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

Figures & data

Table 1 Demographic characteristics of patients included in the study (n=219)

Variable	All patients (n=219)	Low HRQOLa (n=111)	High HRQOLb (n=108)	P-value
Female, n (%)	81 (37.0)	43 (38.7)	38 (35.2)	0.586
Age, mean ± SD	34.1±11.2	34.7±11.9	33.4±10.4	0.396
Educational level, n (%)				0.978
Middle school	52 (23.7)	27 (24.3)	25 (23.1)
High school	62 (28.3)	31 (27.9)	31 (28.7)
College	105 (47.9)	53 (47.7)	52 (48.1)
Marital status, n (%)				0.129
Single	81 (37.0)	39 (35.1)	42 (38.9)
Married	134 (61.2)	68 (61.3)	66 (61.1)
Divorced	4 (1.8)	4 (3.6)	0 (0.0)
Procreation status, n (%)				0.961
Childless	99 (45.2)	50 (45.0)	49 (45.4)
Have children	120 (54.8)	61 (55.0)	59 (54.6)
Employment status, n (%)				0.028
Unemployment	40 (18.3)	23 (20.7)	17 (15.7)
Previous employment	48 (21.9)	31 (27.9)	17 (15.7)
Current employment	131 (59.8)	57 (51.4)	74 (68.5)
Type of medical costs, n (%)				0.207
Self-pay	128 (58.4)	60 (54.1)	68 (63.0)
Medical insurance	91 (41.6)	51 (45.9)	40 (37.0)
Proportion of medical costs relative to personal income, n (%)				0.003
<50%	152 (69.4)	67 (60.4)	85 (78.7)
≥50%	67 (30.6)	44 (39.6)	23 (21.3)

Notes:

a IBDQ total scores were lower or equal to the median level of IBDQ scores.

b IBDQ total scores were more than the median level of IBDQ scores. Median IBDQ total scores =173.

Abbreviations: HRQOL, health-related quality of life; SD, standard deviation; IBDQ, Inflammatory Bowel Disease Questionnaire.

Table 2 Clinical characteristics of patients included in the study (n=219)

Variable	All patients (n=219)	Low HRQOL (n=111)	High HRQOL (n=108)	P-value
CD, n (%)	146 (66.7)	76 (68.5)	70 (64.8)	0.566
Active disease, n (%)	56 (25.6)	46 (41.4)	10 (9.3)	<0.001
HBI (CD, n=146), median (range)	2.0 (0–11)	4.0 (0–11)	1.0 (0–7)
PMS (UC, n=73), median (range)	1.0 (0–9)	3.0 (0–9)	0.0 (0–4)
Disease duration (years), mean ± SD	5.2±4.1	5.6±4.5	5.5±4.4	0.916
Age of diagnosis, years (CD, n=146), n (%)				0.606
A1 (≤16)	6 (4.1)	3 (3.9)	3 (4.3)
A2 (17–40)	125 (85.6)	67 (88.2)	58 (82.9)
A3 (>40)	15 (10.3)	6 (7.9)	9 (12.9)
Location (CD, n=146), n (%)				0.574
L1 (ileal)	16 (11)	10 (13.2)	6 (8.6)
L2 (colonic)	11 (7.6)	4 (5.3)	7 (10.0)
L3 (ileocolonic)	98 (67.1)	52 (68.4)	46 (65.7)
L4 (upper GI tract)	21 (14.4)	10 (13.2)	11 (15.7)
Behavior (CD, n=146), n (%)				0.910
B1 (inflammatory)	62 (42.5)	31 (40.8)	31 (44.3)
B2 (stricturing)	47 (32.2)	25 (32.9)	22 (31.4)
B3 (penetrating)	37 (25.3)	20 (26.3)	17 (24.3)
Perianal disease (CD, n=146), n (%)				0.692
No	102 (69.9)	52 (68.4)	50 (71.4)
Yes	44 (30.1)	24 (31.6)	20 (28.6)
Extent of colitis (UC, n=73), n (%)				0.161
E1 (proctitis)	10 (13.7)	2 (5.7)	8 (21.1)
E2 (left side)	30 (41.1)	16 (45.7)	14 (36.8)
E3 (pancolitis)	33 (45.2)	17 (48.6)	16 (42.1)
Treatment, n (%)				0.011
No treatment	11 (5.0)	7 (6.3)	4 (3.7)
Mesalazine	19 (8.7)	14 (12.6)	5 (4.6)
Steroid	18 (8.2)	14 (12.6)	4 (3.7)
Immunosuppressive	110 (50.2)	47 (42.3)	63 (58.3)
Biologics	61 (27.9)	29 (26.1)	32 (29.6)
Relapses of IBD in last year, n (%)	75 (34.2)	50 (45.0)	25 (23.1)	0.001
Hospitalizations for IBD in last year, n (%)	85 (38.8)	54 (48.6)	31 (28.7)	0.002
History of surgical resection, n (%)	50 (22.8)	28 (25.2)	22 (20.4)	0.392

Abbreviations: HRQOL, health-related quality of life; CD, Crohn’s disease; HBI, Harvey and Bradshaw Index; PMS, partial Mayo score; UC, ulcerative colitis; GI, gastrointestinal; IBD, inflammatory bowel disease.

