Jörn von Wietersheim

Psychological treatment may reduce the need for healthcare in patients with Crohn's disease

Background Few published studies examine the influence of psychological treatment on health care utilization in Crohns disease. Methods The present substudy of a prospective, randomized, multicenter trial conducted in 69 of 488 consecutive Crohns disease (CD) patients was designed to investigate the way in which healthcare utilization is influenced by psychotherapy and relaxation in addition to standardized glucocorticoid therapy. Before and after a 1‐year period of standardized somatic treatment the psychotherapy and control groups were compared with regard to hospital and sick‐leave days. Predictors of healthcare utilization were analyzed. Results The comparison between groups before and after psychological treatment showed a significantly higher decrease of mean hospital days (P < 0.03) and sick‐leave days in the treatment group compared with the controls. When a covariate analysis was applied to compare the data at randomization, the difference in hospital days remained statistically a trend (P < 0.1). Multivariate regression analysis detected a significant gender and depression effect for hospital days (cor r2 = 0.114) and a significant gender and age effect for sick‐leave days (cor r2 = 0.112). Conclusion A significant drop in healthcare utilization after psychological treatment demonstrates a clear benefit of this additional therapy. This is important, since the study failed to demonstrate significant changes in the psychosocial status or somatic course of study patients. Clinical and psychological factors influencing these outcomes are discussed. (Inflamm Bowel Dis 2007)

Effect of psychotherapy and relaxation on the psychosocial and somatic course of Crohn's disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn's Disease.

OBJECTIVE Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohns disease (CD). METHODS The present study, a prospective, randomized multicenter investigation conducted with 108 of 488 consecutive CD patients, was designed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a standardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status. Based on the same standardized somatic treatment, the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation. RESULTS A total of 81 (75%) of 108 randomized patients completed the psychosocial follow-up. The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status (depression, anxiety, psychosocial-communicative status and health-related quality of life). The mean Becks Depression Inventory (BDI) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group. At the 1-year follow-up, the scores for depression have been 7.8 (psychotherapy group) and 7.8 (control group). In the 2-year follow-up, 84 patients were classified into four groups on the basis of somatic course; 23% of the control group and 30% of the psychotherapy group showed episode-free courses, 29% and 17% respectively underwent surgery due to failure of immunosuppressive or medical therapy, and a further subranking showed no significant differences between the two groups (P=.125). At the 1-year follow-up, the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8. From the patients point of view, at the end of the 2-year follow-up, the overall subjective evaluation of the effectiveness of psychotherapy was positive. CONCLUSION The patients included showed no psychosocial disturbances of clinical relevance. Although a tendency toward fewer surgical interventions, fewer relapses and reduction of depression was noted, the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course. Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention.

Prädiktoren für die medizinische Inanspruchnahme am Beispiel von Patienten mit der Diagnose Morbus Crohn

ZusammenfassungZiel:In der Studie sollten Prädiktoren für eine medizinische Inanspruchnahme in Form von Arbeitsunfähigkeits-(AU-) und Krankenhaus-(KH-)Tagen am Beispiel von Patienten mit der Diagnose Morbus Crohn identifiziert werden.Patienten und Methodik:Vor diesem Hintergrund erfolgte die Analyse von 499 Patienten, welche über einen Zeitraum von 2 Jahren beobachtet wurden und aus denen eine Stichprobe von 87 Patienten gezogen wurde. Die Inanspruchnahme wurde anhand von AU- und KH-Tagen operationalisiert. Als mögliche Prädiktoren einer Inanspruchnahme fungierten soziodemographische, psychische und krankheitsspezifische Variablen.Ergebnisse:Im Rahmen einer linearen Regressionsanalyse erwiesen sich mit den AU-Tagen als abhängige Variable das Geschlecht (b = 43,01; p = 0,032) und die Depressivität (b = 2,949; p = 0,014) als statistisch signifikante, unabhängige Einflussvariablen (R2 = 0,189). Im Regressionsmodell mit der abhängigen Variable KH-Tage waren das Geschlecht (b = 19,863; p = 0,006) und das Alter (b = 0,785; p = 0,029) statistisch signifikant (R2 = 0,114). Für die somatische Krankheitsschwere ließ sich kein Zusammenhang mit der Inanspruchnahme in Form von KH- bzw. AU-Tagen nachweisen.Schlussfolgerung:Psychosoziale Faktoren wie Depressivität, Geschlecht und Alter haben demnach einen geringen, aber messbaren Einfluss auf die medizinische Inanspruchnahme bei Morbus Crohn. Eine stärkere Berücksichtigung dieser Charakteristika in der klinischen Praxis würde nicht nur die individuelle Lebensqualität verbessern, sondern zugleich die Inanspruchnahme gesundheitlicher Leistungen reduzieren.AbstractPurpose:The objective of the study was to identify predictors of health-care utilization in Crohns disease.Patients and Methods:Therefore, data of 499 patients was collected over a 2-year period. A sample of 87 patients was taken and analyzed. Health-care utilization was measured as work disability days and hospital bed days. Sociodemographic, mental as well as somatic variables were used as possible predictors of health-care utilization.Results:In a linear regression model with work disability days, the variables gender (b = 43.01; p = 0.032) and depressiveness (b = 2.949; p = 0.014) turned out to be significant (R2 = 0.189). In a linear regression model with hospital bed days, the variables gender (b = 19.863; p = 0.006) and age (b = 0.785; p = 0.029) proved to be significant (R2 = 0.114). No significant result was found for somatic variables such as severity of disease.Conclusion:Psychosocial variables such as depressiveness, gender and age have, therefore, a low but measurable impact on health-care utilization of patients with Crohns disease. Increased consideration of these variables in clinical practice would not only improve the quality of life of these patients but also reduce health-care utilization.

