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
Checked for plagiarism Yes
Review by Single-blind
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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