Published April 3, 2014
Contrary to physicians’ expectations, when patients with irritable bowel syndrome (IBS) rated their overall health, the severity of their symptoms played only a modest role in their assessments, a University at Buffalo study has found.
Instead, fatigue, coexisting medical problems and negative social interactions had a stronger effect on patients’ perceptions of their own health.
These surprising findings are leading us toward a better understanding of the complexity of our patients’ health, and they may eventually contribute to improved clinical outcomes for those with a variety of chronic illnesses, says lead author Jeffrey M. Lackner, PsyD, associate professor of medicine.
Non-biomedical factors “may be more important to perceived health than health care professionals have ever suspected,” says Lackner.
Often, patients’ perceptions are at odds with “medical reality” or what a physician assesses physically, notes the behavioral medicine specialist.
“It’s a much more complex, cognitive process that incorporates a number of medical and social factors that are not necessarily on a physician’s radar screen.”
Self-reported health is crucial, however, because it has been found to be a “strong and robust predictor for mortality and morbidity, even when controlled for the presence of disease symptoms,” Lackner explains.
His team’s study is one of “very few” to look at self-reported health in relation to gastrointestinal (GI) disease, he notes.
IBS is a disabling and intractable disorder that affects an estimated 25 million to 50 million Americans, including twice as many women as men. Patients may experience abdominal pain, diarrhea and constipation.
Lackner’s research has focused on developing and testing novel treatments for functional GI disease, including IBS.
As director of the internationally known UB Behavioral Medicine Clinic, he helps patients with various painful disorders gain control of symptoms that have not adequately responded to standard medical treatments.
He is conducting two major studies funded by the National Institute of Diabetes and Digestive and Kidney Diseases to assess the effectiveness of behavioral self-management training in reducing IBS symptoms and related difficulties.
These studies, underway at UB and Northwestern University in Chicago, constitute the largest IBS clinical trial ever conducted and one of the largest behavioral trials of its kind ever funded by the National Institutes of Health.
All 234 patients involved in the health assessment study, including more than 180 women, were already participating in the larger studies. All had reported moderate-to-severe IBS symptoms that interfered with their quality of life.
In addition to IBS, participants were assessed for three aspects of personal well-being: somatic or medically unexplained symptoms, psychological factors and social factors.
They rated their health on a five-point scale from poor to excellent.
The paper, “The Impact of Physical Complaints, Social Environment and Psychological Functioning on IBS Patients’ Health Perceptions: Looking Beyond GI Symptom Severity” has been published in the American Journal of Gastroenterology, part of the Nature Publishing Group.
Lackner also discussed the paper in an informal interview with the journal’s editor.
Co-authors from UB’s Behavioral Medicine Clinic are Gregory D. Gudleski, PhD, research assistant professor, and Travis J. Stewart and Gary J. Iacobucci, both research assistants.
Additional co-authors are from Wayne State University in Detroit and UCLA.