Preliminary evidence supporting a framework of psychological adjustment to inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a chronic, relapsing and remitting autoimmune disease that includes Crohn’s disease (CD) and ulcerative colitis (UC). The prevalence of IBD is estimated at 396 cases per 100,000 worldwide, affecting up to 1.4 million people in the U.S.1 Current standard of care in IBD treatment is aimed at managing the inflammatory response during flare episodes and maintaining remission with an emphasis on adhering to a regular medication regimen.2 It is known that individuals with chronic disease experience alterations in quality of life and functioning in the physical, psychological, social, and occupational realms. For people with IBD, quality of life is compromised,3–10 and has been shown to be correlated with factors such as psychological distress,3–7 social support,4,6 and coping.3,6,10 Most experts will agree that when patients receive a new diagnosis of IBD, a natural psychological adaptation response occurs in a relatively short period of time. For example, a common reaction to a new diagnosis of IBD might include: an initial evaluation of the disease’s impact on life activity and plans; an emotional response including relief, distress, grief, and guilt; and a behavioral response that may include taking new medications, seeking social support, modifying diet, and managing stress. This adaptation, or adjustment, is a complex and dynamic process likely influenced by age of onset of disease, disease severity, the scope of interference in life and future plans, core beliefs about health and illness, illness attributions, emotional state, learned behaviors, and disease-related demands. After the initial adaptation to the diagnosis occurs, patients may experience ongoing adjustment challenges given the chronic and often unpredictable course of IBD. Throughout the adjustment process, patients may feel frustrated, sad, develop fears, miss work, and avoid social events and traveling due to the relapsing and remitting course of IBD. Moreover, physicians and patients often express an interest in more comprehensive treatment options that address both medical and psychological aspects of IBD. Psychological adjustment to chronic disease has been an important focus in the areas of cardiovascular disease, cancer, multiple sclerosis, and rheumatoid diseases. Stanton et al11 identify 5 indicators of adjustment to chronic illness including: mastery of disease-related adaptive tasks, preservation of functional status, absence of psychological disorder, low negative affect, and preservation of quality of life. Investigating psychological adjustment to IBD is important because it may help to further explain patient-reported outcomes in IBD. The aims of this study were 3-fold: 1) to identify sensitive and specific measures of adjustment to IBD including functional status, psychological functioning, and health-related quality of life; 2) to examine the relationship of such constructs to disease characteristics, illness and stress perceptions, disease acceptance, coping, healthcare utilization, and missed work; and 3) to provide preliminary evidence supporting a framework of adjustment to IBD on which future research can be built. We hypothesized that we would observe statistically significant correlations across adjustment variables and disease characteristics, illness and stress perceptions, disease acceptance, coping, healthcare utilization, and missed work.