The Impact of Disease Specific Knowledge on Anxiety, Depression, and Quality of Life in Patients With Inflammatory Bowel Disease

Abstract

Introduction: Disease specific knowledge among inflammatory bowel disease (IBD) pts remains lacking. Our study aims to (1) determine extent of disease specific knowledge among IBD pts and (2) determine impact of IBD knowledge on anxiety, depression and quality of life (QoL). Methods: We prospectively recruited adult IBD pts from a tertiary care GI clinic in Beirut, Lebanon. Demographic data was collected and pts were asked to fill in the following questionnaires: (1) Short IBD Questionnaire (SIBDQ) as a meaure of QoL (2) Harvey-Bradshaw Index (HBI) for Crohn disease (CD) and ulcerative colitis (UC) Activity Index (UCAI) for UC pts as a measure of disease activity (3) Hospital Anxiety and Depression Scale (HADS) as measure of axiety and depression, and (4) Crohn and Colitis Knowledge (CCKnow) questionnaire as measure of IBD-soecific knowledge. Pearson chi-square, student t-test and multivariate analysis were used for statistical analyses. Results: A total of 51 pts were included; 60.8% males, mean age 34.7yrs±13.2. 62.7% had CD, 35.3% UC and 2% IBD-unclassified. Majority of pts (56.9%) were unmarried and had a university degree (74.5%). Mean CCKnow score for all pts was 7.88±4.28, median 7, mode 6, with 51% scoring≥8. Of all pts, 49% had anxiety, 23.5% depression, mean SIBDQ score 45.82 ± 14.66, with 60.8% having a poor QoL. The 32 CD pts had a mean CCKnow of 8.75±4.99, median 8, mode 5, with 53.13% scoring≥8, and mean HBI 5.47±4.30. The 18 UC pts had a mean CCKnow of 7.22±3.42, median 6, mode 6, with 44.4% scoring ≥8, and mean UCAI 5.47±3.7. There were no significant differences amongst pts who knew more about their IBD (CCKnow score≥8) and those who lack disease specific knowledge (Table 1). When analyzing CD and UC pts separately, CD pts who knew about their IBD had a tendency to be more anxious;p=0.077(Table 2). After controlling for disease activity, level of education, age and age at diagnosis in the entire sample, IBD-knowledge was not found to be associated with any of the following outcomes: anxiety, depression, or QoL. However, when analyzing CD pts, those with more IBD-specific knowledge (CCknow≥8) had a tendency to have more anxiety;p=0.053. Conclusion: IBD pts in Lebanon knew less about their IBD compared to values reported in the literature. There were no differences between pts who knew about their disease compared to those who did not, except for a trend towards significance in anxiety amongst CD pts with more CD knowledge.641_A Figure 1. Differences between patients with knowledge about their IBD compared to those who lack IBD-specific knowledge (CCKnow cut-off of 8 which is the mean for the sample studied)641_B Figure 2. Differences between patients with knowledge about their IBD compared to those who lack IBD-specific knowledge (CCKnow cut-off of 8 which is the mean for the sample studied); CD and UC patients analyzed separately