رابطه ی بین ادراک بیماری و شدت علایم در بیماران مبتلا به سندرم روده ی تحریک پذیر

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، گروه روان‌پزشکی، دانشکده‌ی پزشکی، مرکز تحقیقات روان-تنی(سایکوسوماتیک)، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استادیار، گروه روان‌پزشکی، دانشکده‌ی پزشکی، مرکز تحقیقات علوم رفتاری، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشجوی پزشکی، کمیته‌ی تحقیقات دانشجویی، مرکز تحقیقات علوم رفتاری، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 دانشیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

5 دانشیار، گروه آمار زیستی و اپیدمیولوژی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: ادراک بیماری در فرد بیمار بر پایه‌ی جذب اطلاعات از منابع مختلف و باورهای بیمار شکل می‌گیرد و می‌تواند سلامت روانی و توانایی فرد در تطابق با بیماری را تحت تأثیر قرار دهد. هدف این مطالعه بررسی ارتباط بین ادراک بیماری و شدت علایم‌ در بیماران مبتلا به سندرم روده‌ی تحریک‌پذیر (Irritable bowel syndrome  یا IBS) بود.روش‌ها: در یک مطالعه‌ی مقطعی 160 بیمار مبتلا به IBS مراجعه ‌کننده به درمانگاه سایکوسوماتیک و گوارش وابسته‌ی به بیمارستان خورشید اصفهان انتخاب شدند. بیماران با استفاده از مقیاس‌های ادراک بیماری و شدت علایم‌ در مبتلایان به IBS مورد بررسی قرار گرفتند. داده‌های پژوهش با استفاده‌ی از مدل‌های ضریب همبستگی Pearson و رگرسیون چند متغیری مورد تجزیه و تحلیل قرار گرفت.یافته‌ها: بین ادراک بیماری و شدت علایم‌ مبتلایان ضریب همبستگی معنی‌دار‌ مشاهده شد (546/0 = r ، 001/0 > P). نتایج تحلیل رگرسیون نشان داد که 39 درصد از تغییرات شدت علایم‌ مبتلایان به IBS توسط متغیرهای ادراک بیماری قابل تبیین است (63/0 = R، 39/0 = R square). ضرایب رگرسیون نشان داد که ‌این توانایی پیش‌بینی کنندگی مربوط به دو زیرمقیاس شناخت علایم (04/0 = P)‌ و عواطف (04/0 = P)‌ بود. با این وجود سایر زیرمقیاس‌ها تأثیری در این رابطه نداشتند.نتیجه‌گیری: این مطالعه نشان داد که بین ادراک بیماری و شدت علایم‌ در مبتلایان به  IBS رابطه وجود دارد و تغییرات شدت علایم‌ مبتلایان به IBS، تا حدی توسط متغیرهای ادراک بیماری پیش‌بینی می‌شود. بنابراین مداخلات روان‌شناختی بر پایه‌ی ادراک بیماری به منظور کنترل شدت علایم‌ در درمان مبتلایان IBS پیشنهاد می‌شود.

کلیدواژه‌ها

عنوان مقاله [English]

The Relationship between Illness Perception and Symptom Severity in Pa-tients with Irritable Bowel Syndrome

نویسندگان [English]

  • Hamid Afshar 1
  • Reza Bagherian 2
  • Nasim Foroozandeh 3
  • Newsha Khorramian 3
  • Hamed Daghaghzadeh 4
  • Mohammad Reza Maracy 5
  • Peyman Adibi 4
1 Associate Professor, Department of Psychiatry, School of Medicine, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Assistant Professor, Department of Psychiatry, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Student of Medicine, Student Research Committee, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
4 Associate Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
5 Associate Professor, Department of Epidemiology & Biostatistics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
چکیده [English]

Background: Patient`s illness perception is formed base on patient`s beliefs and perceived information about their condition and it may influence the individual’s mental health and how the patient deal with the medical condition. The aim of this study was to determine the relationship between illness perception and symptom severity in patients with irritable bowel syndrome (IBS).Methods: In a cross-sectional study, 160 consecutive IBS patients, referred to the gastrointestinal and psychosomatic clinics at khorshid hospital in Isfahan, were selected. The patients completed illness perception questionnaires and the IBS Symptom Severity Scoring System (IBS-SSS). Data was analyzed by pearson correlation and multi variant regression models.Finding: A relationship between illness perception and symptom severity in patients with IBS was observed (R = 0.546, P = 0.001). The results showed that 39% of variation in symptom severity is predicted by variation in illness perception components (R = 0.63, R Squer = 0.39). Rregression model showed that only the identity and emotion components of illness perception can predict symptom severity variation (P = 0.04). However, there is no relationship between other subscales of illness perception and symptom severity.Conclusion: This study showed that there is a relationship between illness perception and symptom severity. So the interventions based on illness perception is proposed for managing symptom severity in IBS.Keywords: Illness perception, Symptom severity, Irritable bowel syndrome, Psychological factors.

