The personality traits activity, self-reproach, and negative affect jointly predict clinical recurrence, depressive symptoms, and low quality of life in inflammatory bowel disease patients

Abstract

Background: The bidirectional "gut-brain axis" has been implicated in the pathogenesis of inflammatory bowel diseases (IBD). While the influence of stress and depressive symptoms on IBD is well-characterized, the role of personality remains insufficiently investigated.

Methods: Personality was assessed in 1154 Swiss IBD cohort study (SIBDCS) patients via the NEO-Five-Factor Inventory (NEO-FFI) as well as in 2600 participants of the population-based CoLaus¦PsyCoLaus cohort study (NEO-FFI-revised). The NEO-FFI subcomponents activity, self-reproach and negative affect were associated with higher IBD disease activity and were combined to a NEO-FFI risk score. This risk score was validated and its effect on clinical IBD course and psychological endpoints was analysed in time-to-event and cumulative incidence analyses.

Results: In time-to-event analyses, a high NEO-FFI risk score was predictive for the clinical endpoints of new extraintestinal manifestation [EIM, adjusted hazard ratio (aHR) = 1.64, corrected p value (q) = 0.036] and two established composite flare endpoints (aHR = 1.53-1.63, q = 0.003-0.006) as well as for the psychological endpoints depressive symptoms (aHR = 7.06, q < 0.001) and low quality of life (aHR = 3.06, q < 0.001). Furthermore, cumulative incidence analyses showed that patients at high NEO-FFI risk experienced significantly more episodes of active disease, new EIMs, one of the flare endpoints, depressive episodes and low disease-related quality of life. Personalities of IBD patients showed only minor differences from the general population sample (Pearson's r = 0.03-0.14).

Conclusions: Personality assessed by the NEO-FFI contained considerable predictive power for disease recurrence, depressive symptoms and low quality of life in IBD patients. Nevertheless, the personalities of IBD patients did not substantially differ from the general population.

Keywords: Five-factor model; Flares; IBD; NEO-FFI; Personality.

Fig. 1

Analysis concept. Flow chart illustrating the order of analysis steps (indicated by grey numbers) and consequent separation of training and validation data (indicated by the vertical dashed line). IBD inflammatory bowel disease, NEO-FFI NEO five-factor inventory, SIBDCS swiss IBD cohort study

Fig. 2

Personality domains and NEO-FFI risk scores of IBD patients and population-based controls. Density plots for the personality domains Neuroticism (a), Extraversion (b), Openness (c), Agreeableness (d) and Conscientiousness (e) as well as for the NEO-FFI risk score (f) stratified for the indicated cohorts. Red/blue dashed lines indicate median score values. Analyses: Mann–Whitney U test. NEO-FFI NEO five-factor inventory, p p value, r Pearson’s r, SIBDCS swiss IBD cohort study, U U statistic

Fig. 3

High NEO-FFI risk increases the hazards for clinical deterioration. Kaplan Meier curves corrected for confounders including Type D personality (see methods) for active disease (a), new EIMs (b) FNCE flares (c), AFFSST flares (d), depressive symptoms (e) and low IBDQ (f) are presented. For the graphics, IBD patients are stratified into 5 groups according to NEO-FFI risk score 20 percentile intervals. The estimates describe the comparison of the high NEO-FFI risk group with the low NEO-FFI risk group (cut-off 11.3). Depressive symptoms were defined as HADS-D ≥ 11. Low IBDQ was defined as values below 170. Analyses: multivariable Cox proportional hazards models. AFFSST active disease, physician-reported flare, new fistula, new stenosis, surgery, or new systemic therapy, aHR adjusted hazard ratio, CDAI Crohn’s disease activity index, CI confidence interval, EIM extraintestinal manifestation, FNCE physician reported flare, non-response to therapy, HADS hospital anxiety and depression scale, IBD inflammatory bowel disease, IBDQ inflammatory bowel disease questionnaire, MTWAI modified truelove and witts severity index, NEO-FFI NEO five-factor inventory

Fig. 4

High NEO-FFI risk increases the cumulative burden of disease. Plots illustrating the cumulative incidence counts (left) and the differences of cumulative incidence for different endpoints between low and high NEO-FFI risk groups (right) for active disease (a), new EIMs (b) FNCE flares (c) and AFFSST flares (d) in IBD patients. Dotted lines in the left plots indicate the maximal values observed and the red dashed line in the right plots mark the zero-difference line. Overlap of the zero-difference line and the 95% confidence interval indicates a lack of significance. Results were obtained by bootstrapping with 1000-fold resampling. Analyses: cumulative incidence analyses. AFFSST active disease, physician-reported flare, new fistula, new stenosis, surgery or new systemic therapy, CDAI Crohn’s disease activity index, CI confidence interval, EIM extraintestinal manifestation, FNCE physician reported flare, non-response to therapy, new complication or EIM, IBD inflammatory bowel disease, MTWAI modified truelove and witts severity index, NEO-FFI NEO five-factor inventory

Fig. 5

High NEO-FFI risk increases the cumulative psychological burden of disease. Plots illustrating the cumulative incidence counts (left) and the differences in cumulative incidence between low and high NEO-FFI risk groups (right) for depressive symptoms (a) and low IBDQ (b) in IBD patients. Dotted lines in the left plots indicate the maximal values observed and the red dashed line in the right plots mark the zero-difference line. Overlap of the zero-difference line and the 95% confidence interval indicates a lack of significance. Results were obtained by bootstrapping with 1000-fold resampling. Depressive symptoms were defined as HADS-D ≥ 11. Low IBDQ was defined as values below 170. Analyses: cumulative incidence analyses. CI confidence interval, HADS hospital anxiety and depression scale, IBD inflammatory bowel disease, IBDQ inflammatory bowel disease questionnaire, NEO-FFI NEO five-factor inventory