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Psychological Distress, Somatization, and Defense Mechanisms Associated with Quality of Life in Inflammatory Bowel Disease Patients

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Abstract

Background Clinical parameters predict health-related quality of life (HRQOL) in inflammatory bowel disease (IBD), but some patients have impaired HRQOL despite being in clinical remission. Objective To identify personality and psychological distress variables associated with HRQOL in IBD. Method In a cross-sectional study of 185 IBD patients, the General Health Questionnaire, the Hopkins’ Symptoms Distress Checklist, the Defense Style Questionnaire and the Life Style Index were administered. The Inflammatory Bowel Disease Questionnaire was used for the assessment of HRQOL. Results Psychological distress was associated with impaired HRQOL in a dose–response fashion. Somatization mediated the relationships of anxiety and depression with HRQOL. Few years of education, more extensive use of the reaction-formation defense mechanism and higher rates of somatization were the variables most closely and independently associated with impaired HRQOL. Conclusions Somatization and reaction-formation are independent correlates of disease-specific HRQOL in IBD patients, and this could be relevant to psychological interventions.

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References

  1. Sainsbury A, Heatley RV. Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2005;21(5):499–508. doi:10.1111/j.1365-2036.2005.02380.x.

    Article  CAS  PubMed  Google Scholar 

  2. Drossman DA, Leserman J, Mitchell M, Li ZM, Zagami EA, Patrick DL. Health status and health care use in persons with inflammatory bowel disease: a national sample. Dig Dis Sci. 1991;36:1746–1755. doi:10.1007/BF01296620.

    Article  CAS  PubMed  Google Scholar 

  3. Vidal A, Gómez-Gil E, Sans M, et al. Health-related quality of life in inflammatory bowel disease patients: the role of psychopathology and personality. Inflamm Bowel Dis. 2008;14(7):977–983. doi:10.1002/ibd.20388.

    Article  PubMed  Google Scholar 

  4. Love JR, Irvine EJ, Fedorak RN. Quality of life in inflammatory bowel disease. J Clin Gastroenterol. 1992;14:15–19. doi:10.1097/00004836-199201000-00005.

    Article  CAS  PubMed  Google Scholar 

  5. Casellas F, Lopez-Vivancos J, Casado A, Malagelada JR. Factors affecting health related quality of life of patients with inflammatory bowel disease. Qual Life Res. 2002;11:775–781. doi:10.1023/A:1020841601110.

    Article  PubMed  Google Scholar 

  6. Casellas F, Arenas JI, Baudet JS, et al. Impairment of health-related quality of life in patients with inflammatory bowel disease: a Spanish multicenter study. Inflamm Bowel Dis. 2005;11:488–496. doi:10.1097/01.MIB.0000159661.55028.56.

    Article  CAS  PubMed  Google Scholar 

  7. Han SW, McColl E, Barton JR, James P, Steen IN, Welfare MR. Predictors of quality of life in ulcerative colitis: the importance of symptoms and illness representations. Inflamm Bowel Dis. 2005;11:24–34. doi:10.1097/00054725-200501000-00004.

    Article  PubMed  Google Scholar 

  8. Tanaka M, Kazuma K. Ulcerative colitis: factors affecting difficulties of life and psychological well being of patients in remission. J Clin Nurs. 2005;14:65–73. doi:10.1111/j.1365-2702.2004.00955.x.

    Article  PubMed  Google Scholar 

  9. Boye B, Jahnsen J, Mokleby K, et al. The INSPIRE study: are different personality traits related to disease-specific quality of life (IBDQ) in distressed patients with ulcerative colitis and Crohn’s disease? Inflamm Bowel Dis. 2008;14(5):680–686. doi:10.1002/ibd.20367.

