Background: Quality of life is often negatively affected in patients with inflammatory bowel diseases (IBD) (Crohn's Disease, CD; ulcerative colitis, UC) associated with depression and anxiety. The clinical need as well as the efficacy of psychotherapeutic interventions in IBD patients is a matter of constant debate. However, the perspective of IBD patients has largely been ignored in this debate.
Methods: Psychometric tests namely the Short-Form IBD Questionnaire (SIBDQ) for quality-of-life assessment, the ADAP test measuring demand for psychological therapy and the Fear-of-Progression Questionnaire Short Form (FoP-Q-SF) as well as disease related questions, e.g. experience with psychotherapy were web-based positioned and advertised by the DCCV (“Deutsche Crohn und Colitis Vereinigung”), the biggest IBD patient organization in Germany. Data were analyzed by a stepwise forward regression model using SPSS Version 19. Statistical significance was set at <0.05.
Results: A total of n=631 patients responded. Data from n=578 (356 CD, 219 UC, 3 unclear) were complete and used for the analysis. 90% of the respondents show an at least slightly diminished quality of life (SIBDQ<60) and 60% had significant fear of disease progression (FoP-Q-SF >36). 55% had a demand for psychotherapy (ADAPT >60). More than half of all IBD patients (n=296) had previous experiences with psychotherapy, while the remaining had not (n=282). This distribution clearly determined the factor “demand for psychotherapy” (chi-square = 23.7, p<0.001). Regression model analysis revealed that psychotherapy demand was dependent on previous experience (p<0.001), fear of progression (p<0.001), quality of life (p=0.001), smoking (p=0.003) and previous surgery (p=0.005) with the total model explaining 29.7% of the variance. The total explained variance of this model was higher in UC alone (37.6%) than in CD alone (25.4%). Other models showed similarly high explanation using fear of progression (49.7%) or quality-of-life (48.5%) as dependent variable.
Conclusions: A high number of patients showed a diminished quality of life as well as a high demand for psychotherapy. Demand for psychotherapy as additional therapy in IBD depends on previous experience with psychotherapy, fear for disease progression but also other disease characteristics. To improve the quality of life of IBD patients, physicians should be aware of the enormous need of IBD patients for additional therapeutic interventions as shown in our cohort. Psychometric tests, as used in our study, could help to identify patients with a need for psychotherapy in the daily routine, to deliver the best possible combined treatment options for IBD patients.