Identification of Coping Strategies in Patients with Inflammatory Bowel Disease: A Cross-sectional Study

Abstract

Purpose: The deleterious psychosocial impact of inflammatory bowel disease (IBD) is well-established. Less is known about coping behavior of IBD patients. The aim of this study is to identify the coping strategies used by patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Outpatients aged 18 years or older with confirmed diagnosis of IBD were recruited. Disease activity was measured using the Harvey Bradshaw index and Modified Mayo Score for CD and UC, respectively. Stress level was assessed with the Perceived Stress Scale, and coping behavior was measured with the Carver Brief COPE Inventory. A logistic regression model was applied to identify associations between patients' coping strategies and disease activity. Covariates included disease status (CD or UC), disease severity (remission/normal, mild/moderate/severe disease) and average stress score. All analyses were performed with Statistical Analysis System (SAS) version 9.3. Results: Sixty patients, 35 with CD and 25 with UC, completed the study. There was no statistical difference between groups in terms of age, gender, ethnicity, and annual household income. Smoking status differed between groups. 26% of CD and 4% of UC patients were current smokers (p=0.02). Venting, self-distraction, behavioral disengagement, use of instrumental support, and religion to cope with IBD were associated with high personal stress. IBD patients with active disease (mild/moderate/severe flare) were more likely to cope with venting and acceptance strategies (p=0.048, OR = 15), compared to patients in remission, (p=0.007, OR = 14) respectively. In addition, 60% of CD patients, compared with 36% of UC, are three times as likely to cope with the disease via positive reframing (p=0.049). Conclusion: Patients cope with IBD by using venting, self-distraction, instrumental support, religion, acceptance, positive reframing, and behavioral disengagement strategies. Coping strategies differed as a function of disease activity and illness type. Future research should attempt to determine which coping methods are most and least effective, and how targeted, evidence-based behavioral intervention may enhance these skills and patient quality of life.