Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability

Objective To examine the relative contributions of disease activity and psychological factors to self-reported symptoms and disability in children with Crohn's disease. Study design Participants (n=127 children age 8-18 years) completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs and coping. Disease activity was measured by the Pediatric Crohn's Disease Activity Index. Structural equation modeling was used to test the effects of disease activity and psychological factors on symptoms and disability. Results In the hypothesized model predicting symptoms, psychological factors (β=0.58; P<.001) were significantly associated with disease symptoms but disease activity was not. The model for disability yielded significant associations for both psychological factors (β=0.75; P<.001) and disease activity (β=0.61, P<.05). Conclusion Crohn's disease symptoms in children and adolescents are not only driven by disease activity. Coping, anxiety, depression, and cognition of illness are important in the patient-reporting of symptom severity and disability. Physicians need to be aware that symptom self-reporting can be driven by psychological factors and may not always be simply an indicator of disease activity. Trial registration ClinicalTrials.gov: NCT00679003.