Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis

Vari Wileman; Joseph Chilcot; Christine Norton; Ailsa Hart; Laura Miller; Imogen Stagg; Natasha Seaton; Richard Pollok; Qasim Aziz; Rona Moss-Morris

doi:10.1093/ecco-jcc/jjae183

Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis

Vari Wileman, Joseph Chilcot, Christine Norton, Ailsa Hart, Laura Miller, Imogen Stagg, Natasha Seaton, Richard Pollok, Qasim Aziz, Rona Moss-Morris

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Abstract

BACKGROUND: Inflammatory bowel disease (IBD) causes fatigue, pain and faecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways.

METHODS: This study was nested within a randomised controlled trial of a digital symptom intervention for people with IBD (n=780). Latent profile analysis (LPA) was conducted on pre-randomisation baseline measures of fatigue, pain, and faecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors.

RESULTS: LPA determined a three-profile model: Moderate (50%), High (40%) and Severe symptoms (10%). Diagnosis and faecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis and IBS-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviours significantly increased the relative risk of High and Severe symptoms profile membership.

CONCLUSIONS: Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioural factors. These factors were also associated with IBS-type symptoms. Recognising the potential impact of cognitive behavioural factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioural interventions to enhance patient care and improve outcomes.

Original language	English
Journal	Journal of Crohn's and Colitis
Early online date	5 Dec 2024
DOIs	https://doi.org/10.1093/ecco-jcc/jjae183
Publication status	E-pub ahead of print - 5 Dec 2024

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Wileman, V., Chilcot, J., Norton, C., Hart, A., Miller, L., Stagg, I., Seaton, N., Pollok, R., Aziz, Q., & Moss-Morris, R. (2024). Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis. Journal of Crohn's and Colitis. Advance online publication. https://doi.org/10.1093/ecco-jcc/jjae183

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title = "Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis",

abstract = "BACKGROUND: Inflammatory bowel disease (IBD) causes fatigue, pain and faecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways.METHODS: This study was nested within a randomised controlled trial of a digital symptom intervention for people with IBD (n=780). Latent profile analysis (LPA) was conducted on pre-randomisation baseline measures of fatigue, pain, and faecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors.RESULTS: LPA determined a three-profile model: Moderate (50%), High (40%) and Severe symptoms (10%). Diagnosis and faecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis and IBS-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviours significantly increased the relative risk of High and Severe symptoms profile membership.CONCLUSIONS: Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioural factors. These factors were also associated with IBS-type symptoms. Recognising the potential impact of cognitive behavioural factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioural interventions to enhance patient care and improve outcomes.",

author = "Vari Wileman and Joseph Chilcot and Christine Norton and Ailsa Hart and Laura Miller and Imogen Stagg and Natasha Seaton and Richard Pollok and Qasim Aziz and Rona Moss-Morris",

note = "{\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of European Crohn{\textquoteright}s and Colitis Organisation.",

year = "2024",

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day = "5",

doi = "10.1093/ecco-jcc/jjae183",

language = "English",

journal = "Journal of Crohn's and Colitis",

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Wileman, V , Chilcot, J , Norton, C, Hart, A, Miller, L, Stagg, I, Seaton, N, Pollok, R, Aziz, Q & Moss-Morris, R 2024, 'Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis', Journal of Crohn's and Colitis. https://doi.org/10.1093/ecco-jcc/jjae183

TY - JOUR

T1 - Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease

T2 - a latent profile analysis

AU - Wileman, Vari

AU - Chilcot, Joseph

AU - Norton, Christine

AU - Hart, Ailsa

AU - Miller, Laura

AU - Stagg, Imogen

AU - Seaton, Natasha

AU - Pollok, Richard

AU - Aziz, Qasim

AU - Moss-Morris, Rona

PY - 2024/12/5

Y1 - 2024/12/5

N2 - BACKGROUND: Inflammatory bowel disease (IBD) causes fatigue, pain and faecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways.METHODS: This study was nested within a randomised controlled trial of a digital symptom intervention for people with IBD (n=780). Latent profile analysis (LPA) was conducted on pre-randomisation baseline measures of fatigue, pain, and faecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors.RESULTS: LPA determined a three-profile model: Moderate (50%), High (40%) and Severe symptoms (10%). Diagnosis and faecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis and IBS-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviours significantly increased the relative risk of High and Severe symptoms profile membership.CONCLUSIONS: Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioural factors. These factors were also associated with IBS-type symptoms. Recognising the potential impact of cognitive behavioural factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioural interventions to enhance patient care and improve outcomes.

AB - BACKGROUND: Inflammatory bowel disease (IBD) causes fatigue, pain and faecal urgency/incontinence symptoms. Identifying symptom profile subgroups and related psychological correlates might enable earlier intervention and more effective tailored treatment pathways.METHODS: This study was nested within a randomised controlled trial of a digital symptom intervention for people with IBD (n=780). Latent profile analysis (LPA) was conducted on pre-randomisation baseline measures of fatigue, pain, and faecal incontinence. Multinominal logistic regression examined associations between profile membership and clinical, demographic and psychological factors.RESULTS: LPA determined a three-profile model: Moderate (50%), High (40%) and Severe symptoms (10%). Diagnosis and faecal calprotectin were not associated with profile membership, but female gender, comorbidity, time since diagnosis and IBS-type symptoms were associated with High and Severe symptoms profiles. Depression, anxiety, negative symptom perceptions, all-or-nothing and avoidance behaviours significantly increased the relative risk of High and Severe symptoms profile membership.CONCLUSIONS: Many participants experienced symptoms even when deemed to be in clinical remission. After controlling for clinical, inflammatory, and demographic factors, the relative risk of High or Severe symptom profile membership was associated with potentially modifiable cognitive behavioural factors. These factors were also associated with IBS-type symptoms. Recognising the potential impact of cognitive behavioural factors in exacerbating symptoms can lead to earlier identification of patients who require support and allows treatment plans to be tailored more precisely. The findings from this study promote a more integrated approach to IBD management, combining medical treatment with cognitive behavioural interventions to enhance patient care and improve outcomes.

U2 - 10.1093/ecco-jcc/jjae183

DO - 10.1093/ecco-jcc/jjae183

M3 - Article

C2 - 39656929

SN - 1873-9946

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

ER -

Modifiable psychological factors are associated with clusters of pain, fatigue, faecal incontinence and IBS-type symptoms in inflammatory bowel disease: a latent profile analysis

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