    Article  PubMed  Google Scholar 

  10. Moreno-Jiménez B, López Blanco B, Rodríguez-Muñoz A, Garrosa Hernández E. The influence of personality factors on health-related quality of life of patients with inflammatory bowel disease. J Psychosom Res. 2007;62(1):39–46. doi:10.1016/j.jpsychores.2006.07.026.

    Article  PubMed  Google Scholar 

  11. Turnbull GK, Vallis MT. Quality of life in inflammatory bowel disease: the interaction of disease activity with psychosocial function. Am J Gastroenterol. 1995;90:1450–1454.

    CAS  PubMed  Google Scholar 

  12. Nordin K, Pahlman L, Larsson K, Sundberg-Hjelm M, Lööf L. Health related quality of life and psychological distress in a population based sample of Swedish with inflammatory bowel disease. Scand J Gastroenterol. 2002;37:450–457. doi:10.1080/003655202317316097.

    Article  CAS  PubMed  Google Scholar 

  13. Janke KH, Klump B, Gregor M, Meisner C, Haeuser W. Determinants of life satisfaction in inflammatory bowel disease. Inflamm Bowel Dis. 2005;11:272–286. doi:10.1097/01.MIB.0000160809.38611.f7.

    Article  PubMed  Google Scholar 

  14. Guthrie E, Jackson J, Shaffer J, Thompson D, Tomenson B, Creed F. Psychological disorder and severity inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn’s disease. Am J Gastroenterol. 2002;97:1994–1999. doi:10.1111/j.1572-0241.2002.05842.x.

    Article  PubMed  Google Scholar 

  15. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  16. Kellner R. Somatization: theories and research. J Nerv Ment Dis. 1990;178:150–160. doi:10.1097/00005053-199003000-00002.

    Article  CAS  PubMed  Google Scholar 

  17. Thompson WG. Gastrointestinal symptoms in the irritable bowel compared with peptic ulcer and inflammatory bowel disease. Gut. 1984;25(10):1089–1092. doi:10.1136/gut.25.10.1089.

    Article  CAS  PubMed  Google Scholar 

  18. Forbes A. Clinical presentations. In: Clinician’s Guide to Inflammatory Bowel Disease. London: Chapman & Hall; 1997:164.

  19. Simren M, Axelsson J, Gillberg R, Abrahamsson H, Svedlund J, Björnsson ES. Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors. Am J Gastroenterol. 2002;97:389–396.

    PubMed  Google Scholar 

  20. Kroenke K, Spitzer RL, Williams JB, et al. Physical symptoms in primary care predictors of psychiatric disorders and functional impairment. Arch Fam Med. 1994;3:774–779. doi:10.1001/archfami.3.9.774.

    Article  CAS  PubMed  Google Scholar 

  21. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64:258–266.

    PubMed  Google Scholar 

  22. Jackson J, Fiddler M, Kapur N, Wells A, Tomenson B, Creed F. Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics. J Psychosom Res. 2006;60(4):357–363. doi:10.1016/j.jpsychores.2006.02.006.

    Article  PubMed  Google Scholar 

  23. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.

    Google Scholar 

  24. Hyphantis TN, Triantafillidis JK, Pappa S, et al. Defense mechanisms in inflammatory bowel disease. J Gastroenterol. 2005;40(1):24–30. doi:10.1007/s00535-004-1491-x.

    Article  PubMed  Google Scholar 

  25. Hyphantis T, Bai M, Tomenson B, Creed F, Tsifetaki N, Voulgari PV et al. The role of psychological distress and personality variables in the disablement process in rheumatoid arthritis. Semin Arthritis Rheum (paper submitted)

  26. Farrokhyar F, Marshall JK, Easterbrook B, Irvine EJ. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health. Inflamm Bowel Dis. 2006;12(1):38–46. doi:10.1097/01.MIB.0000195391.49762.89.

    Article  PubMed  Google Scholar 

  27. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383. doi:10.1016/0021-9681(87)90171-8.

