Psychosocial factors contributing to inflammatory bowel disease activity and health-related quality of life.
OBJECTIVE
This study aimed to examine the contributions of coping and social constraint to disease activity and health-related quality of life (HRQOL) and to examine group differences in disease activity and HRQOL between patients with high versus low anxiety or depression symptoms in adults with inflammatory bowel disease (IBD).


METHODS
This study was a retrospective analysis in which disease activity was measured with either the Harvey-Bradshaw Index or the Simple Clinical Colitis Activity Index. HRQOL was measured with the Short Inflammatory Bowel Disease Questionnaire. Coping was measured with a modified COPE questionnaire. Anxiety and depression symptoms were measured with the Hospital Anxiety and Depression Scale. Social constraint was measured with the Social Constraint Questionnaire. Correlational and regression analyses were performed to assess the relationships between social constraint, coping, anxiety symptoms, depression symptoms, and HRQOL and disease activity.


RESULTS
Data from 80 adults with IBD were reviewed. Social constraint, disengagement coping, anxiety symptoms, and depression symptoms were inversely correlated with HRQOL. Disengagement coping was positively correlated with disease activity. Regression analyses showed that smokers had significantly worse HRQOL than nonsmokers and that greater use of engagement coping was associated with significantly diminished HRQOL. Regression analyses also showed that patients diagnosed between 17 and 40 years of age were significantly less likely to have active disease than patients diagnosed before 16 years of age and that greater use of disengagement coping was associated with increased odds of having active disease.


CONCLUSIONS
Medical providers should be aware that coexisting social constraint and symptoms of anxiety and depression are common in patients with IBD. Screening for these factors, as well as patients' coping styles, should be strongly considered, and patients should be referred to mental health providers as appropriate.
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
Alejandra H
AH
Faust
Leslie F
LF
Halpern
Sharon
S
Danoff-Burg
Raymond K
RK
Cross