SELF-RATED HEALTH IN INFLAMMATORY BOWEL DISEASE CORRELATES WITH ANXIETY, DEPRESSION, CATASTROPHIC THINKING, AND DISEASE SEVERITY

BACKGROUND The construct of self-rated health (SRH) has been found to be strongly associated with objective markers of health status (e.g., disease progression, healthcare utilization, mortality) in both general and disease-specific populations. For individuals with inflammatory bowel disease (IBD), SRH correlates with symptom severity and health-related quality of life. SRH is typically influenced by one’s disease activity, functional status, and coping style, but there is scant research investigating how specific psychological constructs are related to SRH in patients with IBD. This study aimed to examine how SRH correlates with anxiety, depression, and catastrophic thinking patterns. If clarified, results can inform assessment and intervention efforts to improve quality of life in IBD. METHODS Participants were recruited from a gastroenterology clinic in a midwestern academic medical center. Questionnaires included: Hospital Anxiety and Depression Scale (HADS), GI-Cognitions Questionnaire, and the 36-Item Short Form Survey (SF-36). SRH was measured from SF-36 item 1, which asked participants to rate their health on a five-point scale ranging from excellent to poor. Physicians also completed a clinician rating of IBD activity (Partial Mayo Index [PMI] for ulcerative colitis and Harvey Bradshaw Index [HBI] for Crohn’s disease). Pearson correlation analyses were conducted comparing SRH ratings to psychological variables and IBD activity. RESULTS A total of 117 adults participated (mean age = 38.5 years, 59% female; see Table 1 for demographics). Higher ratings of anxiety, depression, somatization, and catastrophic thinking patterns about GI symptoms were significantly correlated with poorer SRH. There was a significant negative correlation between SRH and IBD activity for patients with Crohn’s disease, but not ulcerative colitis. This is likely due to a restricted range of possible scores on the PMI. Table 2 displays correlation analyses. DISCUSSION Results highlight the potential utility of SRH to identify other patient concerns (e.g., anxiety, depression) and allow an additional avenue for medical providers to consider when assessing patients’ illness experience. Assessing SRH could be part of a step-wise screening and referral process in GI clinics. For example, it may be fruitful to assess SRH in a standardized manner such as using the SF-36 item 1, and when poor SRH is detected, additional screening may be warranted such as using the PHQ-9 or GAD-7. If scores are elevated, a referral to a mental health provider with training in psychogastroenterology may help identify psychological factors that could be targeted via behavioral interventions to improve quality of life and coping with illness. Additional clinical recommendations will be discussed.