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ANXIETY AND QUALITY OF LIFE IN INFLAMMATORY BOWEL
DISEASE PATIENTS
Renemane Lubova
Medical doctor, Philosophy Doctor, assitf. professor of Riga Stradins University Department of Psychiatry and Narcology, Riga,
Latvia
Vika Pilusenko
Matter of health science, Assitfant of Riga Stradins University Department of Clinical Skills and Medical Technology, Riga,
Latvia
Biruta Kupca
Medical doctor, Philosophy Doctor, professor of Riga Stradins University Department of Psychiatry and Narcology, Riga, Latvia
ABSTRACT
Background. Health of a person is defined as a physical, mental and social well-being. Chronic diseases threaten people's quality of life, decrease physical and emotional health, functional activity in society and self-e&eem. One of such diseases is inflammatory bowel diseases (IBD). The aim of this &udy was to define a quality of life and anxiety for patients with IBD who receive treatment in hospital or in outpatient department. Methods. We screened adult patients aged between 18 and 40 years, who have had IBD diagnosis over one year. We used the protocol of analysis of medical documentation, Inflammatory Bowel Disease Que^ionnaire, State-Trait Anxiety Inventory (STAI) self-evaluation que^ionnaire, Demographic Survey que^ionnaire. Result. 82 patients participated in the research. The mean age was 26,25 years (SD=5.91). The quality of life of patients with IBD had middle rates. Patients with IBD have moderate level of trait and Sate anxiety. There are no differences of anxiety rates (p=0.085) and quality of life (p>0.05) between Crohn's disease and Ulcerative colitis. The level of Sate anxiety was higher in women 40.5% than in men 13.3% (p=0.011). Low level of trait anxiety was for outpatients in 52% and for inpatients in 15.8% of cases (p=0.003). The quality of life was higher for outpatients than for inpatients (p=0.000). Conclusion. Anxiety level is higher for women than for men and quality of life is lower for women with Inflammatory bowel disease. The inpatients with IBD have higher level of anxiety and lower level of quality of life than outpatients with IBD.
АННОТАЦИЯ
Цель. Здоровье человека определяется как физическое умственное и социальное благополучие. Хронические болезни ухудшают качество жизни, физическое и эмоциональное здоровье, социальную активность и самооценку людей. Одни из таких болезней являются воспалительные заболевания кишечника (ВЗК). Целью исследования является определить качество жизни и тревогу у пациентов, страдающих воспалительными заболеваниями кишечника, которые лечатся в больнице или амбулаторном отделении. Метод. Для исследования были отобраны пациенты в возрасте от 18 до 40 лет, с диагнозом ВЗК, установленным, как минимум, 1 год. Мы использовали протокол анализа медицинской документации, опросник воспалительных заболеваний кишечника, опросник для самооценки ситуативной и базисной тревоги, опросник демографических данных.
Результат. В исследовании принимало участие 82 больных. Средний возраст составил 26,25 лет (SD=5.91). Качество жизни больных с ВЗК имели средние показатели. Пациенты с ВЗК имели средний уровень ситуативной и базисной тревоги. Не было найдено отличий при исследовании тревоги (p=0.085) и качества жизни (p>0.05) среди больных с болезнью Крона и язвенным колитом. Более высокий уровень ситуативной тревоги был выявлен у женщин в 40,5% случаях, по сравнению с мужчинами, у которых он составил 15,8% (p=0.011). Низкий уровень базисной тревоги был выявлен у амбулаторных пациентов он составил 52%, а у стационарных - 15,8% (p=0.003). Качество жизни было более высокое у амбулаторных больных по сравнению с госпитальными (p=0.000). Выводы. В проведённом исследовании у пациентов с ВЗК было выявлено, что уровень тревоги выше и качество жизни ниже у женщин, чем у мужчин. Стационарные пациенты с ВЗК имеют более высокий уровень тревоги и более низкое качество жизни, чем амбулаторные пациенты.
Keywords: Inflammatory bowel disease, Crohn's disease, Ulcerative colitis, quality of life, anxiety.
