Eur J Gastroenterol Hepatol. 2022 Sep 1;34(9):919-924. doi: 10.1097/MEG.0000000000002420.Epub 2022 Jul 21.

Caroline M Roberts ¹, Kaitlyn L Gamwell ², Marissa N Baudino ¹, Clayton S Edwards ¹, Noel J Jacobs ³, Jeanne Tung ⁴, John E Grunow ⁴, Larry L Mullins ¹, John M Chaney ¹

Author information

¹Psychology Department, Center for Pediatric Psychology, Oklahoma State University, Stillwater, Oklahoma.

²Pediatric Pain Medicine, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina.

³General and Community Pediatrics.

⁴Pediatric Gastroenterology, University of Oklahoma Children's Physicians, Oklahoma City, Oklahoma, USA.

Abstract

Background: Elevated depressive symptoms are observed in a significant number of youth with inflammatory bowel disease (IBD) and have been linked to illness stigma and social isolation. Body image dissatisfaction is an understudied variable in the pediatric IBD literature that may be related to both stigma and social difficulties. It is suspected that, due to the stigmatizing nature of IBD, some youth may feel self-conscious about their body image, which contributes to decreased feelings of social belongingness and ultimately depressive symptoms. The current study tested an illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptoms serial mediation model, in which IBD stigma was hypothesized to indirectly influence youth depressive symptoms through the sequential effects of stigma on body image dissatisfaction and thwarted social belongingness.

Methods: Youth with IBD (N = 75) between 10 and 18 years old were recruited from a pediatric gastroenterology clinic and completed psychosocial measures. Disease severity was assessed by a physician global assessment. Current medications and BMI data were collected.

Results: Analyses revealed significant direct effects among the modeled variables and a significant serial indirect path for illness stigma→ body image dissatisfaction→ thwarted belongingness→ depressive symptoms, controlling for sex, BMI and prednisone medication.

Conclusions: Youth who perceive greater IBD stigma are more likely to experience increased body image dissatisfaction due to their IBD, which may engender feelings of social estrangement and ultimately elevated depressive symptoms. Depressive symptoms and the psychosocial challenges faced by youth should be routinely monitored as part of comprehensive IBD management.