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Fatigue in pediatric inflammatory bowel disease: Explained by transdiagnostic and disease-focused factors
Maartje D Stutvoet1, Anouk Vroegindeweij1, Tessa Z Toonen2
1Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Insights
Severe fatigue is common in children with inflammatory bowel disease (IBD), even in remission. Transdiagnostic factors like sleep, activity, and mental health significantly impact fatigue more than disease factors.
Area of Science:
- Pediatric Gastroenterology
- Clinical Psychology
- Quality of Life Research
Background:
- Fatigue is highly prevalent in pediatric inflammatory bowel disease (IBD), persisting even during clinical remission.
- This suggests that factors beyond the disease itself, such as lifestyle and psychological influences (transdiagnostic factors), play a significant role.
Purpose of the Study:
- To determine the prevalence of severe fatigue in children with IBD.
- To investigate the association of fatigue with both IBD-specific clinical factors and broader transdiagnostic factors.
Main Methods:
- Utilized data from the PROactive cohort, including 127 children (ages 8-18) with IBD.
- Assessed fatigue using the Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale.
- Analyzed associations using linear regression, examining IBD clinical data and validated patient-reported outcome measures for transdiagnostic factors.
Main Results:
- Severe fatigue was reported by 29% of children with IBD.
- Only disease activity and comorbidity were significantly associated with fatigue among IBD-focused factors.
- Numerous transdiagnostic factors, including poor sleep, low physical activity, pain, anxiety, depression, and lower life satisfaction, were strongly linked to increased fatigue.
Conclusions:
- Fatigue in pediatric IBD is more closely linked to transdiagnostic factors than to disease-specific elements.
- Integrative care addressing modifiable psychosocial and lifestyle factors is crucial for reducing fatigue and enhancing the well-being of children with IBD.
Objective:
Fatigue is highly prevalent in children with inflammatory bowel disease (IBD), even during clinical remission. This suggests a role for transdiagnostic factors-lifestyle, psychological, and social influences not specific to the disease. This study aimed to assess the prevalence of severe fatigue in pediatric IBD and evaluate its associations with both IBD-focused and transdiagnostic factors.
Methods:
Children with IBD ages 8-18 from the PROactive cohort completed the Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale. IBD-focused clinical data were extracted from electronic health records. Transdiagnostic factors were assessed using validated patient-reported outcome measures. Associations with fatigue were examined using linear regression.
Results:
Among 127 patients (mean age 14.9 ± 2.7 years; 43% male), most were in clinical remission. One hundred six patients self-reported fatigue, and 99 parents reported their child's fatigue. Severe fatigue was self-reported by 29%. Of IBD-focused factors, only disease activity (β = -0.40) and comorbidity (β = -0.18) showed significant associations with fatigue. Of transdiagnostic factors, lower physical, emotional, and social functioning; poorer sleep quality; less physical activity; more pain, anxiety, and depressive symptoms; lower life satisfaction and self-rated health; and increased school absence and pressure were significantly associated with more fatigue. Backward selection retained only transdiagnostic factors in the multivariate model, which explained 78% of fatigue variance.
Conclusion:
Fatigue is common in children with IBD and is more strongly associated with transdiagnostic than disease-focused factors. These findings highlight the importance of integrative care strategies that address modifiable psychosocial and lifestyle domains to reduce fatigue and improve functioning in children with IBD.
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