Socioeconomic and Psychological Factors Associated with Nonadherence to Treatment in Inflammatory Bowel Disease Patients: Results of the ISSEO Survey

Background: Adherence to treatment is a key condition in preventing relapses in inflammatory bowel disease (IBD). The aims of this study were specifically to study socioeconomic and psychological factors and adherence to treatment in a large cohort of patients. Methods: A questionnaire concerning demographic, clinical, and psychosocial characteristics was mailed to 6000 IBD patients belonging to the French association of IBD patients (AFA). The questionnaire was also available on the Website of the AFA for nonmember patients to answer. Good adherence to treatment was defined as taking >= 80% of prescribed medication. Socioeconomic deprivation was assessed using the specific EPICES score (http://www.cetaf.asso.fr) developed in France. Anxiety and depression were assessed using the Hospital Anxiety and Depression scale. Results: A total of 1069 women and 594 men (43.6 +/- 15.4 years) completed the questionnaire; 1450 (87.2%) of them belonged to the AFA. In all, 1044 had Crohn's disease, 36 indeterminate colitis, and 583 ulcerative colitis. Adherence >= 80% was reported by 89.6% of patients. Factors associated with good adherence were: older age (P < 0.01), treatment with anti-tumor necrosis factor (TNF) (P < 0.0001), membership in the AFA (P = 0.006). Nonadherence increases with smoking (P = 0.02), constraints related to treatment (P < 10(-9)), anxiety (P < 10(-6)), and moodiness (P < 10(-5)). There were no differences in adherence for the following: gender, type of IBD, activity and severity of the disease, socioeconomic deprivation, marital status, education level, and depression. Conclusions: In this large cohort of IBD patients, psychological distress and constraints related to treatment decrease adherence to treatment, while membership in a patients' association improves it.