title: Predictors of health-related quality of life and adherence in Crohn's disease and ulcerative colitis: implications for clinical management.
abstract: OBJECTIVE
  Inflammatory bowel disease (IBD) is associated with impaired health-related quality of life (HRQOL) and adherence. Our aim was to identify demographic, clinical, and psychosocial predictors of impaired HRQOL and non-adherence to provider recommendations.
  
  
  METHODS
  Adults with Crohn's disease (CD) or ulcerative colitis (UC) residing within the USA were recruited from online IBD support groups for participation in this cross-sectional study. Data were collected online through standardized instruments, including the Inflammatory Bowel Disease Questionnaire and the Medical Outcomes Study (MOS) general adherence scale. Bivariate analyses and multivariate linear regression were used to assess predictors of HRQOL and adherence.
  
  
  RESULTS
  We recruited 136 individuals, among whom median age was 35 years (range 18-75), and 82 % were female. 57 % had CD, and 43 % had UC. Predictors of lower HRQOL among CD patients were perceived stress (p < 0.0001), number of CD relapses (p < 0.0001), and female gender (p = 0.0015), while among UC patients they were perceived stress (p < 0.0001) and number of UC relapses (p = 0.0017). Predictors of lower adherence to provider recommendations in CD were perceived stress (p = 0.0007) and older age (p = 0.041), while in UC, perceived stress was the only predictor of lower adherence (p = 0.022).
  
  
  CONCLUSIONS
  Among patients with IBD, a higher level of perceived stress is a strong predictor of lower HRQOL and lower adherence to provider recommendations. Additionally, females with CD and patients with higher number of IBD relapses may be at risk of lower HRQOL. Psychological interventions, including physician-facilitated conversations, psychological screeners, and a multidisciplinary approach, may help address impaired HRQOL and adherence and merit further study.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA, anilga_m@yahoo.com.
authors.forename: Anilga
authors.initials: A
authors.lastname: Tabibian
authors.forename: James H
authors.initials: JH
authors.lastname: Tabibian
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Beckman
authors.forename: Laura L
authors.initials: LL
authors.lastname: Raffals
authors.forename: Konstantinos A
authors.initials: KA
authors.lastname: Papadakis
authors.forename: Sunanda V
authors.initials: SV
authors.lastname: Kane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D003424:Crohn Disease / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D011788:Quality of Life; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult