Resilience in Adult Coeliac Patients on a Gluten-Free Diet: A Cross-Sectional Multicentre Italian Study

Overview

Journal Nutrients

Date 2024 Aug 29

PMID 39203732

Authors

Annalisa Schiepatti

Stiliano Maimaris

Simona Randazzo

Daria Maniero

Roland Biti

Giacomo Caio

Lisa Lungaro

Antonio Carroccio

Aurelio Seidita

Davide Scalvini

Carolina Ciacci

Federico Biagi

Fabiana Zingone

Affiliations

Soon will be listed here.

Abstract

Background: Data on resilience, the ability to recover from adversity, in coeliac disease (CeD) are lacking.

Aim: To assess the degree of resilience in patients with CeD on a gluten-free diet (GFD), and its association with clinical features, sociodemographic factors, psychological morbidity, and quality of life (QOL).

Methods: A cross-sectional multicentre Italian study was conducted on adult CeD patients between May 2022 and April 2023. Connor-Davidson Resilience Scale (CD-RISC), the Coeliac Disease-specific Quality of Life Scale (CD-QOL), the State-Trait Anxiety Inventory scale (STAI-Y), and the Beck Depression Inventory scale (BDI) were used to evaluate resilience, QOL, anxiety, and depression, respectively. A multivariate analysis was conducted to identify factors independently associated with the degree of resilience.

Results: A total of 305 patients (221 F, mean age at CeD diagnosis 36 ± 16 years) on a long-term GFD (median 8 years, IQR 3-17) were enrolled. A total of 298/305 patients (98%) had a high level of resilience (CD-RISC ≥ 35). At univariate analysis, resilience was statistically associated with male gender ( = 0.03), age at enrolment ( = 0.02), marital status ( = 0.03), QOL ( < 0.001), anxiety ( < 0.001), and depression ( < 0.001). On multivariate regression analysis, trait anxiety (STAI-Y2, < 0.001) and depression (BDI, = 0.02) were independent predictors of lower levels of resilience.

Conclusions: Higher trait anxiety predicts lower levels of resilience. Targeted interventions in this subgroup of patients may be helpful for their management and follow-up.

Citing Articles

Beyond gluten-free diet: a critical perspective on phase 2 trials on non-dietary pharmacological therapies for coeliac disease.

Scalvini D, Scarcella C, Mantica G, Bartolotta E, Maimaris S, Fazzino E Front Nutr. 2025; 11():1501817.

PMID: 39839296 PMC: 11748180. DOI: 10.3389/fnut.2024.1501817.

References

Zingone F, Maimaris S, Auricchio R, Caio G, Carroccio A, Elli L . Guidelines of the Italian societies of gastroenterology on the diagnosis and management of coeliac disease and dermatitis herpetiformis. Dig Liver Dis. 2022; 54(10):1304-1319. DOI: 10.1016/j.dld.2022.06.023. View

Shiha M, Aziz I . Review article: Physical and psychological comorbidities associated with irritable bowel syndrome. Aliment Pharmacol Ther. 2021; 54 Suppl 1:S12-S23. DOI: 10.1111/apt.16589. View

Halmos E, Deng M, Knowles S, Sainsbury K, Mullan B, Tye-Din J . Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease. Aliment Pharmacol Ther. 2018; 48(1):78-86. DOI: 10.1111/apt.14791. View

Person H, Keefer L . Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Prog Neuropsychopharmacol Biol Psychiatry. 2020; 107:110209. PMC: 8382262. DOI: 10.1016/j.pnpbp.2020.110209. View

Kilpatrick L, Gupta A, Tillisch K, Labus J, Naliboff B, Mayer E . Neural correlates of perceived and relative resilience in male and female patients with irritable bowel syndrome. Neurogastroenterol Motil. 2023; 36(2):e14710. PMC: 11014739. DOI: 10.1111/nmo.14710. View

