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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

Authors Luo XP, Mao R, Chen BL, Qiu Y, Zhang SH, He Y, Chen J, Zeng ZR, Ben-Horin S, Chen MH

Received 1 August 2016

Accepted for publication 31 October 2016

Published 22 December 2016 Volume 2017:11 Pages 23—31

DOI https://doi.org/10.2147/PPA.S118589

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Dr Naifeng Liu

Xia-peng Luo,1,* Ren Mao,1,* Bai-li Chen,1 Yun Qiu,1 Sheng-hong Zhang,1 Yao He,1 Jie Chen,1 Zhi-rong Zeng,1 Shomron Ben-Horin,2 Min-hu Chen1

1Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; 2Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

*These authors contributed equally to this work

Purpose: 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.
Patients and 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.
Conclusion: 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.

Keywords: inflammatory bowel disease, Crohn’s disease, health-related quality of life, anxiety, depression, stress

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