Chronic illness can lead to poorer quality of life - particularly for adolescents. New research shows that spirituality may help teens cope with their conditions.

Two recent studies, led by Michael Yi, MD, associate professor of medicine, and Sian Cotton, PhD, research assistant professor in the department of family medicine, investigated how adolescents with inflammatory bowel disease (IBD) - a condition characterized by chronic inflammation in the intestines - may use spirituality to cope with their illness.

These results were published in online versions of the Journal of Pediatrics and the Journal of Adolescent Health.

Spirituality is defined as one's sense of meaning or purpose in life or one's sense of connectedness to the sacred or divine.

IBD is a term that refers mainly to ulcerative colitis - which causes ulcers in the colon - and Crohn's disease - occurring when the immune system attacks the gastrointestinal tract.

Patients with IBD experience recurrent abdominal pain, bloody stools and diarrhea, among other serious problems, and have an increased risk for colon cancer. Adolescents with IBD are also at risk for numerous psychosocial difficulties, including increased mental health problems and social stigma.

The exact cause of IBD is not known, and there is no cure.

Teams led by Yi and Cotton collected data on socio-demographics, functional health status and psychosocial characteristics as well as spiritual well-being for 67 patients with IBD and 88 healthy adolescents between the ages of 11 and 19.

"Personal characteristics like self esteem, family functioning and social characteristics, like level of peer support, were similar between adolescents with IBD when compared to healthy peers, indicating that adolescents with IBD appear resilient," Yi says. "However, health-related quality of life was significantly poorer in general. On average, when compared to their healthy peers, patients with IBD were willing to trade more years of their life expectancy or risk a greater chance of death in order to achieve a better state of health."

He adds that researchers also found that one of the most important predictors of poorer overall quality of life was having a poorer sense of spiritual well-being.

Cotton's analysis of the same 155 adolescents focused on the relationships between levels of spiritual well-being and mental health outcomes in the adolescents with IBD as compared to their healthy peers.

Levels of spiritual well-being were similar between adolescents with IBD and healthy peers. In addition, higher levels of spiritual well-being were associated with fewer depressive symptoms and better emotional well-being.

"However, even though both healthy adolescents and those with IBD had relatively high levels of spiritual well-being, the positive association between spiritual well-being and mental health outcomes was stronger in the adolescents with IBD as compared to their healthy peers," Cotton says, noting that this indicates spiritual well-being may play a different role for teens with a chronic illness in terms of impacting their health or helping them cope.

Yi and Cotton decided to study IBD because it affects males and females at similar rates, has a relapsing and reduction course and peaks onset during late adolescence.

"While adolescents with IBD have specific issues that are unique to that group, we feel that these studies help to create a systematic approach to better understanding spirituality and religious coping in pediatric populations," Cotton says. "We felt it was best to examine these issues first in a homogenous population and then determine whether these findings can be generalized in adolescents with other chronic conditions or how they might be different across different illness groups."

Researchers are conducting ongoing studies of religious/spiritual coping in adolescents with IBD, asthma and sickle cell disease, with plans for future investigations in additional chronically ill pediatric and adult populations.

Additionally, they are collaborating with outside investigators on a study exploring physicians' views on addressing patients' spiritual or religious needs in clinical settings.

"There are few studies looking at religious or spiritual coping in chronic illness, especially in this age group," Yi says. "We hope to further our studies to include other chronic illnesses and determine whether addressing patients' spirituality in clinical settings would have a valuable impact on mental and physical health outcomes in patients with chronic illness."



The study of adolescents with IBD was conducted at Cincinnati Children's Hospital Medical Center, where both Cotton and Yi have secondary faculty appointments in the pediatrics department, and at University Hospital.

These studies are funded by career development awards by the National Institute for Child Health and Human Development.

Source: Katie Pence
University of Cincinnati