    Article  CAS  PubMed  Google Scholar 

  28. de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol. 2003;56:221–229. doi:10.1016/S0895-4356(02)00585-1.

    Article  PubMed  Google Scholar 

  29. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979;9:139–145.

    Article  CAS  PubMed  Google Scholar 

  30. Morris PL, Goldberg RJ. Validity of the 28-item General Health Questionnaire in hospitalized gastroenterology patients. Psychosomatics. 1989;30(3):290–295.

    CAS  PubMed  Google Scholar 

  31. Garyfallos G, Karastergiou A, Adamopoulou A, et al. Greek version of the General Health Questionnaire: accuracy of translation and validity. Acta Psychiatr Scand. 1991;84:371–378. doi:10.1111/j.1600-0447.1991.tb03162.x.

    Article  CAS  PubMed  Google Scholar 

  32. Bridges KW, Goldberg DP. The validation of the GHQ-28 and the use of the MMSE in neurological in-patients. Br J Psychiatry. 1986;148:548–553. doi:10.1192/bjp.148.5.548.

    Article  CAS  PubMed  Google Scholar 

  33. Derogatis LR. SCL-90-R: Administration, Scoring, and Procedure Manual. 3rd ed. Minneapolis, MN: National Computer Systems; 1994.

    Google Scholar 

  34. Parker JC, Buckelew SP, Smarr KL, et al. Psychological screening in rheumatoid arthritis. J Rheumatol. 1990;17:1016–1021.

    CAS  PubMed  Google Scholar 

  35. Donias S, Karastergiou A, Manos N. Standardization of the symptom checklist-90-R rating scale in a Greek population (in Greek with English abstract). Psychiatriki. 1991;2:42–48.

    Google Scholar 

  36. Bond M. An empirical study of defense styles: The Defense Style Questionnaire. In: Vaillant GE, ed. Ego Mechanisms of Defense: A Guide for Clinicians and Researchers. Washington, DC: American Psychiatric Press; 1992:139–140.

    Google Scholar 

  37. Bond M. Empirical studies of defense style: relationships with psychopathology and change. Harv Rev Psychiatry. 2004;12(5):263–278. doi:10.1080/10673220490886167.

    Article  PubMed  Google Scholar 

  38. Conte HR, Apter A. The life style index: A self-report measure of ego defenses. In: Conte HR, Plutchik R, eds. Ego Defenses: Theory and Measurement. New York: Wiley; 1995:179–201.

    Google Scholar 

  39. Plutchik R, Conte HR. Measuring emotions and their derivatives: Personality traits, ego defenses and coping styles. In: Wetzler A, Katz B, eds. Contemporary Approaches to Psychological Assessment. New York: Brunner-Mazel; 1989.

    Google Scholar 

  40. Guyatt G, Mitchell A, Irvine EJ, et al. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96:804–810.

    CAS  PubMed  Google Scholar 

  41. Mitchell A, Guyatt G, Singer J, et al. Quality of life in patients with inflammatory bowel disease. J Clin Gastroenterol. 1988;10:306–310. doi:10.1097/00004836-198806000-00014.

    Article  CAS  PubMed  Google Scholar 

  42. Pallis AG, Vlachonikolis IG, Mouzas IA. Quality of life of Greek patients with inflammatory bowel disease. Validation of the Greek translation of the inflammatory bowel disease questionnaire. Digestion. 2001;63:240–246. doi:10.1159/000051896.

    Article  CAS  PubMed  Google Scholar 

  43. Vlachonikolis IG, Pallis AG, Mouzas IA. Improved validation of the Inflammatory Bowel Disease Questionnaire and development of a short form in greek patients. Am J Gastroenterol. 2003;98:1802–1812. doi:10.1111/j.1572-0241.2003.07518.x.

