title: Health-related quality of life in youth with Crohn disease: role of disease activity and parenting stress.
abstract: OBJECTIVE
  Health-related quality of life (HRQOL) is an important, but understudied construct in pediatric inflammatory bowel disease. Family level predictors of HRQOL have been understudied as are the mechanisms through which disease activity affects HRQOL. The present study examines the relation between a family level factor (parenting stress) and HRQOL in youth with Crohn disease. Parenting stress is examined as a mechanism through which disease activity affects HRQOL.
  
  
  METHODS
  A total of 99 adolescents with Crohn disease and their parents were recruited across 3 sites. Adolescents completed the IMPACT-III (inflammatory bowel disease-specific HRQOL). Parents completed the Pediatric Inventory for Parents, a measure of medically related parenting stress that assesses stress because of the occurrence of medical stressors and stress because of the perceived difficulty of stressors. Disease activity was obtained from medical records.
  
  
  RESULTS
  Parenting stress because of the occurrence of medical stressors partially mediated the disease severity-HRQOL relation, reducing the relation between these variables from 49.67% to 31.58% (B= -0.56, P < 0.0001). Bootstrapping analysis confirmed that the indirect effect of disease severity on HRQOL via parenting stress significantly differed from zero. Parenting stress because of the perceived difficulty of medical stressors partially mediated the disease severity-HRQOL relation, reducing the relation from 49.67% to 30.29% (B= -0.55, P < 0.0001). The indirect effect was confirmed via bootstrapping procedures.
  
  
  CONCLUSIONS
  As disease severity increased, parenting stress also increased, and adolescent HRQOL decreased. Parenting stress should be considered and assessed for along with medical factors as part of a comprehensive approach to improve HRQOL in adolescents with Crohn disease.
authors.affiliation: *Department of Psychology, Auburn University, Auburn, AL †Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH ‡Department of Clinical & Health Psychology, University of Florida §Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Florida Health, Gainesville ||Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Schubert-Martin Inflammatory Bowel Disease Center, Cincinnati, OH ¶Division of Gastroenterology, Hepatology, and Nutrition, Center for Pediatric Inflammatory Bowel Disease, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Wendy N
authors.initials: WN
authors.lastname: Gray
authors.forename: Shana L
authors.initials: SL
authors.lastname: Boyle
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Graef
authors.forename: David M
authors.initials: DM
authors.lastname: Janicke
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Jolley
authors.forename: Lee A
authors.initials: LA
authors.lastname: Denson
authors.forename: Robert N
authors.initials: RN
authors.lastname: Baldassano
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Hommel
mesh_terms: D000293:Adolescent; D003424:Crohn Disease / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires