Abstract
Because the relationship between Crohn’s Disease (CD) activity and CD-related fatigue remains poorly understood, this study investigated the role of underlying psychological processes (depression, anxiety, and emotional processing). It was expected that the relationship between CD activity and CD-related fatigue would be mediated by depression and anxiety and also by a deficit in emotional processing. This prediction was tested in 110 CD patients who completed self-reported questionnaires assessing fatigue (FSS), clinical activity of Crohn’s Disease (HBAI), psychological suffering (HADS), and emotional processing (EPS-25). A path analysis showed both direct and indirect effects in the relationship between CD activity and CD-related fatigue, accounting for 33% of the variance. One indirect effect on the experience of fatigue was depression, but there was no effect of anxiety. These preliminary results confirmed that disease activity induces an increase in depressive symptoms, which in turn leads to an increase in the level of fatigue. The most novel result of the present study is that emotional processing had an indirect effect on the relationship between CD and CD-related fatigue: when the disease was more active, patients exhibited greater disruption of emotional processing, which in turn led to greater fatigue. These results did not reveal any association between depression and emotional processing. In conclusion, this work highlights the role of emotional processing in CD-related fatigue and the importance of taking this factor into account in order to manage this condition better.
Highlights
Crohn’s Disease (CD), like all types of Inflammatory Bowel Disease (IBD), is characterized by chronic, recurrent inflammation of the gastrointestinal tract that causes the most common symptoms: diarrhea, blood and mucus in the stool, and abdominal cramping
An anxiety-mediating effect was hypothesized in the relationship between Disease activity and Fatigue, we were unable to obtain a model that showed adequate fit indices and with significant structural parameters of the relationship between Disease activity and anxiety and between anxiety and fatigue
Disease activity was positively associated with fatigue (β = 0.18, p < 0.01), depression (β = 0.36, p < 0.001), and Emotional regulation (β = 0.33, p < 0.001)
Summary
Crohn’s Disease (CD), like all types of Inflammatory Bowel Disease (IBD), is characterized by chronic, recurrent inflammation of the gastrointestinal tract that causes the most common symptoms: diarrhea, blood and mucus in the stool, and abdominal cramping. It can cause systemic symptoms outside the gastro-intestinal tract, such as redness or pain in the eyes, mouth sores, painful joints, skin complications, and fatigue. Because fatigue is known to be more acute when CD is clinically active (Dignass et al, 2010; Czuber-Dochan et al, 2013b; Graff et al, 2013; van Langenberg and Gibson, 2014), it is often viewed as a direct consequence of disease activity (Opheim et al, 2014; Artom et al, 2017); and yet, CD-related fatigue persists in 22–41% of patients in clinical remission (Jelsness-Jørgensen et al, 2011; Czuber-Dochan et al, 2013b)
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