title: Over-reaching beyond disease activity: the influence of anxiety and medical economic burden on health-related quality of life in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  Many patients with inflammatory bowel disease (IBD) have impaired health-related quality of life (HRQOL). The influence of psychological and economic factors on HRQOL has not been fully elucidated in IBD. Therefore, we aimed to identify the predictors of HRQOL in an IBD cohort.
  
  
  METHODS
  This was a cross-sectional cohort study of patients presenting to our tertiary IBD center. HRQOL was measured using the 36-item Short Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Perceived stress and perceived social support were also assessed by standardized scales. Demographic, socioeconomic and clinical data were obtained from a prespecified questionnaire and patients' medical records. Univariate analyses and multiple regression analysis were performed to identify predictors of HRQOL.
  
  
  RESULTS
  A total of 242 IBD patients were recruited, and the questionnaire return rate was 90.5% (219/242). The prevalence rates of anxiety and depression were 24.7% and 17.4%, respectively. In all, 30.6% of the patients spent over half of their income to cover medical costs. Multivariate analysis revealed that anxiety symptoms (P<0.001), active disease (P<0.001) and higher medical expenditures (P=0.001) were strong and independent predictors of reduced HRQOL.
  
  
  CONCLUSIONS
  Psychological factors and costs of medical care strongly impair HRQOL in IBD, independent of the disease activity. Psychological counseling and socioeconomic support programs should be considered for integration into the management of IBD patients.
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xia-Peng
authors.initials: XP
authors.lastname: Luo
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Ren
authors.initials: R
authors.lastname: Mao
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Bai-Li
authors.initials: BL
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Sheng-Hong
authors.initials: SH
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Zhi-Rong
authors.initials: ZR
authors.lastname: Zeng
authors.affiliation: Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Min-Hu
authors.initials: MH
authors.lastname: Chen
keywords: Crohn’s disease; anxiety; depression; health-related quality of life; inflammatory bowel disease; stress