From the Guidelines
Having Crohn's disease has significant psychological and spiritual implications, including a high incidence of anxiety, depression, and distress, which can impact daily life and health-related quality of life.
Psychological Implications
- The disease can cause embarrassment, hospitalization, and fears and concerns about the uncertain origin and course of the disease 1
- Anxiety and depression are common in IBD and are associated with poorer outcomes, including the need for hospitalization 1
- One-fifth of patients experience depression and one third experience anxiety 1
- Disease-related distress is a phenomena distinct from psychological morbidities such as anxiety, depression or stress 1
Spiritual Implications
- The disease can impact physical, emotional, and social well-being, leading to a significantly lower health-related quality of life (HRQoL) compared to the general population 1
- Patients may feel stigmatized by IBD, often because it is a bowel disorder, which others may perceive as dirty, or because of associated fatigue, which others may misinterpret as laziness 1
- Self-blame regarding the onset of IBD can lead to poorer adjustment to the disease and reduced HRQoL during remission and relapse 1
Management and Support
- Nurses caring for patients with IBD need to be aware of the psychological impact of IBD, including anxiety, depression and distress, and offer onward referral to appropriate specialist support services if necessary 1
- Brain–gut psychotherapies, including cognitive-behavior therapy (CBT) and gut-directed hypnotherapy, can reduce the symptom burden and improve coping, resilience, and self-regulation skills 1
- Routine screening for signs of psychological morbidity is recommended, with referral to formal psychological counselling and support for those patients demonstrating higher levels of concern 1
From the Research
Psychological Implications
- Studies have shown that Crohn's disease is associated with higher levels of psychological distress, including depression and anxiety 2.
- Personality characteristics such as depression, anxiety, and dependency are frequently reported in patients with Crohn's disease 3.
- The occurrence of stressful life events and the presence of psychopathology are also common in patients with Crohn's disease 3.
- Patients with Crohn's disease may experience alterations in personality functioning, including differences in self-perception and regulation 2.
Spiritual Implications
- Religiousness and spirituality have been associated with better mental health and quality of life in patients with inflammatory bowel disease, including Crohn's disease 4, 5.
- Positive religious and spiritual coping strategies may be beneficial for patients with Crohn's disease, while negative coping strategies may be associated with worse mental health outcomes 5.
- Health professionals should be aware of the religious and spiritual beliefs of their patients, as these beliefs may impact the disease course 4.
Relationship between Psychological and Spiritual Implications
- Social aspects, such as employment status and family income, may influence psychological well-being, resilience, and coping in patients with Crohn's disease more strongly than clinical aspects 6.
- Patients with Crohn's disease may use different coping strategies, such as self-control, positive revaluation, and escape and avoidance, depending on their social and clinical characteristics 6.
- The relationship between psychological and spiritual implications in Crohn's disease is complex and may involve multiple factors, including personality characteristics, stressful life events, and coping strategies 3, 6, 2.