The contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in pediatric inflammatory bowel disease

Background Clinical disease activity associated with inflammatory bowel disease (IBD) can place physical limitations on youths' activities of daily living. In turn, functional limitations potentially contribute to youths' heightened experience of IBD‐induced intrusions on a wide range of routine and valued activities (i.e., illness intrusiveness), which can increase their risk for depressive symptoms. The present study examined the contributions of clinical disease activity, functional disability, and illness intrusiveness to depressive symptoms in youth with IBD. Methods Youth (N = 180) completed the Functional Disability Inventory (FDI), Illness Intrusiveness Scale‐Child (IIS‐C), and Children's Depression Inventory‐2 (CDI‐2). Physicians completed the Physicians Global Assessment of disease activity (PGA). Results Results revealed a mediating effect for functional disability in the association between disease activity and depressive symptoms (PGA → FDI → CDI‐2); illness intrusiveness mediated the association between functional disability and depressive symptoms (i.e., FDI → IIS‐C → CDI‐2). Serial mediation revealed that clinical disease activity conferred an indirect effect on youth depressive symptoms through the sequential effects of functional disability and illness intrusiveness (i.e., PGA → FDI → IIS‐C → CDI‐2). Conclusions Taken together, these findings indicate that youth who encounter more physical limitations as a function of clinical disease activity are more likely to experience an amplified sense of IBD‐related intrusions on their ability to participate in meaningful activities. In turn, heightened illness intrusiveness increases the likelihood of depressive symptoms. Clinical interventions that help youth maintain adequate functional ability in the face of IBD disease activity and encourage involvement in positively valued activities could decrease the negative impact of IBD on youths' emotional adjustment. What is Known Youth with IBD often exhibit significant depressive symptoms that are not entirely explained by clinical disease activity. IBD‐induced intrusions into routine functioning are associated with youth depressive symptoms. What is New Our findings highlight the indirect influence of functional disability and illness‐induced lifestyle disruptions on the association between clinical disease activity and depressive symptoms. Efforts to assist youth in maintaining involvement in their day‐to‐day activities appear to lessen the negativ