Background: Psychological disorders are more frequent in patients with inflammatory bowel diseases (IBD) than in general population, and they are usually more severe during IBD relapse, with a huge impact on quality of life (QoL). The role and the characterization of psychological factors in IBD is not well documented.
Methods: This was a single-center, observational, transversal study. Consecutive adult IBD patients were enrolled and stratified according to disease activity (active/remission). Socio-demographic and clinical data were collected and specific validated questionnaires Symptom Checklist-90-R (SCL-90-R) for psychological distress, Defense Mechanism Inventory (DMI) for psychological defense mechanims, and Inflammatory Bowel Disease Questionnaire (IBDQ) for QoL were administered. We aimed to analyse the frequency of specific psychological factors in IBD subjects, to compare psychological and behavioral factors between patients with active disease or in remission, and to correlate those factors with socio-demographic and clinical data.
Results: 201 IBD patients (CD=47%; UC=53%) were prospectively enrolled, half of them had active disease (HBI>5 or PMS>2). Median IBD-Q (cut-off>209) was significantly lower in patients with active disease compared to those in remission (136.5 vs. 177.5, p<0.001). No patients had psychological scores above the cut-off for normality, but scores slightly below the cut-off were found for somatization, depression, anxiety, Global severity Index (GSI), and Positive Symptom Total (PST). Statistically significant differences were found in active IBD patients for obsessive-compulsive (p=0.026), depression (p=0.013), anxiety (p=0.013), phobic anxiety (p=0.002), psychoticism (p=0.007), GSI (p=0.005), PST (p=0.001) compared to those in remission. Crohn's disease and disease activity were associated with higher probability to have an increased GSI, PST and Positive Symptom Distress Index (PSDI). No significant differences were found for defense mechanisms.
Conclusions: IBD patients suffer from psychological distress and are characterized by impaired QoL, independently from disease activity. Psychological status is significantly impaired in patients with active disease. Psychological support may play a key role in managing IBD patients with active disease.