Determinants of quality of life and psychosocial adjustment to pediatric inflammatory bowel disease: A systematic review focused on Crohn's disease

Background: Crohn's disease is a chronic and unpredictable inflammatory bowel disease that leads to important psychosocial difficulties especially during sensitive developmental stages such as childhood and adolescence. While risk factors for mood disorders have been identified in the literature, those for quality of life and psychosocial functioning have not. Objective: This systematic review explored the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. Method: Four international databases were consulted in March 2020: PubMed, Psychlnfo, PubPsych and Cochrane Library. A series of keywords were entered in each database to identify the most recent relevant studies. Results: One hundred and sixty-eight articles were identified, of which twenty-nine met the inclusion criteria. The majority explored the determinants of quality of life, depression and anxiety, with a few focusing on psychosocial functioning. Consistently with the literature on psychological morbidity, disease activity and parental stress were also strong predictors of quality of life and psychosocial functioning. New evidence showed that abdominal pain, negative illness perceptions and internalizing symptoms were also common predictors of these outcomes. Conclusions: Some risk factors of quality of life, distress and psychosocial functioning are similar, which could indicate that some patients could be at risk of presenting an accumulation of difficulties adjusting to the disease. The identification of these risk factors is fundamental to propose appropriate interventions. Therapeutic education, therapies focused on pain management or on the parent-child relationship can be considered to allow a better adjustment or prevent difficulties.

Automated summary

This systematic review examined the determinants of quality of life and psychosocial adjustment to pediatric Crohn's disease. The findings indicate that disease activity and parental stress are strong predictors, while factors such as abdominal pain, negative illness perceptions, and internalizing symptoms also play a role in impacting outcomes.