心理困扰预测炎症性肠道疾病中的疾病活动:从心身IBD纵向研究的结果
Natasha Seaton1, Joanna L Hudson1, Valeria Mondelli2
1Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
在炎症性肠病 (IBD) 中的心理困扰加剧了症状和成本. 改善睡眠质量可以减少痛苦和疾病活动,积极影响医疗保健使用和生产力.
科学领域:
- 胃肠病学 胃肠病学
- 精神病学是一个精神病学.
- 卫生经济学 卫生经济学
背景情况:
- 心理困扰 (抑郁,焦虑,压力) 在炎症性肠病 (IBD) 中很普遍,并且与患者的治疗结果较差有关.
- 将痛苦与IBD结局联系在一起的行为途径和经济后果仍然不完全理解.
- 一个肠-大脑-行为结果 (GBBO) 框架被提出来研究这些复杂的关系.
研究的目的:
- 测试心理痛苦和IBD疾病活动之间的相互联系.
- 检查健康行为是否调解了痛苦和疾病活动之间的关系.
- 确定是否痛苦和自我报告的疾病活动 (SRDA) 预测了不良结果,独立于炎症,以及疾病活动是否调解了痛苦-结果关系.
主要方法:
- 一组157名IBD患者报告了痛苦,健康行为,SRDA,医疗保健利用和三个6个月间隔的结果.
- 在基线和6个月测量了便calprotectin (FCP),以评估炎症.
- 结构方程建模和混合效应模型用于数据分析.
主要成果:
- 基线心理困扰预测六个月后SRDA增加 (β=0.16,p=0.03),但没有预测FCP.
- 睡眠质量下降调解了55%的痛苦与SRDA关系 (β=0.09,p=0.04).
- 在控制FCP时,痛苦和SRDA独立预测了二级医疗保健使用和与疾病相关的结果 (爆发频率/严重性,缺勤,生产力损失).
结论:
- 心理困扰显著加剧IBD症状,并导致经济成本.
- 睡眠质量差部分调解了痛苦和SRDA之间的联系,突出了它在症状负担中的作用.
- 针对改善睡眠的心理干预可以提供具有成本效益的策略,以减轻痛苦,减少症状负担,减少IBD患者的医疗保健利用率和生产力损失.
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