Prädiktoren für die medizinische Inanspruchnahme am Beispiel von Patienten mit der Diagnose Morbus Crohn@@@Predictors of Health-Care Utilization of Patients with Crohn's Disease. Results of a Prospective Randomized Multicenter Trial: Ergebnisse einer multizentrischen, prospektiv-randomisierten Studie

ZusammenfassungZiel:In der Studie sollten Prädiktoren für eine medizinische Inanspruchnahme in Form von Arbeitsunfähigkeits-(AU-) und Krankenhaus-(KH-)Tagen am Beispiel von Patienten mit der Diagnose Morbus Crohn identifiziert werden.Patienten und Methodik:Vor diesem Hintergrund erfolgte die Analyse von 499 Patienten, welche über einen Zeitraum von 2 Jahren beobachtet wurden und aus denen eine Stichprobe von 87 Patienten gezogen wurde. Die Inanspruchnahme wurde anhand von AU- und KH-Tagen operationalisiert. Als mögliche Prädiktoren einer Inanspruchnahme fungierten soziodemographische, psychische und krankheitsspezifische Variablen.Ergebnisse:Im Rahmen einer linearen Regressionsanalyse erwiesen sich mit den AU-Tagen als abhängige Variable das Geschlecht (b = 43,01; p = 0,032) und die Depressivität (b = 2,949; p = 0,014) als statistisch signifikante, unabhängige Einflussvariablen (R2 = 0,189). Im Regressionsmodell mit der abhängigen Variable KH-Tage waren das Geschlecht (b = 19,863; p = 0,006) und das Alter (b = 0,785; p = 0,029) statistisch signifikant (R2 = 0,114). Für die somatische Krankheitsschwere ließ sich kein Zusammenhang mit der Inanspruchnahme in Form von KH- bzw. AU-Tagen nachweisen.Schlussfolgerung:Psychosoziale Faktoren wie Depressivität, Geschlecht und Alter haben demnach einen geringen, aber messbaren Einfluss auf die medizinische Inanspruchnahme bei Morbus Crohn. Eine stärkere Berücksichtigung dieser Charakteristika in der klinischen Praxis würde nicht nur die individuelle Lebensqualität verbessern, sondern zugleich die Inanspruchnahme gesundheitlicher Leistungen reduzieren.AbstractPurpose:The objective of the study was to identify predictors of health-care utilization in Crohns disease.Patients and Methods:Therefore, data of 499 patients was collected over a 2-year period. A sample of 87 patients was taken and analyzed. Health-care utilization was measured as work disability days and hospital bed days. Sociodemographic, mental as well as somatic variables were used as possible predictors of health-care utilization.Results:In a linear regression model with work disability days, the variables gender (b = 43.01; p = 0.032) and depressiveness (b = 2.949; p = 0.014) turned out to be significant (R2 = 0.189). In a linear regression model with hospital bed days, the variables gender (b = 19.863; p = 0.006) and age (b = 0.785; p = 0.029) proved to be significant (R2 = 0.114). No significant result was found for somatic variables such as severity of disease.Conclusion:Psychosocial variables such as depressiveness, gender and age have, therefore, a low but measurable impact on health-care utilization of patients with Crohns disease. Increased consideration of these variables in clinical practice would not only improve the quality of life of these patients but also reduce health-care utilization.