Stigma moderates the relation between peer victimization, thwarted belongingness, and depressive symptoms in youth with inflammatory bowel disease

Abstract Objective Youth with inflammatory bowel disease (IBD) often experience difficulties communicating about their disease. It is suspected that the stigmatizing nature of IBD symptoms contributes to youths’ health communication difficulties, leaving youth feeling disconnected from their social environment and potentially resulting in decreased social belongingness and poorer emotional functioning. In this study, we tested an illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms serial mediation model. It was anticipated that youth illness stigma would confer a serial indirect effect on youth depressive symptoms through the sequential effects of stigma on health communication difficulties and thwarted social belongingness. Methods Seventy-five youth with IBD between the ages of 10 and 18 completed measures of perceived illness stigma, health communication difficulties, thwarted belongingness, and depressive symptoms. Results Results indicated a significant illness stigma → thwarted belongingness → depressive symptoms simple mediation path. Importantly, findings also revealed a significant serial mediation path for illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms. Conclusions Youth who perceive greater IBD stigma appear to experience increased difficulty communicating about their IBD with others, which in turn is associated with feelings of thwarted social belongingness and ultimately elevated depressive symptoms. These findings suggest that difficulty communicating about IBD is one potential route by which illness stigma has a negative impact on youth adjustment outcomes. Results could also inform clinical interventions to address IBD stigma and health communication difficulties associated with the social and emotional challenges in youth with IBD.

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P045 ILLNESS STIGMA, BODY IMAGE DISSATISFACTION, TWARTED BELONGINGNESS, AND DEPRESSIVE SYMPTOMS IN YOUTH WITH INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.163 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S64-S64

Author(s):

Caroline Roberts ◽

Kaitlyn Gamwell ◽

Clayton Edwards ◽

Marissa Baudino ◽

Jeanne Tung ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Body Image ◽

Depressive Symptoms ◽

Mental Health Professionals ◽

Bowel Disease ◽

Body Image Dissatisfaction ◽

Indeterminate Colitis ◽

Thwarted Belongingness ◽

Inflammatory Bowel ◽

Serial Mediation

Abstract Introduction Inflammatory bowel disease (IBD) involves invasive symptoms and embarrassing treatment side effects (e.g., weight gain/loss). Elevated levels of depressive symptoms are also observed in youth with IBD, and have been linked to perceived illness stigma and feelings of social isolation. One potential variable related to stigma that has received only minimal attention in the pediatric IBD literature is body image dissatisfaction, which is associated with poor social identity development and increased depressive symptoms in healthy youth. Due to the stigmatizing nature of IBD, youth may feel self-conscious about their body image, which contributes to decreased feelings of social belongingness and ultimately depressive symptoms. The current study tested a serial mediation model in which increased youth perceived IBD stigma was hypothesized to have an indirect influence on youth depressive symptoms through the sequential effects of stigma on youth body image dissatisfaction and increased thwarted social belongingness, resulting in a significant illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptom serial mediation path. Methods Youth with IBD (Crohn’s = 36, Ulcerative Colitis = 30, Indeterminate Colitis = 1; Female = 39) between the ages of 10–18 yrs. (M = 14.5; SD = 2.12) were recruited from a pediatric gastroenterology clinic. Time since diagnosis ranged from <1 to 5.74 yrs. (M = 1.58; SD = 1.56). Youth completed measures of IBD stigma (Stigma Scale-Child; SS-C), body image dissatisfaction (Body Image Questionnaire; BIQ), thwarted belongingness (Interpersonal Needs Questionnaire-Thwarted Belongingness Subscale; INQ-TB) and depressive symptoms (Children’s Depression Inventory- 2nd Edition; CDI-2). Disease severity was assessed by physician global assessment. Current medications and Body Mass Index (BMI) data were also collected. Results Eighteen percent reported elevated CDI-2 depression scores. Only gender and BMI were correlated with modeled variables. Further, the BMI → CDI-2 association was greater for youth taking prednisone. Primary analyses examining 95% confidence intervals from 5,000 bootstrapped regression resampling draws revealed significant direct effects for SS-C → BIQ, BIQ → INQ-TB, and INQ-TB → CDI-2. Bootstrapped mediation analyses indicated a significant serial indirect path for SS-C → BIQ → INQ-TB → CDI-2 (effect = 0.92, 95% CI = .141 to 2.187), controlling for gender, BMI, and prednisone medication. Conclusions Youth who perceive greater IBD stigma are more likely to experience increased body image dissatisfaction due to their IBD, which may engender feelings of social estrangement, and ultimately elevated depressive symptoms. Both stigma and body image dissatisfaction should be assessed and addressed in a multidisciplinary fashion by medical providers and mental health professionals.

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Treatment Adherence in Adolescents With Inflammatory Bowel Disease: The Collective Impact of Barriers to Adherence and Anxiety/Depressive Symptoms

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsr092 ◽

2011 ◽

Vol 37 (3) ◽

pp. 282-291 ◽

Cited By ~ 70

Author(s):

W. N. Gray ◽

L. A. Denson ◽

R. N. Baldassano ◽

K. A. Hommel

Keyword(s):

Inflammatory Bowel Disease ◽

Depressive Symptoms ◽

Treatment Adherence ◽

Bowel Disease ◽

Collective Impact ◽

Inflammatory Bowel

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I am a total failure: associations between beliefs and anxiety and depression in patients with inflammatory bowel disease with poor mental quality of life

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465819000444 ◽

2019 ◽

Vol 48 (1) ◽

pp. 91-102 ◽

Cited By ~ 2

Author(s):

Floor Bennebroek Evertsz’ ◽

Mirjam A.G. Sprangers ◽

Laura M. de Vries ◽

Robbert Sanderman ◽

Pieter C.F. Stokkers ◽

...