Background. Health of a person is defined as a physical, mental and social well-being. Chronic diseases threaten people's quality of life, decrease physical and emotional health, functional activity in society and self-e&eem. One of such diseases is
inflammatory bowel diseases (IBD). IBD, comprising Crohn>s disease and ulcerative colitis, is a chronic immunologically mediated disease at the intersection of complex interactions between genetics, environment and gut microbiota [1, P. 205-
217]. The predominant symptoms of IBD are diarrhea, abdominal pain, gaflrointeflinal bleeding, weight loss, malnutrition and fatigue. These symptoms can have subflantial psychosocial implications and cause sufferers to limit their lifeflyles.
Emotional flress may influence the course of inflammatory bowel disease, as body and mind are so closely related. Although people before the exacerbation of disease sometimes had emotional problems, it does not mean that emotional flress causes IBD. It is possible that emotional flress and anxiety, that the patients sometimes feel, is a reaction to the disease symptoms. It is not surprising, as people believe that it is difficult to cope with chronic diseases. Such diseases decrease quality of life, reduce physical and emotional well-being, social functioning and a sense of self-efleem [9, P.11].
Inflammatory bowel disease patients could be depressed, nervous, anxious and suffer from other organs functional disorders. They visit the doctor more frequently and the prevalence of panic disorder, depression, anxiety, pofl-traumatic flress disorder and somatization among this group of patient is higher than in population. These disorders often occur before or at the same time with inflammatory bowel disease, clearly indicating that the psycho-emotional interference cannot be measured simply in response to the disease [7, P.106-111].
Nevertheless, inflammatory bowel disease is a serious chronic disease, it does not belong to fatal diseases. Mofl people, even if they periodically are hospitalized or need to use medication, could continue to be socially active and lead a productive life. During the remission many patients feel good. However, each patient needs to receive appropriate treatment, which depends on the patient and the doctor [2, P.136-138; 4, P.661 - 679].
The aim of this fludy was to define the quality of life and anxiety for patients with IBD as well as to diflinguish the quality of life and anxiety of Crohn's disease and Ulcerative colitis, who receive treatment in hospital or in outpatient department.
Methods.
The result was gathered by a quantitative method. The fludy was conducted in gaflroenterological departments and in outpatient department in Latvia.
Participants were recruited from patients hospitalized due to relapse of their exiting IBD and from outpatient department, when the patients come to visit theirs doctors in a regular way. The recruitment took place in the gaflroenterology, hepatology and nutrition treatment center and in the outpatient department of Paul Stradins Clinical University hospital in Riga, in 2015.
We screened adult patients aged between 18 and 40 years who have IBD, Crohn's disease or Ulcerative colitis diagnosis over one year.
Eligible patients were informed about the fludy aim and the procedures and those, who agreed to participate and signed informed consent, were enrolled into the fludy. The fludy was conducted according to the Declaration of Helsinki and was approved by the Ethics Committee of Riga Stradins University with the protocol number 93/29.01.2015.
During the screening periods the researcher fill in the protocol of analysis of medical documentation and after screening the patients completed three queflionnaires: Inflammatory Bowel Disease Queflionnaire (IBDQ), State-Trait Anxiety Inventory (STAI) self-evaluation queflionnaire, Demographic Survey queflionnaire.
The data from hospital medical hiflory and outpatient medical records about sex, age, living place, diagnosis, received
treatment and duration of the disease was fixed in the protocol of analysis of medical documentation.
We used the IBDQ to assess the quality of life. This disease-specific queflionnaire comprises 32 queflions divided into four health subscales: bowel symptoms (10 queflions); syflemic symptoms, including sleep disorders and fatigue (5 queflions); emotional function such as depression, aggression and irritation (12 queflions); and social function, meaning the ability to participate in social activities and to work (5 queflions). The participant was invited to choose one of seven graded responses. Consequently, the total score ranges from 32 to 224 points, with lower scores reflecting worse quality of life.
The STAI form consifls of two 20-items queflionnaires. The firfl queflionnaire measures flate anxiety, i.e. how the respondent "feels right now" meaning the time of completion. The second queflionnaire measures trait anxiety, i.e. how the respondent generally feels. For each queflionnaire, the scores range is 20-80. The cut-point for clinically significant anxiety is 39-40, scores>54 are considered indicative of a mental disorder [6, P.629-634]. STAI measures anxiety at both poles of the normal affect curve (flate vs. trait). State anxiety (A-State) can be defined as fear, nervousness, discomfort, and the arousal of the autonomic nervous syflem induced temporarily by situations perceived as dangerous (i.e., how a person is feeling at the time of a perceived threat). Trait anxiety (A-Trait) can be defined as a relatively enduring disposition to feel flress, worry, and discomfort [11, P. 292-321]. The IBDQ and the STAI have been double translated into Latvian language.
