Patients with inflammatory bowel disease at risk of sub-optimal outcomes report poorer biopsychosocial functioning than controls: data from two cross-sectional surveys

ABSTRACT

Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder. Standard treatment focuses on reducing the inflammatory burden, however, not all patients respond adequately to conventional medical therapy. These patients, referred to as Patients at Risk of Suboptimal Outcomes (PARSO), have not been studied collectively. The present study aimed to understand the biopsychosocial characteristics of patients with IBD at risk of sub-optimal outcomes for targeted multi-disciplinary treatment to encourage optimal outcomes. Two cross-sectional online surveys, including 760 PARSO and 208 control (non-PARSO) participants, were conducted and their data combined. Biopsychosocial factors included quality of life, pain, disease activity, wellbeing, fatigue, stress, social support, and sleep difficulties. Results suggest that active disease, quality of life, stress, social support, sleep difficulties, fatigue, wellbeing, smoking status, IBD subtype, and pain are significantly associated with membership in a subgroup of PARSO. We also used logistic regression to explore variables associated with the total likelihood of PARSO status. Overall, the model predicted the at-risk status to a substantial degree (R²_−2ll = .41, x² = 401.53, p < .001). Younger age in years, female sex, Crohn’s disease, and greater measured and subjective disease activity significantly increased the likelihood of participants being identified as PARSO; OR CI95% = 0.96 (0.95, 0.97); OR CI95% = 4.46 (2.95, 6.71); OR CI95% = 1.58 (1.05, 2.37); OR CI95% = 3.52 (2.18, 5.69); OR CI95% = 45.99 (14.11, 149.89). A biopsychosocial and personalised approach to IBD care might be necessary to support those at risk of suboptimal outcomes in achieving better long-term wellbeing.

KEYWORDS:

• Inflammatory bowel disease
• mental health
• Patients at Risk of Suboptimal Outcomes
• biopsychosocial factors

Acknowledgments

We would like to acknowledge Crohn’s & Colitis Australia and the Steering Group who established the survey one. We would also like to acknowledge Deakin University 4th Year Psychology students who assisted in data collection for study two.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Consent to participate

All individual participants included in the study provided informed consent.

Consent for publication

Not applicable.

Authors’ contributions

No writing assistance was received. AMW and LO designed the study, collected the data, commented on drafts, and approved the final manuscript. RO contributed to the design of the study, ran the analysis, drafted the manuscript and approved its final version. DS contributed to the design of the study and analysis, commented on drafts, and approved the final manuscript. CE, LB, SD contributed to the design, commented on drafts, and approved the final manuscript.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Deakin University Faculty of Health Research Ethics Committee; HEAG-H 85_2018 (survey one) and HEAG-H 173_2017 (survey two).

Data accessibility statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.