Depression, anxiety, and loneliness among adolescents and young adults with IBD in the UK: the role of disease severity, age of onset, and embarrassment of the condition

Pamela Qualter,Chris Probert,Lucy Bray,Lucy Blake,Steven Allen,Alison Rouncefield-Swales,Bernie Carter,Kay Crook

doi:10.1007/s11136-020-02653-9

Abstract

PurposeAdolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) report higher depressive symptoms and anxiety compared to healthy controls, with disease severity and abdominal pain being important factors. In the current study, building on what young people had told us in our previous work, we examined whether embarrassment of the condition, social self-efficacy, and friendship quality mediated the relationship between abdominal pain and disease severity, and mental health/well-being. We also included loneliness as a component of well-being.MethodsData on depression, anxiety, loneliness, friendship quality, social self-efficacy, and disease embarrassment were collected from 130 AYA with IBD ages 14–25 years; data on disease severity and abdominal pain were taken from their medical records. Structural Equation Modeling (SEM) was used to test the relationships between the variables.ResultsUsing SEM, we established that higher IBD disease activity negatively impacted how AYA felt about their friendships and how embarrassed they were about their condition; embarrassment then influenced reports of mental health, including loneliness. Abdominal pain, disease onset, and social self-efficacy directly predicted internalising problems.ConclusionIn this sample of 14–25-year-old patients with IBD, specifics about the disease (severity and pain) predicted poorer mental health, suggesting discussion of mental health should be part of the clinical dialogue between patient and consultant. In addition, embarrassment about their condition increased depression, anxiety, and loneliness, mediating the relationship between disease severity and well-being. Thus, it is important to consider how perceived stigma affects those with chronic illness, and those issues should be explored in clinic.

Highlights

Inflammatory Bowel Disease (IBD) is a ‘chronic, heterogeneous, relapsing and remitting condition primarily as a consequence of inflammation within the bowel lumen’ [1]
It was the case that the same AYA tended to report all three mental health problems: those who reported higher levels of depressive symptoms were more likely than chance to report elevated levels of anxiety and loneliness, and those with higher anxiety were more likely than chance to be lonely, suggesting high levels of co-morbidity
Consistent with previous research, IBD disease activity was found to influence mental health reporting; extending that work, we found that it did so indirectly by affecting how young people felt about their friendships and how embarrassed they were about their condition

Summary

Introduction

Inflammatory Bowel Disease (IBD) is a ‘chronic, heterogeneous, relapsing and remitting condition primarily as a consequence of inflammation within the bowel lumen’ [1]. Most of the research on mental health among IBD patients is focused on depressive symptoms, with some studies considering anxiety among AYA. Findings from empirical studies suggest that, for IBD among AYA, disease severity (activity and pain) has an impact on mental health and well-being, that effect is found in some studies, but not others [23]. In studies that found an effect, paediatric patients with IBD who reported greater disease activity and more pain reported poorer mental health and well-being compared to peers with IBD in remission [24]: functional impairment and the aggressive treatment regimens for IBD contribute to negative affect

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Conclusion