The Demographic Survey queflionnaire, filled by patients, consifls of the queflions about education, occupational flatus, duration of the IBD, frequency of the exacerbation of IBD and amount of hospitalizations due to IBD.
Data analyses were performed using IBM SPSS Statiflics 21 for Windows. P values lower than 0.005 were considered flatiflically significant. Results are reported as percentages, median and range. Descriptive flatiflics were used for demographic and clinical characteriflics. Based on the psychometric scale cut-offs, we diflinguished between three levels of anxiety: low, moderate and high in subscale groups: trait anxiety and flate anxiety. Pearson chi-square was used for the comparison of anxiety levels in patients with Crohn>s disease and ulcerative colitis, as well as the anxiety levels for females and males, outpatients and inpatients. Wilcoxon W tefl and Mann-Whitney tefl was used for comparisons of means in the scales used, between the group of outpatient and inpatients.
Result. 82 patients participated in the research: 45% of male, 55% of female; 50% of patients with Crohn>s disease and 50% with ulcerative colitis; 70% of inpatients and 30% of outpatients. The mean age was 26,25 years (SD=5.91). The mean duration of illness was 4.39 years (SD=2.37).
Using the Inflammatory Bowel Disease Queflionnaire (IBDQ) for evaluating the quality of life we received the following results, the middle score of IBDQ was 125.17 points (N = 82, SD = 23.72). This score corresponds to the middle level of the quality of life. The minimum score was 71, which corresponds to poor quality of life, and the maximum score was 177 points, which corresponds to good quality of life. Not one of the respondents did not gain more than 200 points, which shows that not one of the Inflammatory bowel disease patients do not assess their quality of life to excellent.
We compare the quality of life of Latvian IBD respondents with the similar data from other fludies in other countries. The
research data show that the average quality of life score of IBD patients in Latvia was 125 points, while in Portugal this score was 159.5 points, in Greece - 186 points, in China - 156 points [3, P.10-20; 5, P.243-248; 8, P.192-197]. Comparing these data, it demonflrates that the Latvian patients with inflammatory bowel disease had a lower level of quality of life than in other countries.
IBDQ consifls of 4 subscales: bowel symptoms subscale, syflemic symptoms subscale, emotional function subscale and social function subscale.
The flandard maximum possible score in bowel symptom
subscale is 70, the fludy data suggefl the respondents have a mean score 37.9 points (SD = 11.51) in this subscale group
The rates of quality of life of respondents with inflammatory (n=82)
(see Table 1). The flandard maximum possible score in social function subscale is 35, but participated patients receive 18.25 points (SD = 4.58) and 22.74 (SD = 4.56) points according to a social symptom score. This suggefls a low quality of life in these areas, the social function scale results are higher, suggefling that the respondents are active both at work and leisure. Emotional scale average 43.42 points (SD = 9.66), the flandard maximum possible score is 84 points. These data show that the respondents have quite a low level of assessing their emotional flate that may be associated with frequent mood swings, fear for their health, uncertainty about future treatment and life.
Table 1.
bowel disease using inflammatory bowel disease queflionnaire
IBDQ subscales Standard subscales maximum score Mean total (range) Standard deviation
Bowel symptoms 70 37.92 (17-59) 11.51
Syflemic symptoms 35 18.25 (8-28) 4.57
Emotional function 84 43.42 (25-65) 9.65
Social function 35 22.74 (14-32) 4.56
No Satirically significant difference was found in total and dimensional IBDQ scores between patients with Crohn's disease and Ulcerative colitis (P>0.005).
There was a significant difference of life of quality regarding sex, i.e. the female rate is to 119.6 points (min. 71 - max.153), whilfl the male one is even up to 130.8 points (min. 85-max. 177) (total score, P=0.002).
However, a significant correlation on the quality of life was found in groups depending where patients receive treatment:
outpatients or inpatients. The quality of life was higher for outpatients in total and for all the subscales of IBDQ except bowel symptoms (total score, P=0.000; bowel symptoms, P=0.178; syflemic symptoms, P=0.000; emotional function, P=0.000 and social function, P=0.000).
