The relationships among psychological distress, stress, disease symptom activity, and coping in adolescents diagnosed with Crohn's disease.

摘要

The primary purpose of this exploratory study was to examine potential pathways among psychological distress, stress, coping and disease activity severity in adolescent patients diagnosed with Crohn's disease (CD). Participants included 41 males and females aged 13-19 years with a diagnosis of CD. Adolescents completed questionnaires assessing depression, anxiety, and hassles. Mothers of participants were asked to complete a demographic questionnaire and collateral ratings of coping used by their adolescents. The Pediatric Crohn's disease Activity Index was used to assess disease severity, and laboratory work was obtained. Salivary cortisol was collected the morning following their enrollment visit. Correlational and regression analyses were used to statistically determine relationships, as well as whether coping mediates or moderates relationships between psychological and physiological variables. Results revealed a significant positive relationship between depression, and more specifically, anhedonia and disease activity in patients with CD. However, it did not support findings that general anxiety and stress (hassles or cortisol) are related to disease activity.; Results further revealed that adolescent reports of increased involuntary engagement coping and involuntary disengagement coping were related to increased levels of anxiety and depression, and increased levels of primary control disengagement coping was related to increased anxiety. In addition, parental reports of child use of secondary control disengagement coping and involuntary disengagement coping strategies were related to increased hassles scores, whereas parental reports of increased use of secondary control engagement coping by adolescents was related to decreased depression scores. None of the types of the adolescent-rated coping strategies were found to be related to disease activity, but parental ratings of increased use of secondary engagement coping strategies by their adolescents was associated with decreased disease activity. Neither mediation nor moderation of the relationships between psychological factors and disease activity by coping was found. Overall, results suggest that depression plays a role in an adolescent's experience of CD, and that treatments aimed at reducing negative coping strategies and increasing secondary control engagement strategies may impact psychological functioning and potentially CD symptom activity.