Penny H, Baggus E, Rej A, Snowden J, Sanders D . Non-Responsive Coeliac Disease: A Comprehensive Review from the NHS England National Centre for Refractory Coeliac Disease. Nutrients. 2020; 12(1). PMC: 7019917. DOI: 10.3390/nu12010216. View

McAllister S, Vincent A, Hassett A, Whipple M, Oh T, Benzo R . Psychological Resilience, Affective Mechanisms and Symptom Burden in a Tertiary-care Sample of Patients with Fibromyalgia. Stress Health. 2013; 31(4):299-305. PMC: 4077991. DOI: 10.1002/smi.2555. View

Zingone F, Secchettin E, Marsilio I, Valiante F, Zorzetto V, Cataudella G . Clinical features and psychological impact of celiac disease at diagnosis. Dig Liver Dis. 2021; 53(12):1565-1570. DOI: 10.1016/j.dld.2021.05.016. View

Luthar S, Cicchetti D, Becker B . The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2000; 71(3):543-62. PMC: 1885202. DOI: 10.1111/1467-8624.00164. View

10.

Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders D, Cellier C . European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019; 7(5):583-613. PMC: 6545713. DOI: 10.1177/2050640619844125. View

11.

Lebwohl B, Sanders D, Green P . Coeliac disease. Lancet. 2017; 391(10115):70-81. DOI: 10.1016/S0140-6736(17)31796-8. View

12.

Beck A, Ward C, Mendelson M, Mock J, ERBAUGH J . An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. DOI: 10.1001/archpsyc.1961.01710120031004. View

13.

Schiepatti A, Maimaris S, Lusetti F, Scalvini D, Minerba P, Cincotta M . High Prevalence of Functional Gastrointestinal Disorders in Celiac Patients with Persistent Symptoms on a Gluten-Free Diet: A 20-Year Follow-Up Study. Dig Dis Sci. 2022; 68(8):3374-3382. PMC: 10352160. DOI: 10.1007/s10620-022-07727-x. View

14.

Parker C, Naliboff B, Shih W, Presson A, Kilpatrick L, Gupta A . The Role of Resilience in Irritable Bowel Syndrome, Other Chronic Gastrointestinal Conditions, and the General Population. Clin Gastroenterol Hepatol. 2020; 19(12):2541-2550.e1. PMC: 7897330. DOI: 10.1016/j.cgh.2020.08.043. View

15.

Biagi F, Andrealli A, Bianchi P, Marchese A, Klersy C, Corazza G . A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease. Br J Nutr. 2009; 102(6):882-7. DOI: 10.1017/S0007114509301579. View

16.

Lenti M, Cococcia S, Ghorayeb J, Di Sabatino A, Selinger C . Stigmatisation and resilience in inflammatory bowel disease. Intern Emerg Med. 2020; 15(2):211-223. PMC: 7054377. DOI: 10.1007/s11739-019-02268-0. View

17.

Chmitorz A, Kunzler A, Helmreich I, Tuscher O, Kalisch R, Kubiak T . Intervention studies to foster resilience - A systematic review and proposal for a resilience framework in future intervention studies. Clin Psychol Rev. 2017; 59:78-100. DOI: 10.1016/j.cpr.2017.11.002. View

18.

Marsilio I, Canova C, DOdorico A, Ghisa M, Zingone L, Lorenzon G . Quality-of-Life Evaluation in Coeliac Patients on a Gluten-Free Diet. Nutrients. 2020; 12(10). PMC: 7601879. DOI: 10.3390/nu12102981. View

19.

Nachman F, del Campo M, Gonzalez A, Corzo L, Vazquez H, Sfoggia C . Long-term deterioration of quality of life in adult patients with celiac disease is associated with treatment noncompliance. Dig Liver Dis. 2010; 42(10):685-91. DOI: 10.1016/j.dld.2010.03.004. View

20.

Hall N, Rubin G, Charnock A . Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther. 2009; 30(4):315-30. DOI: 10.1111/j.1365-2036.2009.04053.x. View