Inflammatory bowel disease (IBD) represents a group of intestinal disorders that includes two main forms, Crohn's disease (CD) and ulcerative colitis (UC). The presence of psychological comorbidities in IBD is clearly documented. Earlier studies have shown that IBD impacts on health connected quality of life and represents a potential risk factor for anxiety and depression.
The present research aims to investigate the role of resilience in protecting patients with inflammatory bowel disease from developing anxiety and depression after IBD diagnosis and treatment.
Resilience represents the individual's ability to successfully adapt to changes, to resist the negative impact of traumatic events or stressful situations, and to avoid the appearance of significant psychological distress. We know from earlier studies that high levels of resilience can attenuate the emotional distress induced by traumatic events. We therefore expect that IBD severity will significantly predict higher level of anxiety and depression, but this effect should become weaker as resilience levels increase.
A sample of about 200 patients affected by IBD will be involved in the study. Resilience will be assessed by the Connor-Davidson Resilience Scale. Depression and anxiety symptoms will be measured by using the Hospital Anxiety and Depression Scale. The clinical disease activity of IBD patients will be assessed according to the Harvey-Bradshaw index for CD patients, and the clinical Mayo Score for UC patients. A moderated regression analysis will be applied in order to test the study hypotheses. To the best of our knowledge, this is the first attempt to examine the protective role of resilience against anxiety and depression among IBD patients.
The current project contributes to the extant literature in several ways.
Several studies have documented the beneficial effects of resilience among patients suffering from different types of illness. For example, Sharpley, Wootten, Bitsika and Christie (2013) have shown that resilience can act as a ¿buffer¿ against depression among prostate cancer patients during the five years following the diagnosis. Other studies have shown that resilience predict a better quality of life in patients with chronic diseases (e.g., Elsenbruch 2011; Farber et al., 2000; Helgeson, Reynolds, & Tomich, 2006; Robottom et al., 2012; Sirois & Hirsch, 2013; Zoccali et al. 2006).
To the best of our knowledge, however, no studies have so far investigated the protective role of resilience against depression and anxiety among IBD patients. Given the increase in IBD among the general population (M¿Koma, 2016), and the detrimental consequences it may imply for physical and psychological health (Sainsbury & Heatley, 2005), it is important to identify factors that may protect against the development of emotional distress in IBD patients.
Data from a recent study (Sehgal et al., 2021) has shown that high levels of resilience are associated with lower disease activity and better quality of life in IBD patients. This is an important finding. However, a distinction should be made between promotive and protective effects. Although the two have often been used interchangeably, there are important differences (Farrington, 1988). Promotive factors, as opposite to risk factors, refer to those variables (or conditions) that predict a lower probability of negative outcomes. This effect is commonly investigated by examining whether the promoting variable (e.g., resilience) is statistically related to the outcome of interest (e.g., emotional distress), using for example linear regression. Most studies on resilience, like the one by Sehgal et al. (2021), have focused on promotive effects.
Protective factors, by contrast, refers to variables (or conditions) that moderate the negative effects of risk factors on a given outcome. When a risk factor (e.g., IBD) is present, the probability of negative outcomes (e.g., emotional distress) decreases as the protective factor (e.g., levels of resilience) increases. This effect can be tested by examining the statistical interaction between risk and promotive factors, including a multiplicative term in a moderated multiple regression (e.g., Rutter, 1987). Few studies have focused on the protective effect of resilience. To the best of our knowledge, this is the first attempt to examine the protective role of resilience against anxiety and depression among IBD patients and, more in general, among patients suffering from chronic diseases.
The present study could have important clinical implications. Although resilience is often seen to possess trait-like characteristics, longitudinal research suggests it is a dynamic construct that is modifiable (Montpetit, et al., 2010). Therefore, resilience of IBD patients can be encouraged and increased through specific psychological interventions. Good and timely resilience treatment could provide protection against adversity in both acute and chronic conditions, improve patients' quality of life and improve their adaptation to the disease.
Selected bibliography
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Dixon, L.J., Kabi, A., Nickerson, K.P., McDonald, C. Combinatorial effects of diet and genetics on inflammatory bowel disease pathogenesis. Inflamm. Bowel Dis. 2015, 21, 912¿922.
García-Alanís M, Quiroz-Casian L, Castañeda-González H, Arguelles-Castro P, Toapanta-Yanchapaxi L, Chiquete-Anaya E, Sarmiento-Aguilar A, Bozada-Gutiérrez K, Yamamoto-Furusho JK. Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease. Gastroenterol Hepatol. 2021; 44(3):206-213.
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