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From the Departments of Medicine and Psychiatry (D.A.D., J.L., Z.L., Y.J.B.H., T.C.T.), Division of Digestive Diseases, and UNC Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC; and Department of Psychology (F.K.), Duke University, Durham, NC.
Address reprint requests to: Douglas A. Drossman, MD, Division of Digestive Diseases, 726 Burnett-Womack Bldg., CB 7080, University of North Carolina, Chapel Hill, NC 27599-7080. Email: drossman{at}med.unc.edu
BACKGROUND: Studies have shown that the nature and quality of coping may positively or negatively affect health outcome; however, this relationship has not been well studied among patients with gastrointestinal (GI) disorders.
OBJECTIVES: The primary objective was to study the effect of different coping strategies on the health outcome of women with GI disorders and how these coping strategies may modify the effects of education, GI disease type, neuroticism, and abuse severity on health outcome.
METHODS: We followed 174 patients in a referral GI clinic for 12 months to assess their health status as a derived variable of daily pain, bed disability days, psychological distress, daily dysfunction, number of visits to physicians, and number of surgeries and procedures. We obtained at baseline their GI diagnosis (functional vs. organic), neuroticism score (NEO Personality Inventory), sexual and/or physical abuse history, and scores on two coping questionnaires. Regressions analyses were used to determine the relative effect of the coping measures on health outcome and their modifying effects on education, GI disease type, neuroticism, and abuse severity.
RESULTS: A higher score on the Catastrophizing scale and a lower score on the Self-Perceived Ability to Decrease Symptoms scale (Coping Strategies Questionnaire ) predicted poor health outcome. Less education, a functional GI diagnosis, a higher neuroticism score, and greater abuse severity also contributed to poor health status. However, the effect of GI disease type and neuroticism on health outcome was significantly reduced by the coping measures.
CONCLUSIONS: Maladaptive coping (eg, catastrophizing) and decreased self-perceived ability to decrease symptoms may adversely affect health outcome and may modify the effect of GI disease type and neuroticism on health outcome.
Key Words: coping • health status • outcome • gastrointestinal disorders • psychosocial factors
Abbreviations: CSQ = Coping Strategies Questionnaire; GI =gastrointestinal; GSI = General Severity Index; IBD =inflammatory bowel disease; NEO scale = neuroticism extraversionopenness scale; SCL-90-R = Symptoms Checklist 90 Revised; SIP= Sickness Impact Profile; WCQ = Ways of CopingQuestionnaire.
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