Original Article

Coping Strategies Used by Adult Patients with Inflammatory Bowel Disease

Authors: Nimisha K. Parekh, MD, MPH, Kristin McMaster, MSW, Douglas L. Nguyen, MD, Shamita Shah, MD, Alissa Speziale, MD, Jocelyne Miller, MD, Gil Melmed, MD

Abstract

Objectives: Symptoms of and treatments for inflammatory bowel disease (IBD) have a significant impact on patients’ quality of life (QOL) and result in an increased prevalence of depression and anxiety disorders. Little is known about the type of coping strategies used by adult patients with IBD to better cope with their chronic illness, however. The objectives of this study were to identify the types of coping styles and their impact on the QOL of patients with IBD.

Methods: The first 150 consecutive participants with IBD were recruited at five major tertiary hospitals and given an anonymous survey consisting of demographic information, the Jalowiec Coping Scale, and the Shortened Inflammatory Bowel Disease Questionnaire.

Results: The cohort was 51.3% men and included 150 participants with a mean age of 39.3 years. The primary coping mechanisms used were confrontive (46.7%), evasiveness (30.0%), optimistic (18.7%), and fatalistic (4.6%) coping. Participants rated confrontive (62.0%), optimistic (26.6%), and evasive (11.4%) coping styles as the most effective. Those who reported an increased frequency of flares scored lower on QOL ( P <0.05) and more often used evasive and fatalistic coping styles ( P < 0.05) compared with other coping strategies; however, after controlling for disease activity, QOL was significantly better for those who primarily used adaptive coping styles compared with those who used maladaptive styles ( P <0.001).

Conclusions: We demonstrated that confrontive, evasive, and optimistic styles of coping are most widely used among patients with IBD. Despite controlling for disease activity, we demonstrated that those who used adaptive coping styles had a higher QOL compared with those who used maladapative coping styles. Future research on coping is warranted to assess coping styles on therapeutic compliance and disease perception.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Ahmad T, Satsangi J, McGovern D, et al. Review article: the genetics of inflammatory bowel disease. Aliment Pharmacol Ther 2001;15:731-748.
 
2. Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine (Baltimore) 1976;55:401-412.
 
3. Hanauer SB. Review article: the long-term management of ulcerative colitis. Aliment Pharmacol Ther 2004;20(4 suppl):97-101.
 
4. Loftus CG, Loftus EV Jr, Harmsen WS, et al. Update on the incidence and prevalence of Crohn’s disease and ulcerative colitis in Olmsted County, Minnesota, 1940--2000. Inflamm Bowel Dis 2007;13:254-261.
 
5. Spiro HM. Six physicians with inflammatory bowel disease. J Clin Gastroenterol 1990;12:636-642.
 
6. Casati J, Toner BB. Psychosocial aspects of inflammatory bowel disease. Biomed Pharmacother 2000;54:388-393.
 
7. Casati J, Toner BB, de Rooy EC, et al. Concerns of patients with inflammatory bowel disease: a review of emerging themes. Dig Dis Sci 2000;45:26-31.
 
8. Walker JR, Ediger JP, Graff LA, et al. The Manitoba IBD cohort study: a population-based study of the prevalence of lifetime and 12-month anxiety and mood disorders. Am J Gastroenterol 2008;103:1989-1997.
 
9. Sewitch MJ, Abrahamowicz M, Bitton A, et al. Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. Am J Gastroenterol 2001;96:1470-1479.
 
10. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000;160:2101-2107.
 
11. Sareen J, Jacobi F, Cox BJ, et al. Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Arch Intern Med 2006;166:2109-2116.
 
12. Persoons P, Vermeire S, Demyttenaere K, et al. The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Aliment Pharmacol Ther 2005;22:101-110.
 
13. Irvine EJ. Development and subsequent refinement of the inflammatory bowel disease questionnaire: a quality-of-life instrument for adult patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 1999;28:S23-S27.
 
14. Jalowiec A, Murphy SP, Powers MJ. Psychometric assessment of the Jalowiec Coping Scale. Nurs Res 1984;33:157-161.
 
15. Goodhand J, Rampton D. Psychological stress and coping in IBD. Gut 2008;57:1345Y1347.
 
16. Larsson K, Loof L, Ronnblom A, et al. Quality of life for patients with exacerbation in inflammatory bowel disease and how they cope with disease activity. J Psychosom Res 2008;64:139-148.
 
17. Schwarz SP, Blanchard EB. Evaluation of a psychological treatment for inflammatory bowel disease. Behav Res Ther 1991;29:167-177.
 
18. van der Zaag-Loonen HJ, Grootenhuis MA, et al. Coping strategies and quality of life of adolescents with inflammatory bowel disease. Qual Life Res 2004;13:1011-1019.