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The Psychosocial Adjustment to Illness in Irritable Bowel Syndrome

By: Dan. L. Dumitrascu, M.D., Ph.D., Mihaela Stanculete, Adriana Farcas, and Debora Nechifor, Third Department of Internal Medicine and Gastroenterology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, Romania

Abstract

Irritable bowel syndrome (IBS) is a disabling condition that impairs the quality of life of patients. A psychological feature called psychosocial adjustment to illness allows some patients to better cope with their illness. Psychosocial adjustment to illness can be quite significantly impaired with many chronic conditions, including IBS. We investigated this feature in females with IBS.

Introduction

Quality of life is frequently impaired in patients with chronic gastrointestinal symptoms.[1-3] The self-perception of the quality of life depends on the patients' own abilities to cope with the distress of the illness. Usually individuals who are better able to adjust to their illness perceive the quality of life as being higher. A poor psychosocial adjustment to illness, in turn, reflects a more severe impairment of the quality of life.

The adjustment to illness is impaired to varying degrees in all patients with GI illnesses including those with upper gastrointestinal symptoms[4], as well as IBS.[5-8] These are chronic conditions that affect personal well-being in ways that impact on professional, family, and social activities. Therefore we decided to study the degree to which women with IBS had impaired psychological adjustment to their illness.

Discussion

Irritable bowel syndrome includes several digestive symptoms that can be chronic or recurrent.[14,15] As such, they are potentially able to impair quality of life.[6,16,17] Measures of psychological adjustment to illness reflect the impact of medical disease on quality of life. The PAIS-SR, an instrument of proven value,[12,18] has been used to study patients with dyspepsia,[4] as well as adjustment to illness in other medical conditions.[12,19,20] This study is the first to use this questionnaire in patients with irritable bowel syndrome.

The patients with IBS showed impaired psychosocial adjustment to illness and reported higher scores in the following domains: health care orientation, vocational environment, domestic environment, sexual relationships, social environment, and psychological distress. Only the domain, extended family relationships, had higher scores not reaching the level of significance.

This study was conducted on European patients. It has been reported that differences in psychological adjustment and perception of illness between different cultures might be encountered in severe organic diseases.[21] Therefore, further studies among U.S. females would be needed to confirm these findings. Nevertheless, we believe that similar results are likely to be found because of their similar clinical features.

The impairment of the adjustment to illness is not specific to the patients with IBS only. The scores of the illness adjustment were similar in females with angina pectoris, who were almost free of digestive symptoms. The patients with angina pectoris presented similar alteration of the adjustment to illness. It seems that the impaired adjustment to illness is not a feature of gastrointestinal suffering, but is rather a consequence of chronic illness.

Conclusion

In female patients with chronic abdominal symptoms due to IBS, psychological adjustment to illness is impaired. This alteration is not specific to IBS and can be found in patients with other chronic diseases. Poor illness adjustment also means low quality of life. The approach to patients with impaired psychosocial adjustment to illness should include work with patients as a means to help improve coping strategies.

References

  1. Wilhelmsen I, Berstad A. Quality of life and relapse of duodenal ulcer before and after eradication of Helicobacter pylori. Scand J Gastroenterol 1994, 29: 874-879.
  2. Talley NJ, Wearer AL, Zinsmeister AR. Impact of functional dyspepsia on quality of life. Dig Dis Sci 1995, 40: 584-589.
  3. Chassany O, Marquis P, Scherrer B, Read N, Finger T, Bergmann JF, Fraitag B, Geneve J, Caulin C. Validation of a specific quality of life questionnaire for functional digestive disorders. Gut 1999, 44: 527-533.
  4. Wilhelmsen I. Quality of life in upper gastrointestinal disorders. Scand J Gastroenterol 1995,30, Suppl. 211,21-25.
  5. Hahn BA, Songkai Y, Strassels S. Impact of irritable bowel syndrome on quality of life and resource use in the United States and United Kingdom. Digestion 1999, 60: 77-81.
  6. Hahn BA, Kirchdoerfer LJ, Fullerton S, Mayer E. Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life. Aliment Pharmacol Ther 1997, 11:553-559.
  7. Patrick DL, Drossman DA,Frederick IO, DiCesare J,Puder KL. Quality of life in persons with irritable bowel syndrome. Development and validation of a new measure. Dig Dis Sci 1998, 43: 400-411.
  8. Wilhemsen I, Bakke A, Tangen Haug T, Endresen IM, Berstad A. Psychological adjustment to stress (PAIS-SR) in a Norwegian material of patients with functional dyspepsia, duodenal ulcer and urinary bladder dysfunction. Clinical validation of the instrument. Scand J Gastroenterol 1994, 29:611-617.
  9. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut 1999, 45, Suppl. II, II43-II47.
  10. Dumitrascu DL, Barnert J, Kirchner T, Wienbeck M. Antral emptyng of semisolid meal measured by real-time ultrasonography in chronic renal failure. Dig Dis Sci 1995, 40: 636-644.
  11. Barnert J, Dumitrascu DL Wienbeck M. Dyspepia in AIDS is correlated to ultrasonograpic changes of antral distension. Eur J Ultrasound 2000, 11: 189-197.
  12. Derogatis LR, Derogatis MF. PAIS ands PAIS-SR. Administration, scoring and procedures manual-II. Clin Psychom Res Inc., Towson, Md, 1990.
  13. Derogatis LR. The psychological adjustment to illness scale (PAIS). J Psychosom Res 1986, 30: 77-97.
  14. Slepoy VD, Pezzotto SM, Kraier L, Burde L, Wohlwend K, Razzari E, Poletto L. Irritable bowel syndrome. Clinical and psychopathological correlations. Dig Dis Sci 1999, 44: 1008-1012.
  15. Talley NJ. Irritable bowel syndrome: definition, diagnostic and epidemiology. Bailliere's Best Pract Res Clin Gastroenterol 1999, 13: 371-384.
  16. Whitehead WE, Bosmajian L, Zondermann AB, Costa PT, Schuster MM. Symptoms of psychological distress associated with irritable bowel syndrome. Gastroenterology 1988, 95, 709-714.
  17. Drossman DA, Creed FH, Fava GA, Olden KW, Patrick DL, Toner BB, Whitehead WE. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterol Int 1995, 8: 2-44
  18. Rodrigues JR, Kanasky Jr WF, Jackson SI, Perri MG. The Psychological adjustment to illness scale-self report: factor structure and item stability. Psychol Assess 2000, 12: 409-413.
  19. Peleg-Oren N, Sherer M, Soskolny V. Effect of gender on the social and psychological adjustment of cancer patients. Soc Work Health 2003, 37: 17-34.
  20. Weir R, Browne G, Tunks F, Gafni A, Roberts J. Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used. Clin J Pain 1996, 12: 277-290.
  21. Erbil P, Razvi D, Farvacques C, Bilge N, Paesmans M, Van Houtte P. Cancer patients psychological adjustment and perception of illness: cultural differences between Belgium and Turkey. Support Care Cancer 1996, 4: 456-461.

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Last modified on August 6, 2007 at 11:08:59 AM