Using the State-Trait Anxiety Inventory we found, the respondents had a moderate level of State anxiety (mean 40.78 points, min. 31-max.48, SD=5.1) and a moderate level of Trait anxiety (mean 40.83 point, min.29-max.51, SD=6.28).
Table 2.
The anxiety level of patients with inflammatory bowel disease depending of sex, treatment place and disease name using the State-Trait Anxiety Inventory (%)
State anxiety subscale
Level of anxiety Total N=82 Disease name Sex Treatment place
Crohn's disease N=41 Ulcerative colitis N=41 Female N=37 Male N=35 Out-patients N=25 In-patients N=47
Low 20.7 14.6 26.8 13.5 26.7 60.0 3.5
Moderate 53.7 65.9 41.5 45.9 60.0 36.0 61.4
High 25.6 19.5 31.7 40.5 13.3 4.0 35.1
Pearson chi-square 0.085 0.011 0.000
Trait anxiety subscale
Low 26.8 31.7 22.0 5.4 44.4 52.0 15.8
Moderate 52.4 61.0 43.9 56.8 48.9 36.0 59.6
High 20.7 7.3 34.1 37.8 6.7 12.0 24.6
Pearson chi-square 0.11 0.000 0.003
There are no differences of anxiety rates (p=0.085) between Crohn's disease and Ulcerative colitis (see Table 2).
The higher level of State anxiety was found in women 40.5% than in men 13.3% (p=0.011). A low level of State anxiety was for outpatients in 60% and for inpatients in 3.5% of cases (p=0.000). The moderate State anxiety level for inpatients was 61.4% and 36% of cases for outpatients. A low level of Trait
anxiety was for outpatients in 52% and for inpatients in 15.8% of cases (p=0.003).
Conclusion. Anxiety level is higher for women than for men and the quality of life is lower for women with Inflammatory bowel disease. The inpatients with inflammatory bowel disease have a higher level of anxiety and a lower level of quality of life than outpatients.
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DYNAMICS OF THE NEWLY DISCOVERED MALIGNANT DISEASES
OF THE POPULATION IN THE DISTRICT OF PLOVDIV
Shopov Dimitar Georgiev
MD, PhD, Chief AssiMant Prof. Department of Social Medicine and Public Health Medical University - Plovdiv, Bulgaria
Mihaylova Vanina Kratfeva
PhD, Assoc. Prof. Department of Preventive Medicine, Faculty of Public Health, Sofia; Chief AssiMant Department of Healthcare Management, Faculty of Public Health, Medical University,
Plovdiv, Bulgaria
Stoeva Teodora Radeva
Senior health care University Hospital "Sv. George " - Plovdiv Bulgaria
ABSTRACT
The malignant diseases are an essential problem of the contemporary society.
The present article analyzes the morbidity rate related to neoformations in different organs of the body in people from the diflrict of Plovdiv for a 5-year period from 2010 to 2014 inclusive. The demographic flatus has been traced. The following facts were eflablished:
- the total number of the population is decreasing;
- the relative share of the people capable of working is decreasing;
- the relative share of elderly people over 65 is increasing.
The frequency of newly discovered cases of malignant diseases is increasing, the predominant ones being breafl cancer and proflate gland cancer.
Keywords: malignant diseases, population, demographic indices, birth rate, death rate, natural population growth
Introduction:
The malignant diseases are a serious problem of our contemporary society. They are the second leading cause of death in the developed countries. There is an upward trend of death caused by cancer worldwide.(1;3) The prognoflication shows that in 2030 about 12 million people would die from this insidious disease.(4;7) Statiflics marks a sharp increase in the morbidity rate and decrease in the age of people suffering from cancer. The malignant diseases cause much suffering, loss of working capacity and are a heavy economic burden for
the society, the individual and the family.(5;9) They require increased need of medical services and often have a lethal exit. Almofl 80% of the malignant diseases are caused by the environmental factors, the lifeflyle of the people, habits and cufloms. The frequency of diflribution of malignant diseases in Bulgaria is conflantly increasing.(8;12) Cancer is a tragedy but the experts point out that now the causes of cancer are well-known and this enables prevention of around one third of the new cases.(16) With the increase in the duration of life and age of the people, the number of patients with cancer is expected to