کلیدواژه‌ها [English]

  • Illness Perception
  • Symptom severity
  • Irritable Bowel Syndrome
  • Psychological factors

مراجع

  1. Owyang C. Irritable Bowel Syndrome. In: Fauci AS, Eugene B, Hauser SL, Longo DL, Jameson J, editors. Harrison's principles of internal medicine.New York: McGraw-Hill; 2008. p. 1899-903.
  2. Drossman DA, Lowman BC. Irritable bowel syndrome: epidemiology, diagnosis and treatment. Clin Gastroenterol 1985; 14(3): 559-73.
  3. Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 1982; 83(3): 529-34.
  4. Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ 1992; 304(6819): 87-90.
  5. Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ, III. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 1991; 101(4): 927-34.
  6. Hungin APS, Tack J, Mearin F, Whorwell PJ, Dennis E, Barghoui V. Irritable bowel syndrome (IBS): prevalence and impact in the USA - the truth in IBS (T-IBS) survey. Am J Gastroenterol 2002; 97: 242.
  7. Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2004; 2(12): 1064-8.
  8. Hayee B, Forgacs I. Psychological approach to managing irritable bowel syndrome. BMJ 2007; 334(7603): 1105-9.
  9. Talley NJ. Conquering irritable bowel syndrome: a guide to liberating those suffering with chronic stomach or bowel problems. Chicago: PMPH-USA; 2006.
  10. Enck P, Martens U, Klosterhalfen S. The psyche and the gut. World J Gastroenterol 2007; 13(25): 3405-8.
  11. Deary V, Chalder T, Sharpe M. The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clin Psychol Rev 2007; 27(7): 781-97.
  12. Dinan TG, Quigley EM, Ahmed SM, Scully P, O'Brien S, O'Mahony L, et al. Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker? Gastroenterology 2006; 130(2):
  13. -11.
  14. Karling P, Norrback KF, Adolfsson R, Danielsson A. Gastrointestinal symptoms are associated with hypothalamic-pituitary-adrenal axis suppression in healthy individuals. Scand J Gastroenterol 2007; 42(11): 1294-301.
  15. Kilkens TO, Honig A, Fekkes D, Brummer RJ. The effects of an acute serotonergic challenge on brain-gut responses in irritable bowel syndrome patients and controls. Aliment Pharmacol Ther 2005; 22(9): 865-74.
  16. Faresjo A, Grodzinsky E, Johansson S, Wallander MA, Timpka T, Akerlind I. Psychosocial factors at work and in every day life are associated with irritable bowel syndrome. Eur J Epidemiol 2007; 22(7): 473-80.
  17. Koloski NA, Boyce PM, Talley NJ. Somatization an independent psychosocial risk factor for irritable bowel syndrome but not dyspepsia: a population-based study. Eur J Gastroenterol Hepatol 2006; 18(10): 1101-9.
  18. Lea R, Whorwell PJ. Psychological influences on the irritable bowel syndrome. Minerva Med 2004; 95(5): 443-50.
  19. Kovacs Z, Kovacs F. Depressive and anxiety symptoms, dysfunctional attitudes and social aspects in irritable bowel syndrome and inflammatory bowel disease. Int J Psychiatry Med 2007; 37(3): 245-55.
  20. Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology 1988; 95(3): 701-8.
  21. Whitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clin North Am 1991; 20(2): 249-67.
  22. Hislop IG. Psychological significance of the irritable colon syndrome. Gut 1971; 12(6): 452-7.
  23. Crane C, Martin M, Johnston D, Goodwin GM. Does depression influence symptom severity in irritable bowel syndrome? Case study of a patient with irritable bowel syndrome and bipolar disorder. Psychosom Med 2003; 65(5): 919-23.
  24. Lackner JM, Quigley BM, Blanchard EB. Depression and abdominal pain in IBS patients: the mediating role of catastrophizing. Psychosom Med 2004; 66(3): 435-41.
  25. Leventhal H, Nerenz DR, Steele DJ. Illness representation and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Social psychological aspects of health. Volume 4 of Handbook of psychology and health.New Jersey: L. Erlbaum Associates; 1984. p. 219-52.
