Ford, Sarah Theresa (2009)
Clin.Psy.D. thesis, University of Birmingham.
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Coeliac Disease (CD) is an autoimmune disease in which the enzyme gluten causes inflammation and damage to the small intestine. Untreated the condition may predispose symptomatic individuals to serious diseases such as cancer, type I diabetes, osteoporosis, gynaecological problems in women, peripheral and central nervous system disorders and other autoimmune diseases. In Europe it is estimated that the condition may affect between 1 in 200 to 1 in 500 people. CD is incurable but symptoms are managed by a gluten-free diet (GFD) for life. Most research looking at CD has focused on the biological basis of the disease rather than the impact of the condition from the individual’s subjective view. The few existing studies suggest that the chronicity of the condition, the limitations imposed by the need to follow a permanent restrictive diet and the risk of other associated diseases can have a negative impact on health-related quality of life (HRQoL) and psychological well-being. However, knowledge in this area remains sparse to-date. The aim of this review was to systematically review the literature published within the last decade to investigate the effects of living with CD in respect of psychological well-being and HRQoL. Twenty-one relevant studies were identified and critically reviewed. Attention was paid to the methodology, outcome measures, type of CD and sample characteristics. Difficulties when interpreting and comparing the results of the reviewed studies included differences in: design and measures used, sample populations, country of origin, age group, CD type, duration of GFD and adherence rates. The reviewed data suggest that in addition to a reduced HRQoL, psychological distress, especially self-reported symptoms of depression are commonly found in individuals with CD. Although anxiety symptoms are commonly experienced, these tend to decrease on a GFD. However, depressive symptoms may persist even in treated individuals.
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