Clinical management of inflammatory bowel disease: Beyond disease activity. I. Assessing psychosocial factors

Inflammatory bowel disease (IBD) is a chronic, relapsing disorder that can be very disabling to the patient and often leads to significant lifestyle problems (eg, emotional distress, social isolation, work impairment and disability). Available evidence strongly indicates that health status is influenced by psychosocial factors as well as disease activity. This is the first of a two-part series, the purpose of which is to provide a framework to guide the gastroenterologist in the assessment and management of psychosocial factors that impact on the health status of the IBD patient. Part 1 contains a review of existing approaches to assessment of psychosocial factors, which include focusing on psychosomatic or psychiatric factors. The growing body of evidence in support of a 'biopsychosocial' approach to understanding and treating health status is reviewed. In this approach, distress and disability are not seen as due to psychopathology, but stemming directly from the experience of illness itself. Part II will focus on specific strategies to maximize psychosocial adjustment to this disabling illness.