Psychological well-being is the major determinant of global health in the first year following a diagnosis of inflammatory bowel disease in children

Anastasia Amelia Mekhael; A Natisha Nabbijohn; David Mack; Alain Stintzi; Janice Susan Cohen; C Meghan McMurtry

doi:10.1016/j.jpsychores.2025.112142

Psychological well-being is the major determinant of global health in the first year following a diagnosis of inflammatory bowel disease in children

J Psychosom Res. 2025 Jul:194:112142. doi: 10.1016/j.jpsychores.2025.112142. Epub 2025 May 16.

Authors

Anastasia Amelia Mekhael¹, A Natisha Nabbijohn², David Mack³, Alain Stintzi⁴, Janice Susan Cohen⁵, C Meghan McMurtry⁶

Affiliations

¹ Department of Psychology, University of Guelph, 87 Trent Lane, Guelph, Ontario N1G 2W1, Canada. Electronic address: amekhael@uoguelph.ca.
² Department of Psychology, University of Guelph, 87 Trent Lane, Guelph, Ontario N1G 2W1, Canada. Electronic address: anabbijo@uoguelph.ca.
³ Children's Hospital of Eastern Ontario IBD Centre, 401 Smyth Rd, Ottawa, Ontario K1H 8L1, Canada; Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa K1H 8M5, Ontario, Canada. Electronic address: dmack@cheo.on.ca.
⁴ Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa K1H 8M5, Ontario, Canada. Electronic address: astintzi@uottawa.ca.
⁵ Mental Health Consultation Liaison Service, Mental Health, Children's Hospital of Eastern Ontario (CHEO), 401 Smyth Rd, Ottawa, Ontario K1H 8L1, Canada; School of Psychology, Faculty of Social Sciences, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, Canada; CHEO Research Institute, Ottawa, ON, Canada. Electronic address: jcohen@cheo.on.ca.
⁶ Department of Psychology, University of Guelph, 87 Trent Lane, Guelph, Ontario N1G 2W1, Canada; Pediatric Chronic Pain Program, McMaster Children's Hospital, Department of Paediatrics, Children's Health Research Institute, Western University, Canada. Electronic address: cmcmurtr@uoguelph.ca.

PMID: 40412339
DOI: 10.1016/j.jpsychores.2025.112142

Abstract

Inflammatory bowel disease (IBD) represents a group of disorders with no known cure. IBD is impacted by biopsychosocial factors. The burden, psychosocial difficulties, and gene-environment interaction involved in the manifestation of IBD necessitate a fuller understanding of factors which worsen or ameliorate IBD. Case complexity (CC) captures current and historical biopsychosocial risks for individuals with IBD and holds promise for understanding variation in treatment response and individuals' experiences with IBD. The present study aimed to understand the relative contributions of: 1) historical vs. current factors impacting CC in predicting global health; and 2) biological, psychological, social, family, and health system factors on global health. Within a longitudinal design, 8-17-year-old youth (N = 83) completed the self-report Pediatric Global Health 7 + 2 at diagnosis (baseline) and 4- and 12 months post-diagnosis. The p-IBD-INTERMED, a clinical-decision support tool, which standardizes inter-professional assessment of biopsychosocial risks contributing to CC was completed by the healthcare provider team at the same timepoints. CC was associated with global health at all time points (T1_r = -0.27; T2_r = -0.42; T3_r = -0.50). Hierarchical regression revealed that across time the relative contribution of historical CC was surpassed by current CC when predicting global health (at T1 β_HCC=-0.13_;β_CCC = -0.17; at T3 β_HCC = -0.04; β_CCC = -0.48). In this cohort, at 4- and 12-months post diagnosis, psychological factors were the only domain of current CC to significantly predict global health, accounting for 29.1 % and 24.1 % of its variance respectively. Findings suggest that the global health of patients with IBD is not fixed by early life experiences.

Background: Inflammatory bowel disease (IBD) represents a prevalent group of disorders with no known cure. IBD is impacted by myriad biopsychosocial factors. The pervasive burden, pronounced psychosocial difficulties, and the potential gene-environment interaction involved in the manifestation of IBD necessitate a fuller understanding of factors which might worsen or ameliorate IBD. Case complexity (CC) captures current and historical biopsychosocial risks for individuals with IBD and holds promise for understanding variation in treatment response and individuals' experiences with this chronic illness.

Aims: We sought to understand the relative contributions of: 1) historical vs. current factors impacting CC in predicting global health (self-reported); and 2) biological, psychological, social, family, and health system factors on global health.

Methods: Within a longitudinal design, 8-17-year-old youth (N = 83) completed the self-report Pediatric Global Health 7 + 2 at diagnosis (baseline) and 4- and 12 months post-diagnosis. The p-IBD-INTERMED, an interview-based measure of CC, was completed by the healthcare provider team at the same timepoints.

Results: CC was associated with global health at all time points (T1_r = -0.27; T2_r = -0.42_; T3_r = -0.50). Hierarchical regression revealed that across time points the relative contribution of historical CC was surpassed by current CC when predicting global health (at T1 β_HCC= - 0.13_;β_CCC= - 0.17_; at T3 β_HCC= - 0.04_;β_CCC= - 0.48). In this cohort of newly diagnosed children that had good medical response by one-year post diagnosis, at 4- and 12-months post diagnosis, psychological factors were the only domain of current CC to significantly predict global health, accounting for 29.1 % and 24.1 % of its variance respectively.

Discussion: Findings suggest that the global health of IBD patients is not fixed by early life experiences and shed light onto potential psychosocial treatment targets.

Keywords: Biopsychosocial; Case complexity; Global health; IBD; Longitudinal.

MeSH terms

Adolescent
Child
Female
Global Health*
Humans
Inflammatory Bowel Diseases* / psychology
Longitudinal Studies
Male
Psychological Well-Being