Els van de Vijver

91 and a considerable proportion of the adolescents did not have fathers living with them.(14) Psychological variables In another paper, the Detroit team assessed 56 adolescents with IBD (aged between 11 and 17 years) with the Revised Children’s Manifest Anxiety Scale and found that adolescents with a negative affect (i.e., those who reported anxiety and depression) also experienced more pain and fatigue.(15) The group from Chicago and Texas used the Children’s Depression Inventory and found that adolescents with primarily inactive IBD did not report more depressive symptoms than healthy controls (1.4 vs. 1.3%).(6) Functional factors related to IBD Disease type The studies that used questionnaires to assess fatigue did not observe differences between CD and UC patients (8, 12, 16). The German research group that evaluated physical activity with a wearable device found that patients with CD tended towards taking fewer steps per day (8), and UC patients had a shorter duration of physical activity compared with healthy controls.(8) DISCUSSION Eight studies were included in this systematic review. These studies were selected for their focus on fatigue in adolescents with IBD. Key findings This review demonstrates that fatigue, exhaustion, diminished physical activity and trouble sleeping are more common in children and adolescents with IBD than in their healthy peers. Fatigue is likely to be a multifactorial phenomenon and includes biological factors (such as disease activity), psychobehavioral factors (such as anxiety, depression and family support) and functional factors (such as decreased functional capacity). The model depicted in Figure 2 addresses the various etiological factors and the connection Systematic review: fatigue 91