Table 3 Psychological characteristics of patients included in the study (n=219)

Variable	All patients (n=219)	Low HRQOL (n=111)	High HRQOL (n=108)	P-value
IBDQ, mean ± SD
Total scores	168.2±31.4	144.0±24.4	193.1±13.0	<0.001
Bowel symptoms	56.4±9.4	50.0±8.4	63.0±4.6	<0.001
Systemic symptoms	23.9±5.8	19.9±4.9	28.0±3.2	<0.001
Emotional function	61.1±12.4	52.1±9.8	70.4±6.8	<0.001
Social impairment	26.8±7.0	22.0±6.4	31.7±3.0	<0.001
SF-36, mean ± SD
PF	86.7±15.8	81.2±18.3	92.4±9.9	<0.001
RP	60.8±39.1	41.2±38.5	81.0±27.9	<0.001
BP	68.8±18.8	61.0±19.9	76.8±13.5	<0.001
GH	47.0±20.1	38.2±16.3	56.0±19.6	<0.001
VT	63.5±18.8	55.0±19.0	72.2±14.1	<0.001
SF	69.3±22.7	56.1±21.8	82.9±13.8	<0.001
RE	62.7±38.5	43.2±38.0	82.7±27.1	<0.001
MH	68.3±17.3	60.6±16.6	76.2±14.2	<0.001
HADS
HADS-Anxiety, mean ± SD	5.5±3.7	7.5±3.6	3.4±2.4	<0.001
HADS-Depression mean ± SD	4.7±3.7	6.5±3.9	2.9±2.5	<0.001
HADS-Anxiety >7, n (%)	54 (24.7)	48 (43.2)	6 (5.6)	<0.001
HADS-Depression >7, n (%)	38 (17.4)	34 (30.6)	4 (3.7)	<0.001
PSS-10, mean ± SD	15.7±6.4	18.0±6.1	13.3±5.9	<0.001
MSPSS, mean ± SD	64.9±10.7	63.4±12.0	66.5±9.1	0.033

Abbreviations: HRQOL, health-related quality of life; IBDQ, Inflammatory Bowel Disease Questionnaire; SD, standard deviation; SF-36, 36-item Short Form Health Survey; PF, physical functioning; RP, role-physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role-emotional; MH, mental health; HADS, Hospital Anxiety and Depression Scale; PSS-10, Perceived Stress Scale-10; MSPSS, Multidimensional Scale of Perceived Social Support.

Figure 1 Comparison of IBDQ total scores between three groups.

Notes: Group 1: patients with neither anxiety nor depression, group 2: patients with either anxiety or depression and group 3: patients with both anxiety and depression. **P<0.01 and ***P<0.001
Abbreviation: IBDQ, Inflammatory Bowel Disease Questionnaire.

Table 4 Univariate relationships between variables and IBDQ total scores

Variable	t	r	F	P-value
Demographic factors
Gender	0.554			0.580
Age		−0.087		0.201
Educational level			0.113	0.893
Marital status	0.854			0.394
Procreation status	0.901			0.368
Employment statusa	−2.452			0.015
Proportion of medical costs relative to personal incomeb	3.345			0.001
Clinical factors
Type of disease	−0.150			0.881
Disease activity	8.459			<0.001
Disease duration (≤5 versus >5 years)	1.448			0.149
Relapses for IBD in last year	4.109			<0.001
Hospitalizations for IBD in last year	3.315			0.001
Previous IBD surgery	0.371			0.711
Psychological factors
HADS-Anxiety		−0.660		<0.001
HADS-Depression		−0.533		<0.001
PSS-10		−0.433		<0.001
MSPSS		0.163		0.016

Notes:

a Unemployment versus employment.

b <50% versus ≥50%.

Abbreviations: IBDQ, Inflammatory Bowel Disease Questionnaire; IBD, inflammatory bowel disease; HADS, Hospital Anxiety and Depression Scale; PSS-10, Perceived Stress Scale-10; MSPSS, Multidimensional Scale of Perceived Social Support; t, Student’s t-test; r, Pearson’s correlation coefficient; F, analysis of variance.

Table 5 Multiple linear regression analyses between variables and IBDQ total scores

Variable	B	Standard error	Beta coefficient	t	P-value
HADS-Anxiety	−4.691	0.369	−0.549	−12.730	<0.001
Disease activity	−30.234	3.118	−0.421	−9.696	<0.001
Medical costa	−9.381	2.904	−0.138	−3.231	0.001
Adjusted R2	0.611

Note:

a Proportion of medical costs relative to personal income: <50% versus ≥50%.

Abbreviations: IBDQ, Inflammatory Bowel Disease Questionnaire; HADS, Hospital Anxiety and Depression Scale; t, Student’s t-test.