Clinical management of inflammatory bowel disease: Beyond disease activity. Part II: Strategies for maximizing psychosocial health

Inflammatory bowel disease (IBD) remains a chronic, relapsing disorder that can be very disabling to the patient and often leads to significant problems in living (eg, emotional distress, social isolation, work impairment and disability). In part I of this paper, published in an earlier issue of this Journal, the authors reviewed available evidence indicating that health status is influenced strongly by psychosocial factors in addition to disease activity. The purpose of the present paper is to provide a specific framework to guide the gastroenterologist in the assessment and management of psychosocial factors that impact on the health status of the IBD patient. Guidelines for managing these psychosocial factors are provided. A central thesis of this paper is that the gastroenterologist, whether alone or in conjunction with a mental health specialist, must manage psychosocial as well as disease activity factors in the ongoing care of patients.