Post-traumatic stress in Crohn's disease and its association with disease activity
- Rafael J A Cámara,
- Marie-Louise Gander,
- Stefan Begré,
- Roland von Känel,
- Swiss Inflammatory Bowel Disease Cohort Study Group
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
- Correspondence to Professor R von Känel, Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland;
Contributors RJAC, SB and RvK developed the hypothesis and the study design. RJAC presented the data and drafted the manuscript. RJAC and M-LG analysed and interpreted the findings and performed the literature search. SB and RvK supervised the project. All authors participated in the literature search, revised the manuscript critically and approved the final version.
- Accepted 15 October 2010
- Published Online First 1 December 2010
Objective Violence, accidents and natural disasters are known to cause post-traumatic stress, which is typically accompanied by fear, suffering and impaired quality of life. Similar to chronic diseases, such events preoccupy the patient over longer periods. We hypothesised that post-traumatic stress could also be caused by Crohn's disease (CD), and that CD specific post-traumatic stress could be associated with an increased risk of disease exacerbation.
Methods A cohort of CD patients was observed over 18 months in various types of locations providing gastroenterological treatment in Switzerland. The cohort included 597 consecutively recruited adults. At inclusion, CD specific post-traumatic stress was assessed using the Post-traumatic Diagnostic Scale (range 0–51 points). During follow-up, clinical aggravation was assessed by combining important outcome measures. Patients with post-traumatic stress levels suggestive of a post-traumatic stress disorder (≥ 15 points) were compared with patients with lower post-traumatic stress levels as well as with patients without post-traumatic stress. Also, the continuous relation between post-traumatic stress severity and risk of disease exacerbation was assessed.
Results The 88 (19.1%) patients scoring ≥15 points had 4.3 times higher odds of exacerbation (95% CI 2.6 to 7.2) than the 372 (80.9%) patients scoring <15 points, and 13.0 times higher odds (95% CI 3.6 to 46.2) than the 45 (9.8%) patients scoring 0 points. The odds of exacerbation increased by 2.2 (95% CI 1.6 to 2.8) per standard deviation of post-traumatic stress.
Conclusions CD specific post-traumatic stress is frequent and seems to be associated with exacerbation of CD. Thus gastroenterologists may want to ask about symptoms of post-traumatic stress and, where relevant, offer appropriate management according to current knowledge.
Funding This work was supported by grant 33CSCO-108792 from the Swiss National Science Foundation to RvK and SB (Mental Health Core Project of the Swiss inflammatory Bowel Disease Cohort study). The funding source was not involved in data collection, management, analysis, interpretation or writing, or in the decision to submit the manuscript for publication.
Competing interests None.
Ethics approval This study was conducted with the approval of the Lausanne University Ethics Committee, Kantonale Ethikkommission Bern, Ethikkommission beider Basel, Ethikkommission des Kantons St Gallen, Kantonale Ethikkommission Zürich and Commission Centrale d'Éthique de la Recherche.
Provenance and peer review Not commissioned; externally peer reviewed.