Effects of social support on the clinical course of Crohn's disease

Authors

  • Rafael J.A. Cámara MD,

    1. Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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  • Paul S. Lukas PhD,

    1. Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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  • Stefan Begré MD,

    1. Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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  • Valérie Pittet PhD,

    1. Healthcare Evaluation Unit, Institute of Social & Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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  • Roland von Känel MD,

    Corresponding author
    1. Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
    • Professor of Medicine, Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland
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  • Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) Group


  • Supported by grant 33CSCO-108792 from the Swiss National Science Foundation to Roland von Känel & Stefan Begré (Mental Health Core Project of the Swiss Inflammatory Bowel Disease Cohort Study). The funding source was neither involved in data collection, management, analysis, interpretation, or writing, nor in the decision to submit the article for publication.

  • Author Contributions and Financial Disclosure: Dr. Cámara, Dr. Begré, and Prof. von Känel developed the hypothesis and the study design. Dr. Cámara drafted the article. Dr. Cámara and Dr. Lukas analyzed, presented (tables and figures), and interpreted the data. Dr. Begré and Prof. von Känel supervised the project. Valérie Pittet provided support in the conceptualization of the study design and assistance in the validation of questionnaires. All authors participated in the literature search, revised the article critically, and approved its final version. Each author states that no financial conflicts of interest exist.

Abstract

Background:

Social support has been found to be protective from adverse health effects of psychological stress. We hypothesized that higher social support would predict a more favorable course of Crohn's disease (CD) directly (main effect hypothesis) and via moderating other prognostic factors (buffer hypothesis).

Methods:

Within a multicenter cohort study we observed 597 adults with CD for 18 months. We assessed social support using the ENRICHD Social Support Inventory. Flares, nonresponse to therapy, complications, and extraintestinal manifestations were recorded as a combined endpoint indicating disease deterioration. We controlled for several demographic, psychosocial, and clinical variables of potential prognostic importance. We used multivariate binary logistic regression to estimate the overall effect of social support on the odds of disease deterioration and to explore main and moderator effects of social support by probing interactions with other predictors.

Results:

The odds of disease deterioration decreased by 1.5 times (95% confidence interval [CI]: 1.2–1.9) for an increase of one standard deviation (SD) of social support. In case of low body mass index (BMI) (i.e., 1 SD below the mean or <19 kg/m2), the odds decreased by 1.8 times for an increase of 1 SD of social support. In case of low social support, the odds increased by 2.1 times for a decrease of 1 SD of BMI. Low BMI was not predictive under high social support.

Conclusions:

The findings suggest that elevated social support may favorably affect the clinical course of CD, particularly in patients with low BMI. (Inflamm Bowel Dis 2011;)

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