% smokers) and 305 CD patients (age 45.2 (15.1) years, 60.1% women, disease duration 9.0 (4.0-16.0) years, 2.6% smokers). Psychological scores for UC vs. CD were: GSI 1.24 (0.8) vs. 0.9 (0.8) p<0.001, LTE 2.0 (1.0-4.0) vs. 1.5 (0-3.0), COPE Emotion-focused-strategies 24.5 (5.7) vs. 23.0 (5.7) p<0.03, COPE Planning-focused-strategies 16.4 (4.5) vs. 15.4 (4.2) p<0.04, COPE Dysfunctional-strategies (5.7) vs. 22.0 (5.0) p<0.01, SWLS 20.1 (8.0) vs. 21.0 (8.0), SF-36-Physical 37.8 (29.2-44.6) vs. 38.5 (32.4-46.1), SF-36-Mental (30.0-45.6) vs. 33.0 (26.6-44.6). ES was moderate (3 on scale 1-5) in UC and CD. UC disease activity was significantly associated with female gender, age, ES, GSI, LTE, all COPE strategies, SWLS and both SF-36 (p<0.02-0.001). CD activity was significantly associated with work status, smoking, ES, GSI, LTE, Dysfunctional COPE, SWLS and both SF-36 (p<0.05-0.001). A multiple linear regression model was created for UC (adjusted R square 0.11, model significance <0.001) and CD (0.185, <0.001). UC activity was predicted (R squared change) by GSI (9.1% of the variance), ES (6.9%), COPE Planning (4.2%), LTE (1.3%). CD activity was predicted by LTE (5%), GSI (4%), older age (1%). Conclusions: In this model, psychological stress impacted on both active UC (GSI) and active CD (LTE), whereas economic status im-pacted on UC only. Planning-focused coping was significant for active UC but not CD. Additional research is required to determine whether other psycho-social variables predict activity in these diseases.