Christine P. Dancey

The understanding of their illness amongst people with irritable bowel syndrome: a Q methodological study

Irritable Bowel Syndrome (IBS) refers to a collection of gastrointestinal symptoms which affect up to 22% of the Western population. Although the disorder costs the British National Health Service and employers vast sums of money in terms of repeated physician visits, medications, and loss of productivity, the cause or causes of IBS are still unknown, and there is no cure which is lastingly effective. Since IBS is not life-threatening, and the symptoms can be hidden from others, many consider it a trivial disorder. For an individual with IBS, however, the uncertainty regarding cause, diagnosis and treatment may lead to anxiety and constant searching for causes, or to hopelessness and resignation. The present study aims to help clarify these problems by discovering how those who suffer from IBS understand the nature and causality of their own illness. Through use of Q methodology with a sample of 60 people with IBS, a taxonomy of 7 clear and distinct accounts is identified and described. These data (based on Q factor analysis) are described in qualitative detail and discussed in relation to the problem of improving communication with doctors, and untangling issues of responsibility for illness.

The relationship between daily stress and symptoms of irritable bowel: a time-series approach

Irritable bowel syndrome (IBS), a chronic disorder that includes symptoms such as abdominal pain and altered bowel habits, affects up to 22% of people in Western populations. The causes of IBS are not well understood, but are believed to be multifactorial. Although stress is widely believed to be implicated, empirical evidence in support of this is lacking, perhaps because a typical between-participants analysis ignores individual differences and therefore may obscure any link. The present study used a within-person, lagged time-series approach to investigate the links between everyday stress and symptomatology in 31 IBS sufferers. Both everyday stress and symptomatology exhibited serial dependence for a statistically significant proportion of sufferers. Multiple regression analysis carried out on same-day and lagged relationships up to and including 4 days found that, for over half the participants, everyday stress and symptoms were related. The best regression model was one in which symptoms were a function of hassles and symptoms on the previous 2 days, and hassles on the same day, fitting the data for 67% of participants. This prospective study confirms other studies that have suggested stress is a significant factor in IBS, and concludes that stress management programs may be both useful and cost-effective in the treatment of IBS.

Stroop interference and negative priming in patients with multiple sclerosis

The experiment reported represents a preliminary assessment of the ability of multiple sclerosis (MS) patients to inhibit distracting stimuli in a selective attention task. Twenty MS and 20 matched control participants were given a card version of the Stroop colour-word interference task. Four conditions were included; neutral (strings of coloured Xs), congruent (colour and word matched), Stroop interference (colour and word conflicted) and ignored repeated (again, conflicting colour and words, but colour on trial n matched the word on trial n-1). Response times (RTs) to 30 trials in each condition were measured to the nearest second. Increased Stroop interference scores were evident for the MS patients relative to the control group. However, a negative priming effect was evident for both MS and control groups; RTs were longer for the ignored repeated condition relative to the Stroop interference condition. This suggests that both groups were able to inhibit distractors on trial n-1, and that increased Stroop interference scores, for MS patients were not due to a complete breakdown of inhibitory processing. Although negative priming effects did not differ across the groups, the possibility of a partial breakdown in inhibitory processes could not be ruled out. Other explanations for increased Stroop interference in MS patients are also briefly considered.

Perceived stigma, illness intrusiveness and quality of life in men and women with irritable bowel syndrome

Illness intrusiveness--illness-induced disruptions to lifestyles, activities and interests--compromises quality of life (QOL) in chronic disease. Illness intrusiveness derives from aspects of disease (e.g. severity of symptoms) and treatment and its impact is moderated by psychological, social factors and biological sex/gender. The present study tested: (A) the validity of the illness intrusiveness framework in irritable bowel syndrome (IBS) and (b) the hypothesis that the psychosocial impact of IBS differs between men and women. A mail survey, completed by 117 national charity members, included the Illness Intrusiveness Ratings Scale and self-report QOL measures. Results indicated that both the severity of IBS symptoms and perceived stigma correlated significantly with QOL. As hypothesized, illness intrusiveness mediated these relationships and sex differences were evident. Although symptom severity was associated with a more powerful QOL impact among women as compared to men, perceived stigma was associated with a greater QOL impact in men. A sex 2 illness intrusiveness interaction indicated that QOL decreased more precipitously among men than women as illness intrusiveness increased. Illness intrusiveness was also a more powerful mediator of the relation between symptom severity and QOL among men than women: reduced QOL was related more directly to symptom severity among women than men. These results bear on the ways in which gender socialization shapes sex differences in the wider experience of IBS and raise implications for general versus sex-specific treatments.

Cognitive function in people with chronic illness: inflammatory bowel disease and irritable bowel syndrome.

Recent research has shown that people with chronic illnesses often experience cognitive deficits, such deficits may be specific to a particular type of illness, reflecting the disease process itself, or they may be deficits that are common across a number of chronic illnesses. Our study investigated whether people with an organic disease (Inflammatory Bowel Disease) show cognitive dysfunction relative to the control group and people with a functional illness (Irritable Bowel Syndrome), and if so, to elucidate the mechanisms by which such dysfunction occurs. A quasi-experimental design using three groups of participants provided scores on IQ, memory, and cognitive flexibility. Differences in absolute scores were slight. However, a noticeable interaction effect was found between group and IQ: The illness groups showed a deficit in verbal IQ relative to both their own performance IQ and to that of the control groups verbal IQ. This verbal deficit cannot be explained by depression, cognitive load, or medication.

