O-019 Anxiety in Pediatric IBD: A Predictor for Disease Relapse and Increased Health Care Use.

BACKGROUND: The impact of anxiety on disease relapse and health care use for pediatric patients diagnosed with inflammatory bowel disease (IBD) still requires further inquiry. Anxiety can influence health care utilization through multiple avenues, including manipulation of inflammatory processes central to IBD, and via somatic manifestation of psychological stress that may be misinterpreted as disease symptoms or medication side effects. The aim of this study was to examine the association between anxiety and risk for disease relapse, and test whether anxiety predicted greater gastrointestinal (GI) health care utilization over a 12-month period.

METHODS: Families were asked to complete Child and Parent versions of an anxiety questionnaire (Screen for Child Anxiety Related Emotional Disorders; SCARED) at their GI visit check-in, as part of a larger study (Reigada et al, in press). To be included in this study, children had to return a completed questionnaire, receive their primary IBD care at the medical practice, and remain a patient for ≥1 year. The final sample included 86 children ages 11 to 18 (M = 15.0, SD = 2.0) and their caregivers (n = 77). The number of disease relapses and GI health care utilization frequencies (i.e., GI office encounters, outpatient procedures, and hospital-based interventions) were extracted from medical records during the 12 months following completion of the anxiety questionnaire (i.e., baseline). Physicians also used documentation from patient charts to complete measures of disease activity at baseline and 12 months later. Analysis of variance was used to compare anxiety levels between those who experienced 2 or more disease relapses, and those who experienced 0 to 1. Poisson regressions were used to model relationships between child- and caregiver-reported anxiety symptoms and GI health care utilization. IBD relapses (0, 1, ≥2) and change in disease activity were also entered into the models.

RESULTS: The sample was predominantly white (81%) and the majority was male (56%). Children who experienced 2 or more disease relapses over 12 months (n = 14) had a mean baseline SCARED score of 19.6 (SD = 13.7), compared to a mean score of 12.6 (SD = 10.3) reported by children who had 0 to 1 IBD relapses (P < 0.05). Caregiver-reported anxiety symptoms did not differ between groups. Higher anxiety at baseline, irrespective of reporter, predicted greater total GI health care use (Ps < 0.01). Examination of individual GI visit types showed that child and caregiver-proxy reports predicted hospital-based interventions (P < 0.001), but not office encounters or outpatient procedures. Findings remained significant after controlling for disease severity (Ps < 0.05).

CONCLUSIONS: Results suggest that elevated self-reported anxiety may signal those children at risk for repeated disease relapses. Findings also show that child anxiety predicts the use of pediatric IBD health care over the subsequent year, especially hospital-based interventions such as emergency room visits and surgery. The influences of anxiety on health care utilization remained after accounting for disease severity, suggesting that health-seeking behavior may be influenced by emotional factors in addition to disease processes. Future studies should incorporate biological markers of disease and measures of somatic symptoms, as well as test the health and cost benefits of treating anxiety in pediatric IBD.