Children with bowel disease prone to emotional problems

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According to a new study, more than one-third of children with mild inflammatory bowel disease (IBD) also suffered from psychological problems, such as symptoms of anxiety and depression.

Also, parents of children with the disease reported that their children had more problems socially than did parents of healthy children, said Laura Mackner, a study co-author and an assistant professor of pediatrics at Ohio State University.

Mackner and her colleague, Wallace Crandall, an assistant professor of clinical pediatrics at Ohio State University, compared the psychological health of 41 children with mild IBD to 27 healthy children in the areas of body image, self-esteem and behavioral, emotional, social, school and family functioning. The children with IBD had been diagnosed at least a year before the study began.
“The strength of family relationships, along with a higher self-esteem may play more important roles than having active IBD. Children with poor family relationship and lower self-esteem may be at greater risk of developing behavioral and emotional problems, even with mild IBD.”

“We thought these patients would be doing pretty well in managing all aspects of their disease, given that they had had the condition for at least a year and that they only had mild symptoms at the time of the study,” Crandall said. “We were surprised to find so many with psychological issues.”

The researchers took their study a step further, and analyzed the behavior, emotional and social functioning of 50 children with active IBD as well as those in remission. They wanted to see if there was a relationship between these factors and the severity of the illness, family functioning and self-esteem.

Mackner reported the team’s findings August 8 in Toronto at the annual meeting of the American Psychological Association.

Inflammatory bowel disease is really a group of chronic intestinal disorders, and the course of the disease is often unpredictable. Symptoms result from inflammation of the bowel, and may include abdominal pain, bleeding and diarrhea. Children diagnosed with IBD are often given a combination of medications, including drugs that affect the immune system, with side effects that range from mild to severe, such as vomiting, diarrhea, rash, hair loss, pancreatitis, bone loss and decreased white blood cell counts.

Children ages 11 to 17 and their parents and teachers were asked to complete questionnaires. Questions covered self-esteem, body image and behavioral, emotional, social, school, and family functioning. Parents were asked to rate how their child behaved socially and emotionally at home, while teachers were asked to describe each child’s behavior at school. The children described themselves by filling out a self-esteem and body image checklist.

According to parental reports, more than three times as many children with mild IBD had significant behavioral and emotional problems as compared to healthy children. Such problems included being withdrawn, anxious or depressed. Similarly, teachers of children with IBD reported that these students had more attention problems and were absent from school one-and-a-half times as often as healthy children.

Also, none of the parents of the healthy children reported that their child suffered from social problems, while 17 percent of parents of children with IBD indicated that their child had experienced social problems, such as being withdrawn and getting teased. Interestingly, there wasn’t a large difference in self-esteem and body image between the healthy children and the children with the disease.

“We don’t know much about body image, self-esteem and overall social functioning in children with IBD,” Crandall said, adding that, in the future, he and Mackner want to study the psychological functioning of children newly diagnosed with IBD.

The researchers did find that children with IBD who had stronger family relationships and higher self-esteem also had better behavioral and emotional functioning.

“In this case, the strength of family relationships, along with a higher self-esteem may play more important roles than having active IBD,” Mackner said. “Children with poor family relationship and lower self-esteem may be at greater risk of developing behavioral and emotional problems, even with mild IBD.”

In contrast, the researchers also found that having active IBD could be more important than family factors or self-esteem when it comes to social functioning.

“Better family relationships and higher self-esteem may not buffer the impact that having active IBD has on social functioning,” Mackner said.

“Now we want to know what happens psychologically from the very beginning,” she continued. “Research on adults with IBD has shown that patients with better coping skills and less psychological distress have fewer hospitalizations and visits to the doctor’s office.”

“While medication is necessary in controlling IBD, psychosocial interventions may help improve the course of the disease,” Crandall said.

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