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. 2023 Jun 17:16:17562848231179335.
doi: 10.1177/17562848231179335. eCollection 2023.

Because I'm happy - positive affect and its predictive value for future disease activity in patients with inflammatory bowel diseases: a retrospective cohort study

Brian M Lang  1   2 , Martina Ledergerber  3 , Sebastian Bruno Ulrich Jordi  3   4 , Niklas Krupka  4 , Luc Biedermann  3 , Philipp Schreiner  3 , Pascal Juillerat  4 , Jacqueline Wyss  4 , Stephan R Vavricka  3 , Jonas Zeitz  3   5 , Roland von Känel  6 , Gerhard Rogler  3 , Niko Beerenwinkel  1   2 , Benjamin Misselwitz  7
Affiliations

Because I'm happy - positive affect and its predictive value for future disease activity in patients with inflammatory bowel diseases: a retrospective cohort study

Brian M Lang et al. Therap Adv Gastroenterol. .

Abstract

Background: While the detrimental impact of negative emotions on the clinical course of inflammatory bowel disease (IBD) and quality of life has been extensively investigated, evidence for a potential impact of positive emotions is scarce.

Objectives: We aim to analyse contributing factors of positive affect and their predictive value for disease course in IBD patients.

Design: In this retrospective cohort study, epidemiological, psychosocial and IBD disease characteristics of Swiss IBD cohort study patients were analysed longitudinally.

Methods: Epidemiological, psychosocial and disease characteristics were extracted from the database of the Swiss IBD cohort study. Participants' positive emotions were assessed cross-sectionally with the seven-item Marburg questionnaire (range 1-6) addressing positive affect in different aspects of daily life. Predictors of positive emotions were identified by linear regression. The quantitative longitudinal impact of positive emotions on the further disease course was analysed using a multivariable Cox proportional hazards model.

Results: Among 702 IBD patients, those reporting more positive emotions were found to have significantly less intense medical treatment, less pain and fewer depressive symptoms (p < 0.05). A higher percentage of variability in positive emotions was explained by pain (36%) and depressive symptoms (13%) than by epidemiological characteristics (0.3%), or characteristics of IBD and its treatment (2.4%). Patients with higher levels of positive emotions (score > 3.5) experienced longer flare-free survival, also after adjusting for confounders (adjusted hazard ratio: 0.39, p < 0.05).

Conclusions: The absence of pain and depressive symptoms were the strongest drivers for high positive affect. Higher scores of positive affect were associated with longer disease-free survival in IBD patients.

Keywords: disease course; inflammatory bowel disease; positive affect.

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Conflict of interest statement

BML, ML, SBUJ, NB, NK, JW, RvK and PJ have no competing interests to declare. LB reports fees for consulting/advisory board from Abbvie, MSD, Vifor, Falk, Esocap, Calypso, Ferring, Pfizer, Shire, Takeda, Janssen, Ewopharma. PS received consulting fees from Pfizer, Abbvie, Takeda and Janssen-Cilag and travel support from Falk, UCB and Pfizer. SRV has received consulting fees, speakers honorary and unrestricted research grants from Abbott, Alfasigma, Amgen, Arenapharm, Falk Pharma GmbH, Ferring Pharmaceuticals, Gilead, iQuone, Janssen, MSD, Permamed, Pfizer Inc, Sanofi-Aventis, Takeda, Tillotts, UCB, and Vifor. JZ reports fees for consulting/advisory board from Abbvie, Janssen and traveling fees from Abbvie, Takeda and Vifor. GR declares consulting fees from Abbvie, Augurix, BMS, Boehringer, Calypso, Celgene, FALK, Ferring, Fisher, Genentech, Gilead, Janssen, MSD, Novartis, Pfizer, Phadia, Roche, UCB, Takeda, Tillots, Vifor, Vital Solutions and Zeller; speaker’s honoraria from Astra Zeneca, Abbvie, FALK, Janssen, MSD, Pfizer, Phadia, Takeda, Tillots, UCB, Vifor and Zeller; and grants support from Abbvie, Ardeypharm, Augurix, Calypso, FALK, Flamentera, MSD, Novartis, Pfizer, Roche, Takeda, Tillots, UCB and Zeller. BM reports traveling fees from Takeda, Vifor, Gilead and MSD. BM received fees as a speaker from Takeda. BM has served at an advisory board for Gilead, Takeda and BMS. BM has received research grants from MSD and BMS unrelated to the submitted work.

Figures

Figure 1.
Figure 1.
Positive affect in Swiss IBD cohort patients. Yellow and blue scatter plots: distribution and median value of positive affect (as assessed by the Marburg questionnaire) for CD and UC patients from the SIBDCS. Filled circles: Median reported positive affect. Whiskers: Upper and lower interquartile range for reported positive affect. Black dashed vertical line: Cut-off of 3.5 used in subsequent calculations for high/low positive affect. Healthy controls and fibromyalgia syndrome patients: Ranges for a healthy control and a fibromyalgia syndrome cohort reported in the literature. CD, Crohn’s disease; UC, ulcerative colitis; IBD, inflammatory bowel disease; SIBDCS, The Swiss IBD cohort study.
Figure 2.
Figure 2.
Relative importance of variables predicting positive affect. Four multivariable linear regression models are fit predicting positive affect as a continuous variable. Relative importance is calculated with proportional marginal variance decomposition. Relative importance of model variables within each model are shown with area proportional to importance: (a) epidemiological model, (b) IBD characteristics, (c) pain model and (d) psychological model. IBD, inflammatory bowel disease.
Figure 3.
Figure 3.
Relative importance of variables in Lasso-penalized model for positive affect. A lasso-penalized regression is fit predicting positive affect as a continuous variable. Relative importance is calculated with proportional marginal variance decomposition. Relative importance of model variables within each model are shown with area proportional to importance.
Figure 4.
Figure 4.
Kaplan–Meier curves for flare-free survival. Positive affect is split into two categories (high/low) around the value of 3.5. Red curve: High positive affect (>3.5). Blue curve: Low positive affect (⩽ 3.5). Shaded regions are 95% CI for the Kaplan–Meier curves. ‘p’ is the unadjusted log-rank test p-value. ‘adjusted p’ is the unadjusted p-value for positive affect from a multivariable Cox proportional hazards model.
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