title: Effect of threatening life experiences and adverse family relations in ulcerative colitis: analysis using structural equation modeling and comparison with Crohn's disease.
abstract: OBJECTIVE
  We published that threatening life experiences and adverse family relations impact Crohn's disease (CD) adversely. In this study, we examine the influence of these stressors in ulcerative colitis (UC).
  
  
  METHODS
  Patients completed demography, economic status (ES), the Patient-Simple Clinical Colitis Activity Index (P-SCCAI), the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), the Short-Form Health Survey (SF-36), the Brief Symptom Inventory (BSI), the Family Assessment Device (FAD), and the List of Threatening Life Experiences (LTE). Analysis included multiple linear and quantile regressions and structural equation modeling, comparing CD.
  
  
  RESULTS
  UC patients (N=148, age 47.55±16.04 years, 50.6% women) had scores [median (interquartile range)] as follows: SCAAI, 2 (0.3-4.8); FAD, 1.8 (1.3-2.2); LTE, 1.0 (0-2.0); SF-36 Physical Health, 49.4 (36.8-55.1); SF-36 Mental Health, 45 (33.6-54.5); Brief Symptom Inventory-Global Severity Index (GSI), 0.5 (0.2-1.0). SIBDQ was 49.76±14.91. There were significant positive associations for LTE and SCAAI (25, 50, 75% quantiles), FAD and SF-36 Mental Health, FAD and LTE with GSI (50, 75, 90% quantiles), and ES with SF-36 and SIBDQ. The negative associations were as follows: LTE with SF-36 Physical/Mental Health, SIBDQ with FAD and LTE, ES with GSI (all quantiles), and P-SCCAI (75, 90% quantiles). In structural equation modeling analysis, LTE impacted ES negatively and ES impacted GSI negatively; LTE impacted GSI positively and GSI impacted P-SCCAI positively. In a split model, ES had a greater effect on GSI in UC than CD, whereas other path magnitudes were similar.
  
  
  CONCLUSIONS
  Threatening life experiences, adverse family relations, and poor ES make UC patients less healthy both physically and mentally. The impact of ES is worse in UC than CD.
authors.affiliation: aSpitzer Department of Social Work, Ben-Gurion University of the Negev Departments of bPublic Health cHealth Systems Management dTechnical Staff, Faculty of Health Sciences, Ben-Gurion University of the Negev eDepartment of Gastroenterology and Hepatology, Soroka Medical Center, Beer-Sheva, Israel.
authors.forename: Vered
authors.initials: V
authors.lastname: Slonim-Nevo
authors.forename: Orly
authors.initials: O
authors.lastname: Sarid
authors.forename: Michael
authors.initials: M
authors.lastname: Friger
authors.forename: Doron
authors.initials: D
authors.lastname: Schwartz
authors.forename: Ruslan
authors.initials: R
authors.lastname: Sergienko
authors.forename: Avihu
authors.initials: A
authors.lastname: Pereg
authors.forename: Hillel
authors.initials: H
authors.lastname: Vardi
authors.forename: Terri
authors.initials: T
authors.lastname: Singer
authors.forename: Elena
authors.initials: E
authors.lastname: Chernin
authors.forename: Dan
authors.initials: D
authors.lastname: Greenberg
authors.forename: Shmuel
authors.initials: S
authors.lastname: Odes
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000209:etiology / Q000523:psychology* / Q000534:rehabilitation; D003424:Crohn Disease / Q000209:etiology / Q000523:psychology* / Q000534:rehabilitation; D005192:Family Health; D005195:Family Relations; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires