The Impact of Socio-Demographic Factors on the Daily Hassles Experienced by Patients With Crohnʼs Disease

Abstract

Introduction: Patients' mental well-being is a major health resource, affected by daily mundane stressors. This attribute is poorly understood in Crohn's disease (CD). We measured stress in Israeli CD patients, and determined which socio-demographic factors impact it. Methods: Non-selected adult CD patients attending a tertiary medical facility or canvassed by the Patients' Association completed the Daily Hassles Scale (51-question stress measure, Kohn & Macdonald, 1992), indicating their exposure to stressful events in the last month. Total (range 51—204, high ratings indicate more stress) and Subscale Daily Hassles Scores were calculated. Socio-demographic parameters of patients were independent variables. Data are means±SD. Results: The cohort comprised 166 men (38.5%), 265 women (61.5%), aged 39.4±14.6 y. Harvey-Bradshaw Index was 4.8±5.0; 56.6% patients in remission, 19% mild, 20.2% moderate, 14.2% severe. Total Daily Hassles Score was 88.6±25.1 in men, 86.9±23.9 in women (p=0.49), but Sub-Scale Works Hassles Score was higher in men (13.1±4.8) than women (11.8±4.7, p=0.01). Divorced patients had a higher Social Hassles Score (19.8±7.4) than married (16.1±5.0), widowed (17.8±5.1) or single persons (17.5±5.7) (p=0.002). Total Daily Hassles Score was higher in patients with bad economic status (106.2±24.6) vs.medium (85.8±21.9), good (77.5±17.7) and very good (65.2±12.4) (p=0.001). Patients born in the Former Soviet Union (FSU) and Israel had higher Work-Related Hassles Scores (12.5±5.2 and 12.3±4.4, respectively) than those born in America-Western Europe (A-WE) and Asia-Africa (10.6±6.3, 9.7±3.2 ) (p=0.03). Patients born in A-WE or Israel had a higher rate of daily hassles related to Time Management (17.8±7.0, 17.4±5.7) than those from Asia-Africa or FSU (14.4±4.9, 16.0±4.7) (p=0.05). There were significant negative associations of patient age with sub-scales of Daily Hassles, Works Hassles, Time, and Social Acceptance; and of disease duration with Total Daily Hassles, Social Hassles, Works Hassles, Social Acceptance, and Stigmatization. Conclusion: In CD patients, theDaily Hassles Scores and Sub-Scores varied by gender, age, disease duration, economic status, family status and country of birth (culture). Giving attention to these findings will improve the ability of their patients to cope with their disease.