    Article  PubMed  Google Scholar 

  44. Altman DG. Practical Statistics for Medical Research. London: Chapman and Hall; 1991.

    Google Scholar 

  45. Miles J, Shevlin M. Applying Regression and Correlation. London: Sage; 2003:165–191.

    Google Scholar 

  46. Walker EA, Gelfand MD, Gelfand AN, Creed F, Katon WJ. The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease. Gen Hosp Psychiatry. 1996;18(4):220–229. doi:10.1016/0163-8343(96)00036-9.

    Article  CAS  PubMed  Google Scholar 

  47. Riedl A, Schmidtmann M, Stengel A, et al. Somatic comorbidities of irritable bowel syndrome: a systematic analysis. J Psychosom Res. 2008;64(6):573–582. doi:10.1016/j.jpsychores.2008.02.021.

    Article  PubMed  Google Scholar 

  48. Jackson JL, Passamonti M. The outcomes among patients presenting in primary care with a physical symptom at 5 years. J Gen Intern Med. 2005;20(11):1032–1037. doi:10.1111/j.1525-1497.2005.0241.x.

    Article  PubMed  Google Scholar 

  49. Martin A, Chalder T, Rief W, Braehler E. The relationship between chronic fatigue and somatization syndrome: a general population survey. J Psychosom Res. 2007;63(2):147–156. doi:10.1016/j.jpsychores.2007.05.007.

    Article  PubMed  Google Scholar 

  50. Hollifield M, Paine S, Tuttle L, Kellner R. Hypochondriasis, somatization, and perceived health and utilization of health care services. Psychosomatics. 1999;40(5):380–386.

    CAS  PubMed  Google Scholar 

  51. Bond M, Perry JC. Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. Am J Psychiatry. 2004;161(9):1665–1671. doi:10.1176/appi.ajp.161.9.1665.

    Article  PubMed  Google Scholar 

  52. Vaillant GE. Ego Mechanisms of Defense: A Guide for Clinicians and Researchers. Washington, DC: American Psychiatric Press; 1992:246.

    Google Scholar 

  53. Lackner JM, Gurtman MB. Patterns of interpersonal problems in irritable bowel syndrome patients: a circumplex analysis. J Psychosom Res. 2005;58(6):523–532. doi:10.1016/j.jpsychores.2005.02.015.

    Article  PubMed  Google Scholar 

  54. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69(9):881–888. doi:10.1097/PSY.0b013e31815b00c4.

    Article  PubMed  Google Scholar 

  55. Creed F, Fernandes L, Guthrie E, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology. 2003;124(2):303–317. doi:10.1053/gast.2003.50055.

    Article  PubMed  Google Scholar 

  56. Gazzard BG, Price HL, Libby GW, Dawson AM. The social toll of Crohn’s disease. BMJ. 1978;2:1117–1119.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We express our gratitude to all the patients for their willingness to participate in our study. We also acknowledge the assistance in data collection and express our appreciation to the former research group of the First Division of Internal Medicine and Hepato-Gastroenterology Unit, Medical School, University of Ioannina: M. Economou, G. Fillis, A. Kiouliou and A. Petrou.

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Authors and Affiliations

  1. Department of Psychiatry, Medical School, University of Ioannina, 45110, Ioannina, Greece

    Thomas N. Hyphantis, Marina Bai & Venetsanos Mavreas

  2. Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK

    Thomas N. Hyphantis, Barbara Tomenson & Francis Creed

  3. 1st Division of Internal Medicine & Hepato-Gastroenterology Unit, Medical School, University of Ioannina, Ioannina, Greece

    Epameinondas Tsianos

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  1. Thomas N. Hyphantis
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  2. Barbara Tomenson
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Correspondence to Thomas N. Hyphantis.

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Hyphantis, T.N., Tomenson, B., Bai, M. et al. Psychological Distress, Somatization, and Defense Mechanisms Associated with Quality of Life in Inflammatory Bowel Disease Patients. Dig Dis Sci 55, 724–732 (2010). https://doi.org/10.1007/s10620-009-0762-z

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