  26. Botha-Scheepers S, Riyazi N, Kroon HM, Scharloo M, Houwing-Duistermaat JJ, Slagboom E, et al. Activity limitations in the lower extremities in patients with osteoarthritis: the modifying effects of illness perceptions and mental health. Osteoarthritis Cartilage 2006; 14(11): 1104-10.
  27. Scharloo M, Kaptein AA, Weinman J, Bergman W, Vermeer BJ, Rooijmans HG. Patients' illness perceptions and coping as predictors of functional status in psoriasis: a 1-year follow-up. Br J Dermatol 2000; 142(5): 899-907.
  28. Scharloo M, Kaptein AA, Weinman JA, Hazes JM, Breedveld FC, Rooijmans HG. Predicting functional status in patients with rheumatoid arthritis. J Rheumatol 1999; 26(8): 1686-93.
  29. Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, et al. Depression as a risk factor for coronary artery disease: evidence, mechanisms, and treatment. Psychosom Med 2004; 66(3): 305-15.
  30. Weinman J, Petrie KJ. Illness perceptions: a new paradigm for psychosomatics? J Psychosom Res 1997; 42(2): 113-6.
  31. Spiegel B, Strickland A, Naliboff BD, Mayer EA, Chang L. Predictors of patient-assessed illness severity in irritable bowel syndrome. Am J Gastroenterol 2008; 103(10): 2536-43.
  32. Gerson JM, Gerson CD. Relationship Between Pain Beliefs, Stress Perception and Symptom Severity inIBS. Gastroenterology 2008; 134(1): 418.
  33. Rutter CL, Rutter DR. Illness representation, coping and outcome in irritable bowel syndrome (IBS). Br J Health Psychol 2002; 7(Part 4):
  34. -91.
  35. Broadbent E, Petrie KJ, Main J, Weinman J. The brief illness perception questionnaire. J Psychosom Res 2006; 60(6): 631-7.
  36. Bagherian R, BahramiEhsan H, Saneei H. Relationship Between History ofyocardial Infraction and CognitiveRepresentation of Myocardial Infraction. Journal of Research in Psychological Health 2008; 2(2): 29-39.
  37. Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther 1997; 11(2): 395-402.
  38. Gholamrezaei A, Nemati K, Emami MH. Which end point is more comprehensive in reflecting changes in irritable bowel syndrome treatment trials? Am J Gastroenterol 2009; 104(11): 2859.
  39. Gerson CD, Gerson MJ, Awad RA, Chowdhury A, Dancey C, Poitras P, et al. Irritable bowel syndrome: an international study of symptoms in eight countries. Eur J Gastroenterol Hepatol 2008; 20(7): 659-67.
  40. Petrie KJ, Weinman J, Sharpe N, Buckley J. Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study. BMJ 1996; 312(7040): 1191-4.
  41. Murphy H, Dickens C, Creed F, Bernstein R. Depression, illness perception and coping in rheumatoid arthritis. J Psychosom Res 1999; 46(2): 155-64.
  42. Dempster M, McCorry NK, Brennan E, Donnelly M, Murray LJ, Johnston BT. Do changes in illness perceptions predict changes in psychological distress among oesophageal cancer survivors? J Health Psychol 2011; 16(3): 500-9.
  43. Petrie K, Moss-Morris R, Weinman J. The impact of catastrophic beliefs on functioning in chronic fatigue syndrome. J Psychosom Res 1995; 39(1): 31-7.
  44. Whitehead WE. Assessing the effects of stress on physical symptoms. Health Psychol 1994; 13(2): 99-102.
  45. Welgan P, Meshkinpour H, Beeler M. Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Gastroenterology 1988; 94(5 Pt 1): 1150-6.
  46. Gomborone J, Dewsnap P, Libby G, Farthing M. Abnormal illness attitudes in patients with irritable bowel syndrome. J Psychosom Res 1995; 39(2): 227-30.
  47. Asmundson GJ, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev 1999; 19(1): 97-119.
  48. Petrie KJ, Cameron LD, Ellis CJ, Buick D, Weinman J. Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial. Psychosom Med 2002; 64(4): 580-6.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 137 - شماره پیاپی 137
خرداد و تیر 1390
صفحه 526-536

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  • تاریخ دریافت: 22 خرداد 1390
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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