P045 ILLNESS STIGMA, BODY IMAGE DISSATISFACTION, TWARTED BELONGINGNESS, AND DEPRESSIVE SYMPTOMS IN YOUTH WITH INFLAMMATORY BOWEL DISEASE
Authors: Roberts Caroline , Gamwell Kaitlyn , Edwards Clayton , Baudino Marissa , Tung Jeanne , Jacobs Noel , Grunow John , Gillaspy Stephen , Mullins Larry , Chaney John 
Published: January 2020

Abstract

Introduction
Inflammatory bowel disease (IBD) involves invasive symptoms and embarrassing treatment side effects (e.g., weight gain/loss). Elevated levels of depressive symptoms are also observed in youth with IBD, and have been linked to perceived illness stigma and feelings of social isolation. One potential variable related to stigma that has received only minimal attention in the pediatric IBD literature is body image dissatisfaction, which is associated with poor social identity development and increased depressive symptoms in healthy youth. Due to the stigmatizing nature of IBD, youth may feel self-conscious about their body image, which contributes to decreased feelings of social belongingness and ultimately depressive symptoms. The current study tested a serial mediation model in which increased youth perceived IBD stigma was hypothesized to have an indirect influence on youth depressive symptoms through the sequential effects of stigma on youth body image dissatisfaction and increased thwarted social belongingness, resulting in a significant illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptom serial mediation path.

Methods
Youth with IBD (Crohn’s = 36, Ulcerative Colitis = 30, Indeterminate Colitis = 1; Female = 39) between the ages of 10–18 yrs. (M = 14.5; SD = 2.12) were recruited from a pediatric gastroenterology clinic. Time since diagnosis ranged from &lt;1 to 5.74 yrs. (M = 1.58; SD = 1.56). Youth completed measures of IBD stigma (Stigma Scale-Child; SS-C), body image dissatisfaction (Body Image Questionnaire; BIQ), thwarted belongingness (Interpersonal Needs Questionnaire-Thwarted Belongingness Subscale; INQ-TB) and depressive symptoms (Children’s Depression Inventory- 2nd Edition; CDI-2). Disease severity was assessed by physician global assessment. Current medications and Body Mass Index (BMI) data were also collected.

Results
Eighteen percent reported elevated CDI-2 depression scores. Only gender and BMI were correlated with modeled variables. Further, the BMI → CDI-2 association was greater for youth taking prednisone. Primary analyses examining 95% confidence intervals from 5,000 bootstrapped regression resampling draws revealed significant direct effects for SS-C → BIQ, BIQ → INQ-TB, and INQ-TB → CDI-2. Bootstrapped mediation analyses indicated a significant serial indirect path for SS-C → BIQ → INQ-TB → CDI-2 (effect = 0.92, 95% CI = .141 to 2.187), controlling for gender, BMI, and prednisone medication.

Conclusions
Youth who perceive greater IBD stigma are more likely to experience increased body image dissatisfaction due to their IBD, which may engender feelings of social estrangement, and ultimately elevated depressive symptoms. Both stigma and body image dissatisfaction should be assessed and addressed in a multidisciplinary fashion by medical providers and mental health professionals.