The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs

Janice S Cohen; John S Lyons; Eric I Benchimol; Nicholas Carman; Camille Guertin; David R Mack

doi:10.1016/j.jpsychores.2019.02.002

The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs

J Psychosom Res. 2019 Apr:119:26-33. doi: 10.1016/j.jpsychores.2019.02.002. Epub 2019 Feb 6.

Authors

Janice S Cohen¹, John S Lyons², Eric I Benchimol³, Nicholas Carman⁴, Camille Guertin⁵, David R Mack⁶

Affiliations

¹ Behavioral Neurosciences and Consultation Liaison Service, Mental Health, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada; School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada; CHEO Research Institute, Ottawa, ON, Canada.
² Chapin Hall, University of Chicago, Chicago, IL, United States.
³ CHEO Research Institute, Ottawa, ON, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; ICES uOttawa, Ottawa, ON, Canada; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology & Nutrition, Ottawa, ON, Canada.
⁴ Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology & Nutrition, Ottawa, ON, Canada.
⁵ School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada; CHEO Research Institute, Ottawa, ON, Canada.
⁶ CHEO Research Institute, Ottawa, ON, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology & Nutrition, Ottawa, ON, Canada. Electronic address: [email protected].

PMID: 30947814
DOI: 10.1016/j.jpsychores.2019.02.002

Abstract

Objective: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization.

Methods: We performed a cross-sectional study of children (aged 8-17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization.

Results: Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2-3 on the pIBD-INTERMED "mental health/cognitive threat" item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17-24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00-122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70-43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00-45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity.

Conclusions: The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.

Keywords: Biopsychosocial screening; Children; Crohn's disease; Inflammatory bowel disease; Integrated care; Ulcerative colitis.

MeSH terms

Adolescent
Child
Cross-Sectional Studies
Female
Humans
Inflammatory Bowel Diseases / psychology*
Male
Mass Screening / methods*