Role of Social and Psychological Factors in Determining Severity of Disease in Adult Patients With Crohn's Disease

Michael Friger, Orly Sarid, Dan Greenberg, Hillel Vardi, Doron Schwartz, Vered Slonim-Nevo, Selwyn H. Odes

Research output: Contribution to journalMeeting Abstractpeer-review


Introduction. Crohn's disease (CD) is an idiopathic, incurable inflammatory disease of the gastrointestinal tract. Early onset (age ≤40 years) and a stricturing/penetrating phenotype generally imply more severe disease. We hypothesize that social and psychological factors too might impact on disease severity, and their early recognition could help to improve the prognosis of patients. Methods. Adult CD patients were assessed at follow-up for demography and current clinical status, including the Harvey-Bradshaw Index of disease severity (HBI) expanded to incorporate medications, hospitalizations and surgeries. Patients completed the following questionnaires: SF-36 generic Quality of Life (4 physical and 4 mental health scales), and Carver's Brief COPE Inventory (14 domains). Based on these data, and dividing patients into 2 age groups (Montreal classification), we built a multifactorial model using
multivariate linear regression. Results. The cohort comprised 322 patients, 129 men (40.1%) and 193 women (59.9%), with mean age (SD) 38.2 (14.7) years. Main socio-economic characteristics were as follows: marital status: married 52.8%, single 34%, divorced 7.1%; economic status: poor 13.8%, moderate 49.4%, good 26.1%; religion: Jewish 92.3%, Muslim 3.4%. Expanded HBI scores were: onset ≤40y, mean 14.7 (7.9), range 2 - 41; onset >40y, mean 13.8 (6.4), range 2 - 39 (p = ns). By univariate analysis, there were significant differences for the following scales, shown in order as disease onset ≤40y (210 patients) and disease onset >40y (112 patients), mean (SD), respectively: SF36: Social functioning 63.3 (29.1) and 72.8 (25.9), COPE: Positive reframing 5.3 (1.8) and 4.8 (1.8), COPE: Substance use 2.6 (1.4) and 2.3 (0.9). In the regression model for disease onset ≤40y, the adjusted R square was 0.159, and the following variables (beta given in brackets) impacted significantly on disease severity: SF36: Social functioning (-0.23), SF36: General health (-0.19), COPE: Positive reframing (0.21). By contrast, in the model for disease onset >40y, adjusted R square 0.353, the variables impacting significantly on disease severity were: SF36: Social functioning (-0.23), SF36: General health (-0.39), COPE: Emotional support (0.24), Economic status 0.23. However, no associations of gender, marital status and religion with severity were found. Conclusions. All of the considered factors - socio-demographic, quality of life and coping skills - significantly impacted on the severity of Crohn's disease. Moreover, economic status, and certain SF36 and COPE scales show significant interaction with age
in their associations with Crohn's disease severity. These findings require attention in the clinical setting.
Original languageEnglish GB
Pages (from-to)S247-S247
Issue number4
StatePublished - Apr 2015


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