P616. Impact of psychological factors in relapse of Crohn's disease
To our knowledge, few researches focused on the influence of psychological factors on relapse of Crohn's disease. One of the main studies is described by Bitton et al (2008). It highlights the interaction between emotion focused coping strategies and perceived stress. Other factors such as depression and anxiety are also advanced to explain relapse (Mittermaier et al, 2004). The goals of our study are firstly, to identify with a prospective dimension, any psychosocial factoring involved on relapse of this disease. In a second time, we will confront these results with a qualitative perspective which assesses illness experience.
73 adult patients (47 women, 26 men), mean age 43 years (SD = 18.5), in remission and without medication they were followed during 9 months or less in case of relapse. Disease activity was determined by Harvey–Bradshaw index. Each month, patients completed standardized measures of perceived stress (Perceived Stress Scale-10), disease specific stressors (Machrostresseur), daily hassles (Hassles scale), quality of life (Inflammatory Bowel Disease Questionnaire), coping strategies (Ways of Coping Checklist) and emotional distress (Symptom Check List 90 -R, General Health Questionnaire12).
19% of patients relapsed. We used a Mann–Whitney test to compare relapsing patient's mean scores just before the relapse versus patients in remission's scores. Our results showed high levels of perceived stress (p < 0.05), of stressors related to the disease's physical impact (p < 0.05) and a lower quality of life (p < 0.05) in the group of patients who relapsed. No significant difference about other factors was observed.
A Wilcoxon test on relapsing patients's group, didn't show any significant difference between baseline and the month before the relapse, whatever the assessed psychological dimensions.
Patients with a higher level of perceived stress, of stress related to physical impact of the disease and a lower quality of life are more likely to relapse. These results could be explained by a focus on physical symptoms and difficulties for the patients to exceed the physical reality for elaborate psychically the illness. The group of patients who relapsed didn't present difference between scores, from baseline until the month before relapse. We suggest the existence of vulnerabilities relative to illness experience, present before the beginning of participation to our study. To continue we will investigate on this issue from a series of semi directive interviews focused on illness experience. Our first results show us the importance to consider the level of stress and quality of life to improve psychological support for these patients.
This study was supported by grant from Association François Aupetit.