Italian IBD Patients Coping With Covid-19 Emergency: The Mitigating Role of Psychological Readiness to Engage in Self-care.

To the Editors,

The coronavirus 2019 (Covid-19) pandemic particularly troubled the Italian health care system that had to rapidly adjust its procedures to guarantee the continuity and quality of care to all patients, including IBD patients. Occhipinti and Pastorelli, in their special report on IBD[1] published recently, described the challenges in dealing with a systemic reconfiguration of their Hospital Unit in Policlinico San Donato, Milan. Their contribution has indubitable value by offering an organizational perspective. However, the report did not consider patients’ psychological elaboration of an event, which can be fundamental in influencing IBD patients’ care process,[2] even more in this stressful emergency. Having psychologically active and empowered patients is indeed recognized as an effective way of achieving better care outcomes, as also highlighted in the authors’ report.[1] Therefore, we conducted an online survey with a sample of 1014 IBD Italian patients, in collaboration with the national patient association AMICI Onlus. This survey aimed to explore the role of the patient’s psychological predisposition to be an active and empowered player of the health care system (Patient Health Engagement [PHE][3]) in dealing with the Covid-19 emergency. The PHE has previously been found to play a protective role in better clinical, psychological, and organizational outcomes.[4] The PHE scale measures 4 incremental levels of PHE.[5] In this model, people changed from being completely overwhelmed by the crisis to regaining a proactive role in taking the reins of their health to positively manage it. We found that patients with higher levels of PHE had significantly lower levels of the perceived risk of Covid-19 emergency and experienced lower levels of stress and higher levels of coping self-efficacy, suggesting a patient’s more adaptive psychological functioning.

Moreover, patients with higher levels of PHE scored significantly higher on perceived responsibility for preventing risk infection; contrarily, patients with lower PHE levels had lower trust in health care and a greater number of canceled hospital visits (Table 1). To conclude, in our study, a psychological predisposition to be engaged (PHE) seemed to mitigate patients’ reactions to the Covid-19 emergency. In response to Occhipinti and Pastorelli, we suggest doctors help patients change their perspectives to become active partners in the health care community. Finally, we highlight the organizational value of PHE in emergency management. Profiling patients on this parameter is important to identify higher-risk patients and thus create a “red flag” monitoring system that would allow for personalized intervention and communication strategies to be more effective.

TABLE 1.

Main Results From the Survey Based on 1014 IBD Italian Patients by PHE Levels*

Dependent variables		Engagement Levels Comparison
		Arousal -Adhesion	Arousal -Eudaimonic project	Adhesion-Eudaimonic project
Perceived risk [F (2, 995) = 67.000; P = 0.000]		0.438 (0.061)***	0.935 (0.082) ***	0.495 (0.076)***
Stress perception [F (2, 1011) = 165.296; P = 0.000]		0.556 (0.044)***	1.018 (0.057)***	0.462 (0.050)***
Coping self-efficacy [F (2, 1011) = 150.073; P = 0.000]		-1.380 (0.116)***	-2.541 (0.149)***	-1.160 (0.132)***
Responsibility in preventing risk infection [F (2, 1010) = 12.601; P = 0.000]		-0.272 (0.072)**	-0.406 (0.090)***	-0.133 (0.073)
Trust in health care [F (2, 1007) = 10.272; P = 0.000]		-0.249 (0.068)**	-0.338 (0.085)***	-0.089 (0.072)
		Engagement Levels
		Arousal	Adhesion	Eudaimonic project
Visits canceled Chi-square = 20.408(df = 2), P < 0.001
Yes	Counting	104	152	38
	% of total	10.3%	15.0%	3.7%
	Std res.	3.0	-0.8	-2.2
No	Counting	164	406	150
	% of total	16.2%	40.0%	14.8%
	Std res.	-1.9	.5	1.4

Note: (1) Values in cells represent mean differences; (2) Standard errors are reported in brackets; (3) Significance in marked with asterisks (* sig. at P < 0.05; ** sig. at P < 0.01; ***sig. at P < 0.001); (4) Cells with an absolute value of std. res >2 are marked in bold (5) Std res = standard residues (6) df = degrees of freedom.

*PHE model was validated with 4 levels representing 4 possible profiles of psychological predisposition (Blackout, Arousal, Adhesion, Eudaimonic project) to be engaged in health management, as described in Graffigna G., Barello S., and Bonanomi A., 20173. In this survey, for statistical reasons, Blackout and Arousal profiles were aggregated because they contained small numbers of people to be analysed individually.