title: Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease.
abstract: OBJECTIVE
  To investigate the relationship between sense of coherence, psychological distress and health related quality of life in inflammatory bowel disease (IBD).
  
  
  METHODS
  This cross-sectional study enrolled a consecutive sample of 147 IBD (aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service. Sixty-four participants met diagnostic criteria for Crohn's disease, while eighty-three patients had ulcerative colitis. Socio-demographic data (education, age, race, gender, gross monthly income and marital status), disease-related variables (illness activity, relapse rate in past 2 years, history of surgery and time since diagnosis), sense of coherence (Antonovsky's SOC scale), psychological distress symptoms (Hospital Anxiety and Depression Scale) and health-related quality of life (HRQoL; WHOQOL-Bref) were assessed. Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQoL in patients with IBD and to provide indications for possible moderating or mediating effects. In addition, formal moderation and mediation analyses (Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC, psychological distress symptoms and HRQoL.
  
  
  RESULTS
  Lower SOC scores (std beta= -0.504; P < 0.001), female gender (std beta = 0.176; P = 0.021) and White race (std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms, while lower levels of SOC (std beta = -0.438; P < 0.001) and higher relapse rate (std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms. A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms, as the interaction term (time since diagnosis X SOC) had beta coefficients of -0.191 (P = 0.009) and -0.172 (P = 0.026), respectively. Lower levels of anxiety symptoms (std beta = -0.369; P < 0.001), higher levels of SOC (std beta = 0.231; P = 0.016) and non-White race (std beta = -0.229; P = 0.006), i.e., mixed-race, which represented the reference category, were independently associated with higher levels of overall HRQoL. Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL. In addition, anxiety mediated the association between SOC and satisfaction with health, as well as its relationship with physical, mental, and social relations HRQoL. Depressive symptoms also mediated the association between SOC and mental HRQoL.
  
  
  CONCLUSIONS
  Our data indicated that SOC is an important construct, as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.
authors.affiliation: Thiago H Freitas, Gilberto S Alves, Hesley LL Miranda, André F Carvalho, Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-040, CE, Brazil.
authors.forename: Thiago H
authors.initials: TH
authors.lastname: Freitas
authors.affiliation: Thiago H Freitas, Gilberto S Alves, Hesley LL Miranda, André F Carvalho, Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-040, CE, Brazil.
authors.forename: Elias
authors.initials: E
authors.lastname: Andreoulakis
authors.affiliation: Thiago H Freitas, Gilberto S Alves, Hesley LL Miranda, André F Carvalho, Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-040, CE, Brazil.
authors.forename: Gilberto S
authors.initials: GS
authors.lastname: Alves
authors.affiliation: Thiago H Freitas, Gilberto S Alves, Hesley LL Miranda, André F Carvalho, Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-040, CE, Brazil.
authors.forename: Hesley L  L
authors.initials: HL
authors.lastname: Miranda
authors.affiliation: Thiago H Freitas, Gilberto S Alves, Hesley LL Miranda, André F Carvalho, Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-040, CE, Brazil.
authors.forename: Lúcia L B C
authors.initials: LL
authors.lastname: Braga
authors.affiliation: Thiago H Freitas, Gilberto S Alves, Hesley LL Miranda, André F Carvalho, Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-040, CE, Brazil.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hyphantis
authors.affiliation: Thiago H Freitas, Gilberto S Alves, Hesley LL Miranda, André F Carvalho, Translational Psychiatry Research Group, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza 60430-040, CE, Brazil.
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001938:Brazil / Q000453:epidemiology; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D060685:Sense of Coherence; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
keywords: Anxiety; Coping; Crohn’s disease; Depression; Quality of life; Sense of coherence; Ulcerative colitis