Irritable bowel syndrome: an international study of symptoms in eight countries.

Objectives This report is a preliminary comparative study of irritable bowel syndrome symptoms in eight countries, USA, Mexico, Canada, England, Italy, Israel, India, and China. We also assessed global symptom patterns and correlations and relationships to several psychosocial variables. Methods Two hundred and thirty-nine participants completed a bowel symptom scale composed of four symptoms, abdominal pain or discomfort, bloating, diarrhea, and constipation as well as two psychosocial questionnaires, quality of relationship and attribution of symptoms to physical or emotional factors. Results Pain score in Italy, with the least urban population, was significantly higher than six of the seven other countries whereas it was lowest in India and England. Bloating was highest in Italy and constipation was highest in Mexico, both significantly higher than five other countries. Diarrhea was higher in China than five other countries. All significance values were P<0.05. Globally, diarrhea was less common than constipation, P<0.001 and bloating significantly correlated with constipation as well with pain, P<0.05. Composite analysis of psychosocial variables and symptoms indicated that family conflict correlated directly, P<0.05, whereas family support correlated indirectly, P<0.01, with pain and bloating. Pain, bloating and diarrhea were significantly attributed to physical etiology, P<0.01, whereas only diarrhea was attributed to emotional cause, P<0.05. Conclusion This study suggests that there are significant variations in irritable bowel syndrome symptoms in different geographic locations around the world. Various hypotheses that may explain our data such as cultural beliefs, gut contamination, urban and rural location, dietary practice, and psychosocial factors should be further investigated.

Learning to cope with chronic illness. Efficacy of a multi-component treatment for people with chronic fatigue syndrome

OBJECTIVE The aim of this study was to determine the efficacy of an out-patient, multi-component programme developed for patients with chronic fatigue syndrome (CFS). METHODS Twenty-two patients were assessed before and after six months of treatment. Findings were compared with 22 individuals on the waiting list. The programme offered medical care as well as information and counselling to help patients to understand, accept and cope with their illness. RESULTS At six months, there were significant differences between the groups for fatigue, self-efficacy and anxiety. Overall, 82% of the treated patients reported feeling better and 23% had improved to such a degree that they were discharged from the clinic. The gains were maintained at twelve months. CONCLUSION This programme was found to be both helpful and acceptable and may provide a useful first-line intervention for many patients with CFS. PRACTICE IMPLICATIONS Short, pragmatic programmes may be as effective as cognitive-behaviour therapy.

Words fail me: The verbal IQ deficit in inflammatory bowel disease and irritable bowel syndrome

Background: Many chronic illnesses are accompanied by impaired cognitive functioning. In people with Inflammatory Bowel Disease (IBD), there is some research to suggest a decrement in verbal IQ (VIQ), when compared to people with Irritable Bowel Syndrome (IBS) and healthy controls. Although this is an important finding, it is necessary to ensure that such deficits are not due to methodological problems such as the failure to take into account pre‐morbid functioning. Methods: A total of 88 people (IBD, N = 29; IBS, N = 29; Controls, N = 30) completed the Wechsler Abbreviated Scale of Intelligence (WASI), the Wechsler Test of Adult Reading (WATR), the Trait Rumination Questionnaire (TRQ), the Center for Epidemiologic Studies Depression Scale (CES‐D), and the General Health Questionnaire (GHQ‐12). Results: We found evidence of a VIQ decrement in both IBD and IBS groups when measured against both healthy controls and against their own pre‐morbid IQ scores (WTAR‐Predicted WAIS‐III IQ measures). However, the decrement was larger (and of clinical significance) in the IBD group but not in the IBS group. Conclusion: Some tentative evidence is presented which suggests that poor VIQ performance may be due in part to interference from excessive rumination.

Symptoms, impairment and illness intrusiveness–their relationship with depression in women with CFS/ME

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is an illness in which physiological and psychological factors are believed to interact to cause and maintain CFS/ME in an individual predisposed to it. The various symptoms and impairments associated with CFS/ME have a large impact on quality of life. The purpose of the present study was to identify the extent to which the core symptoms and impairments associated with CFS/ME relate to depression in women with CFS/ME, and to discover whether these relationships were mediated by illness intrusiveness. CFS/ME was found to be a highly intrusive illness, intruding into more life domains and to a greater degree than other illnesses. The effects of both symptoms and impairment on depression were, in part, mediated by illness intrusiveness. Although symptoms severity and impairment had both direct and indirect effects on depression, illness intrusiveness was the strongest predictor of depression.

The relationship between hassles, uplifts and irritable bowel syndrome: A preliminary study

In a preliminary study, 30 sufferers of irritable bowel syndrome filled in daily symptom sheets and the combined Hassles and Uplifts questionnaire for five weeks. Initially, analyses were carried out for each symptom separately. Results showed that ratings on the hassles and symptoms questionnaires completed in the same week were more highly associated than ratings for hassles and symptoms in different weeks. No one symptom in any week was significantly associated with the following weeks hassles. Similarly, hassles in any one week were not associated with the following weeks symptoms. However, total symptoms were found to be significantly associated with hassles in the following weeks, whereas the association between hassles and total symptoms in the following weeks was not significant. The study suggests that there is a cumulative effect of symptoms such that an increase in the severity of the combined effect of symptoms is associated with an increase in severity of stress in the next week. Increased hassles do not appear to exacerbate symptoms. There was no evidence of an association between uplifts and IB symptoms.