Psychological well-being is the major determinant of global health in the first year following a diagnosis of inflammatory bowel disease in children

Inflammatory bowel disease (IBD) represents a group of disorders with no known cure. IBD is impacted by biopsychosocial factors. The burden, psychosocial difficulties, and gene-environment interaction involved in the manifestation of IBD necessitate a fuller understanding of factors which worsen or ameliorate IBD. Case complexity (CC) captures current and historical biopsychosocial risks for individuals with IBD and holds promise for understanding variation in treatment response and individuals' experiences with IBD. The present study aimed to understand the relative contributions of: 1) historical vs. current factors impacting CC in predicting global health; and 2) biological, psychological, social, family, and health system factors on global health. Within a longitudinal design, 8–17-year-old youth ( N = 83) completed the self-report Pediatric Global Health 7 + 2 at diagnosis (baseline) and 4- and 12 months post-diagnosis. The p-IBD-INTERMED, a clinical-decision support tool, which standardizes inter-professional assessment of biopsychosocial risks contributing to CC was completed by the healthcare provider team at the same timepoints. CC was associated with global health at all time points (T1 r = −0.27; T2 r = −0.42; T3 r = −0.50). Hierarchical regression revealed that across time the relative contribution of historical CC was surpassed by current CC when predicting global health (at T1 β HCC= -0.13 ; β CCC = −0.17; at T3 β HCC = -0.04; β CCC = −0.48). In this cohort, at 4- and 12-months post diagnosis, psychological factors were the only domain of current CC to significantly predict global health, accounting for 29.1 % and 24.1 % of its variance respectively. Findings suggest that the global health of patients with IBD is not fixed by early life experiences. Background Inflammatory bowel disease (IBD) represents a prevalent group of disorders with no known cure. IBD is impacted by myriad biopsychosocial factors. The pervasive burden, pronounced psychosocial difficulties, and the potential gene-environment interaction involved in the manifestation of IBD necessitate a fuller understanding of factors which might worsen or ameliorate IBD. Case complexity (CC) captures current and historical biopsychosocial risks for individuals with IBD and holds promise for understanding variation in treatment response and individuals' experiences with this chronic illness. Aims We sought to understand the relative contributions of: 1) historical vs. current factors impacting CC in predicting global health (self-reported); and 2) biological, psychological, social, family, and health system factors on global health. Methods Within a longitudinal design, 8–17-year-old youth ( N = 83) completed the self-report Pediatric Global Health 7 + 2 at diagnosis (baseline) and 4- and 12 months post-diagnosis. The p-IBD-INTERMED, an interview-based measure of CC, was completed by the healthcare provider team at the same timepoints. Results CC was associated with global health at all time points (T1 r = −0.27; T2 r = −0.42 ; T3 r = −0.50). Hierarchical regression revealed that across time points the relative contribution of historical CC was surpassed by current CC when predicting global health (at T1 β HCC= − 0.13 ; β CCC= − 0.17 ; at T3 β HCC= − 0.04 ; β CCC= − 0.48). In this cohort of newly diagnosed children that had good medical response by one-year post diagnosis, at 4- and 12-months post diagnosis, psychological factors were the only domain of current CC to significantly predict global health, accounting for 29.1 % and 24.1 % of its variance respectively. Discussion Findings suggest that the global health of IBD patients is not fixed by early life experiences and shed light onto potential psychosocial treatment targets.

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