The importance of the family context in inflammatory bowel disease.

Abstract

BACKGROUND: This study examines psychological correlates of inflammatory bowel disease (IBD) to answer these questions: What is the association between individual and family stress levels and the patient's coping ability and severity of illness? How does the level of family functioning correlate with individual coping and illness severity? To what extent are patient and family beliefs about IBD related to symptomatology? METHODS: Seventeen patients and 44 of their family members were studied intensively in an exploration of the psychological response to IBD. They completed a comprehensive battery of self-report questionnaires assessing stressful life events, coping related to the illness, and beliefs regarding IBD. Ratings of family functioning were made from videotaped family discussions about IBD. Treating physicians made independent ratings of past and current disease severity. RESULTS: Surprisingly, recent disease activity was negatively correlated with family stress level (r = -0.794), but was not associated with patient stress level. However, impaired coping with IBD by affected individuals was directly correlated with both individual (r = 0.595) and family-wide (r = 0.724) reported stress levels. Disease severity was also found to be responsive to family communication style (r = 0.431) and to level of family agreement (r = 0.531) regarding the etiology and management of IBD. CONCLUSIONS: These findings suggest that individual stress affects coping with IBD, whereas family-wide stress, communication style, and agreement about disease etiology and management are related to disease activity. The interrelationship of family and patient as well as individual coping with IBD should be evaluated in future studies.