Keyword(s):

Quality Of Life ◽

Inflammatory Bowel Disease ◽

Depressive Symptoms ◽

Psychiatric Disorders ◽

Bowel Disease ◽

Anxiety And Depression ◽

Illness Beliefs ◽

Dysfunctional Beliefs ◽

Inflammatory Bowel

AbstractBackground:According to cognitive behavioural theory, cognitive factors (i.e. underlying general dysfunctional beliefs and (situation) specific illness beliefs) are theorized to lead to outcomes like anxiety and depression. In clinical practice, general dysfunctional beliefs are generally not tackled directly in short-term-therapy.Aims:The goal of the present study was to investigate the associations of general versus specific illness beliefs on anxiety and depressive symptoms and psychiatric disorders among a subgroup of patients with inflammatory bowel disease (IBD) with poor mental quality of life (QoL).Method:This study concerns cross-sectional data, collected at baseline from a randomized clinical trial. One hundred and eighteen patients, recruited at four Dutch hospitals, with poor QoL (score ≤23 on the mental health subscale of the Short-Form 36-item Health-Survey; SF-36) were included. General dysfunctional beliefs were measured by the Dysfunctional Attitude Scale (DAS), specific illness beliefs by the Illness Perceptions Questionnaire-Revised (IPQ-R), anxiety and depressive symptoms by the Hospital Anxiety and Depression Scale (HADS), and psychiatric disorders by the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I).Results:Univariate analyses showed associations between the level of anxiety and/or depression and general dysfunctional beliefs and four specific illness beliefs (consequences, personal control, emotional representations and treatment control). Among patients with IBD with psychiatric disorders, only the DAS was significantly associated with anxiety and depression (DAS added to IPQ-R and IPQ-R added to DAS).Conclusions:Psychological interventions may have to target general dysfunctional beliefs of patients with IBD with co-morbid psychiatric disorders to be effective. These patients with IBD are especially in need of psychological treatment.

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P045 ILLNESS STIGMA, BODY IMAGE DISSATISFACTION, TWARTED BELONGINGNESS, AND DEPRESSIVE SYMPTOMS IN YOUTH WITH INFLAMMATORY BOWEL DISEASE

Gastroenterology ◽

10.1053/j.gastro.2019.11.246 ◽

2020 ◽

Vol 158 (3) ◽

pp. S104

Author(s):

Caroline Roberts ◽

Kaitlyn Gamwell ◽

Clayton Edwards ◽

Marissa Baudino ◽

Jeanne Tung ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Body Image ◽

Depressive Symptoms ◽

Bowel Disease ◽

Body Image Dissatisfaction ◽

Inflammatory Bowel

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Stigma by association: Parent stigma and youth adjustment in inflammatory bowel disease

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsaa083 ◽

2020 ◽

Author(s):

Marissa N Baudino ◽

Megan N Perez ◽

Caroline M Roberts ◽

Clayton S Edwards ◽

Kaitlyn L Gamwell ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Depressive Symptoms ◽

Bowel Disease ◽

Equation Modeling ◽

Illness Intrusiveness ◽

Inflammatory Bowel ◽

Associative Stigma ◽

Parent Illness ◽

Perceived Illness ◽

Youth Depressive Symptoms

Abstract Objective Examine the indirect association between parents’ experience of stigma (i.e., associative stigma) and youth depressive symptoms through the serial effects of associative stigma on parent and youth illness intrusiveness in pediatric inflammatory bowel disease (IBD). Methods During routine clinic visits, 150 youth with well-controlled IBD (ages 10–18 years) completed measures of perceived illness intrusiveness and depressive symptoms. Parents completed measures of associative stigma and illness intrusiveness. Pediatric gastroenterologists provided ratings of IBD disease severity. Results Structural equation modeling revealed significant direct associations for associative stigma → parent illness intrusiveness, parent illness intrusiveness → youth illness intrusiveness, and youth illness intrusiveness → youth depressive symptoms. Results also revealed a significant associative stigma → parent illness intrusiveness → youth illness intrusiveness→ youth depressive symptoms serial mediation path, indicating that parents’ experience of associative stigma indirectly influenced youth depressive symptoms through its sequential effects on parent and youth perceived illness intrusiveness. Conclusions Parents who face stigma related to their child’s IBD (i.e., associative stigma) are more likely to experience IBD-induced lifestyle intrusions (i.e., illness intrusiveness), which in turn is associated with youths’ illness intrusiveness and ultimately youth depressive symptoms. These findings provide further evidence for the important role of illness-related stigma in pediatric IBD, particularly the transactional relation between parents’ associative stigma and youths’ illness appraisals and emotional functioning. The clinical implications of our results for addressing adjustment difficulties in youth with IBD are also discussed.

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