Body image as a predictor of psychopathology in surgical patients with colorectal disease

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Abstract

Objective

This study aimed to test the relevance of a cognitive behavioural model of body image in a prospective study of colorectal surgery patients and to determine if pre-existing body image disturbance influenced psychological adjustment following surgery.

Methods

Sixty-seven adult consecutive colorectal surgery patients completed measures assessing psychopathology, body image related beliefs and health related quality of life during pre-admission for surgery using a questionnaire battery. Each participant was followed up three months after surgery.

Results

Depression and anxiety were positively correlated with body image disturbance and self evaluation at baseline. Those patients who went on to receive stomas experienced a significant deterioration in their body image that was not observed in those whose surgery did not result in the formation of a stoma. In the regression analysis, body image disturbance was a significant predictor of baseline levels of depression and emotional quality of life. Initial levels of body image disturbance remained a significant predictor of depression and anxiety at follow up assessment after medical variables and baseline levels of depression and anxiety, respectively, had been controlled for.

Conclusion

Our findings support the hypothesis that pre-existing vulnerabilities in body image influence emotional adjustment during the recovery phase following surgery. Further research on screening for body image disturbance in surgical patients in order to promote adjustment is warranted.

Introduction

The psychological adjustment to a health threat cannot be fully explained and understood by physical sequelae alone. Bowel diseases, whether they are malignant or benign, can in and of themselves influence mood and other psychosocial outcomes. In addition, treatment for invasive bowel diseases can involve surgical intervention and in some instances results in a stoma which can introduce further issues that may impede adjustment. Research shows that there is an increased prevalence of depression in colorectal cancer patients, particularly those who receive a stoma, which can continue for a considerable period of time after surgery [1]. Even higher rates of affective disorders have been found in patients with inflammatory bowel disease including those who have stomas constructed [2], [3]. One potential reason for the poorer psychosocial adjustment of patients with cancer and/or inflammatory bowel disease who receive stomas is the impact of the stoma on the way in which people view their body.

Disturbances in body image are known to effect psychological adjustment in patients with cancer and other chronic illnesses [4], [5], [6], [7]. Research with colorectal surgical patients has demonstrated that stoma surgery adversely affects body image, which subsequently contributes to lower levels of quality of life [8], [9], [10], [11]. Despite the fact that there have been a handful of prospective studies examining the relationship between stoma status and adjustment (e.g. Refs. [8], [9], [10], [11]), measures of body image disturbance have been taken after surgery. Hence it has been unclear whether body image becomes worse as a result of mood disturbance following surgery, or whether body image disturbance itself precedes and predicts mood disturbance.

The aim of the present study is to investigate whether body image disturbance precedes and predicts subsequent adjustment in a group of consecutive patients awaiting colorectal surgery. We made a number of hypotheses. Firstly, we hypothesised that there would be an interaction between stoma status and time on body image disturbance. That is, those who received a stoma would experience a deterioration in body image which was not experienced by those who did not have a stoma constructed. Further, we hypothesised strong, cross-sectional relationships between body image disturbance and indicators of psychosocial adjustment. Our primary hypothesis of interest was that pre-existing body image disturbance would influence psychological adjustment following surgery, even when controlling for the baseline level of psychosocial function. Specifically, we hypothesised that body image disturbance prior to surgery would predict subsequent depression, anxiety and quality of life, controlling for initial levels of those variables and other related sociodemographic factors.

Section snippets

Participants

Eighty six consecutive colorectal surgical patients with a diagnosis of colorectal cancer or inflammatory bowel disease were approached prior to surgery resulting in sixty‐seven patients being surveyed (recruitment rate = 78%). Eligible participants were over 18 years, had not previously had bowel surgery resulting in stoma and were literate in English. Thirty seven participants had colorectal cancer; while thirty participants were to undergo surgery for benign tumours, diverticulitis, polyps,

Sample characteristics

Demographic characteristics of the sample are reported in Table 1.

Differences between illness groups

There were no significant differences based on disease status in psychopathology, measures of body image or quality of life between the cancer and inflammatory bowel disease patients before surgery. At follow up, the cancer patients reported significantly poorer physical quality of life (t1, 52 = 2.508, P = .015, Cohen's d = 0.68), however, there were no other significant differences between the groups

Discussion

This study aimed to investigate the role of body image disturbance in predicting subsequent adjustment following colorectal surgery. We included patients with colorectal cancer and inflammatory bowel disease awaiting colorectal surgery. There were no differences between the two illness groups at baseline in body image or other measures of psychopathology. Participants who underwent stoma forming surgery experienced greater levels of depression throughout the course of the study. Whilst there

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