SAN DIEGO – More than half of adolescents with inflammatory bowel disease met criteria for one or more DSM-IV disorders, in particular adjustment disorders and major depressive disorder, Dr. Andreas Richterich reported during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.
In addition, adolescents with a psychiatric disorder had higher levels of health-related distress, compared with those who did not have a psychiatric disorder. “What it means is, the way you cope with your illness determines your quality of life,” said Dr. Richterich, of the department of psychosomatics in children and adolescents at University Medical Center Hamburg-Eppendorf (Germany).
“So within the group of somatically ill, it's worth screening for psychiatric disorders to help them.”
In what he said is the first study of its kind, Dr. Richterich and his associates performed a cross-sectional analysis of 47 patients with IBD who were aged 12–18 years. They used the Clinical Assessment Scale for Child and Adolescent Psychopathology and questionnaires to analyze self-, parent, and physician ratings for health-related quality of life, emotional problems, and disease severity as defined by the pediatric Crohn's Disease Activity Index.
Questionnaires used in the study included the IMPACT III, a disease-specific quality of life questionnaire for children and adolescents; the Strengths and Difficulties Questionnaire (SDQ); and the European Quality of Life instrument.
The mean age of the 47 patients was 15 years, and 27 were male. There were 24 cases of Crohn's disease, 20 cases of ulcerative colitis, and 3 cases of colitis indeterminata.
Overall, 26 of the adolescents (55.3%) fulfilled criteria for one or more DSM-IV disorders. Of these, 25.6% were adjustment disorders and 17% were major depressive disorder. The rest included anxiety disorder (6.4%), learning/developmental disorders (4.2%), and attention-deficit hyperactivity disorder (2.1%). Only 15% of patients with DSM-IV disorders had ever been in contact with a child and adolescent psychiatrist or psychotherapist.
Dr. Richterich reported that there was overall agreement between patients, parents, and physicians in the measures of health-related quality of life. SDQ scores for patients with DSM-IV disorders were significantly higher, compared with patients who did not have DSM-IV disorders. Also, quality of life as measured by the IMPACT III was significantly lower in patients with DSM-IV disorders, compared with those who did not suffer from emotional problems.
There was a “dose-response” relationship between the severity of illness and level of reduced quality of life, especially among those who had mild IBD activity. “It's clear that the health-related distress rises with the [IBD] activity,” Dr. Richterich said.
Key limitations of the study, Dr. Richterich added, are the small sample size and the fact that specific questionnaires for depressive disorder and anxiety disorder were not administered.
'It's clear that the health-related distress rises with the [inflammatory bowel disease] activity.' DR. RICHTERICH