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. 2024 May 1;119(5):922-929.
doi: 10.14309/ajg.0000000000002630. Epub 2023 Dec 13.

Understanding Predictors of Fatigue Over Time in Persons With Inflammatory Bowel Disease: The Importance of Depressive and Anxiety Symptoms

Charles N Bernstein  1   2 , John D Fisk  3 , Casandra Dolovich  1 , Carol A Hitchon  1 , Lesley A Graff  2   4 , Renée El-Gabalawy  2   4 , Lisa M Lix  2   5 , James M Bolton  2   6 , Scott B Patten  7 , Ruth Ann Marrie  1   2   5
Affiliations

Understanding Predictors of Fatigue Over Time in Persons With Inflammatory Bowel Disease: The Importance of Depressive and Anxiety Symptoms

Charles N Bernstein et al. Am J Gastroenterol. .

Abstract

Introduction: Fatigue is a complex and frequent symptom in persons with inflammatory bowel disease (IBD), with detrimental impact. We aimed to determine predictors of fatigue over time.

Methods: Two hundred forty-seven adults with IBD participated in a prospective study conducted in Manitoba, Canada, providing data at baseline and annually for 3 years. Participants reported fatigue impact (Daily Fatigue Impact Scale [DFIS]), depression and anxiety symptoms (Hospital Anxiety and Depression Scale [HADS]), and pain (Pain Effects Scale [PES]). Physician-diagnosed comorbidities, IBD characteristics, and physical and cognitive functioning were also assessed. We tested factors associated with fatigue using multivariable generalized linear models that estimated within-person and between-person effects.

Results: Most participants were women (63.2%), White (85.4%), and had Crohn's disease (62%). At baseline, 27.9% reported moderate-severe fatigue impact, 16.7% had clinically elevated anxiety (HADS-A ≥11), and 6.5% had clinically elevated depression (HADS-D ≥11). Overall fatigue burden was stable over time, although approximately half the participants showed improved or worsening fatigue impact between annual visits during the study. On multivariable analysis, participants with a one-point higher HADS-D score had, on average, a 0.63-point higher DFIS score, whereas participants with a one-point higher PES score had a 0.78-point higher DFIS score. Within individuals, a one-point increase in HADS-D scores was associated with 0.61-point higher DFIS scores, in HADS-A scores with 0.23-point higher DFIS scores, and in PES scores with 0.38-point higher DFIS scores. No other variables predicted fatigue.

Discussion: Anxiety, depression, and pain predicted fatigue impact over time in IBD, suggesting that targeting psychological factors and pain for intervention may lessen fatigue burden.

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References

    1. Dibley L, Bager P, Czuber-Dochan W, et al. Identification of research priorities for inflammatory bowel disease nursing in Europe: A Nurses-European Crohn's and colitis organisation Delphi survey. J Crohns Colitis 2017;11(3):353–9.
    1. Stjernman H, Tysk C, Almer S, et al. Worries and concerns in a large unselected cohort of patients with Crohn's disease. Scand J Gastroenterol 2010;45(6):696–706.
    1. Czuber-Dochan W, Ream E, Norton C. Review article: Description and management of fatigue in inflammatory bowel disease. Aliment Pharmacol Ther 2013;37(5):505–16.
    1. Drossman DA, Patrick DL, Mitchell CM, et al. Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns. Dig Dis Sci 1989;34(9):1379–86.
    1. Levenstein S, Li Z, Almer S, et al. Cross-cultural variation in disease-related concerns among patients with inflammatory bowel disease. Am J Gastroenterol 2001;96(6):1822–30.

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