Medication Management in Pediatric Chronic Illness: Should Patient Anxiety be Considered?

Introduction: There is growing support that psychological symptoms can impact various aspects of disease, well-being, and medical treatment for those with a chronic illness like Crohn’s disease (CD). Yet, almost no studies have examined whether psychological symptoms can influence management or efficacy of patient medication regimens. The aims of this project were to examine whether anxiety predicted pediatric patients’ level of medication management, medication prescription changes, and corticosteroid prescription and duration. Method: A total of 105 pediatric patients ages 8-18 (M=14.5, SD=2.3) completed a validated anxiety questionnaire during a GI office visit (baseline). Prescribed IBD medications were recorded for the subsequent year, including changes (i.e., additions, discontinuations, switches) and corticosteroid prescription duration. Disease activity scores were generated at baseline and 12 months. Logistic and Poisson regressions were used to ascertain the predictive value of anxiety for medication treatment level and frequency of prescription changes. A Pearson correlation was conducted to examine the relationship between anxiety and prospective duration of systemic corticosteroid prescription. Results: Anxiety symptoms did not predict a higher level of medication treatment, but did show a trend in predicting a greater frequency of total medication changes over the 12-month study period (p=.07). More specifically, patient-reported anxiety symptoms were significantly predictive of medication switches within the same drug class (pp Discussion: This study is among the first to explore whether psychological symptoms predict multiple aspects of medication management for a chronic illness sample. Findings suggest that physicians should assess for psychological distress, be aware of overlapping physical symptoms associated with CD and anxiety, and treat symptoms holistically. Further empirical investigations are warranted to examine the interplay between emotional symptoms and medication management.