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Psychological distress predicts disease activity in inflammatory bowel disease: Results from the mind-body IBD
Natasha Seaton1, Joanna L Hudson1, Valeria Mondelli2
1Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Background & Aims:
Psychological distress (depression, anxiety, stress) is common in inflammatory bowel disease (IBD) and is linked to poorer outcomes, yet behavioural pathways and economic consequences remain unclear. This study tested a gut-brain-behaviour-outcome (GBBO) framework, testing: 1) reciprocal links between distress and disease activity; 2) whether health behaviours mediate distress-disease activity relationships; 3) if distress and self-reported disease activity (SRDA) predict adverse disease outcomes, controlling for inflammation and 4) whether disease activity mediates relationships between distress and adverse outcomes.
Methods:
IBD patients (n = 157) reported distress, health behaviours, SRDA, healthcare use and disease-related outcomes at 3 waves at 6-month intervals. Faecal calprotectin (FCP) was assayed at baseline and 6 months. Analyses were conducted using structural equation modelling and mixed-effects models.
Results:
Baseline distress predicted higher SRDA six months later (β = 0.16, p=.03) but did not predict FCP; reverse pathways were nonsignificant. Impaired sleep quality mediated 55 % of the effect of distress on future SRDA (β = 0.09, p=.04). Other behaviours were nonsignificant. Controlling for FCP, distress and SRDA independently predicted secondary healthcare usage (primary/secondary care) and disease-related outcomes (flare frequency/severity, absenteeism and productivity loss). FCP was positively related to flare frequency/severity and allied health practitioner visits only. Mediation analysis showed that SRDA partially mediated absenteeism.
Conclusions:
Psychological distress exacerbates symptoms and economic cost. Poor sleep partially mediates the relationship between distress and SRDA, but not inflammation. Psychological interventions that focus on improving sleep could be cost-effective ways to improve mental health and symptom burden, with downstream impact on healthcare utilisation and productivity losses.
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