Background: Patient reported outcomes (PRO), key aspects in the management of inflammatory bowel disease (IBD), are strongly influenced by biopsychosocial factors. Whereas self-efficacy and coping strategies are modifiable social constructs that may improve health outcomes following dedicated intervention. This study aims to evaluate the relationship of PRO and these constructs in additional to traditional biopsychosocial factors.
Methods: We conducted a cross-sectional study on patients with Crohn's disease (CD) or ulcerative colitis (UC) at McGill IBD centre between September 2015 and March 2016. Patients were assessed for quality of life, disability and productivity using validated short IBD questionnaire (SIBDQ), IBD disability index (IBDDI) and work productivity assessment index respectively. Psychological assessment was performed using hospital anxiety and depression score (HADS). Brief COPE questionnaire were used for assessing coping strategies, and general self-efficacy scale was used for efficacy.
Results: 207 (144 CD/63 UC) patients, with median age of 39 (IQR 26) and 88 (42.5%) male, were included. 24.2% of patients had active disease (Harvey Bradshaw >4/Partial Mayo >2). Around one third of patients identified moderate to severe impairment on disability (31.3%), quality of life (33.3%) and productivity (29.1%); along with some degree of anxiety (32.9%) and depression (23.3%). Both poor quality of life (SIBDQ>47) and disability (IBDDI>33) were significantly associated with maladaptive coping (p=0.002 for both) and disease activity (p=0.001/p=0.002, respectively) in multivariate analysis (Table 1). Productivity loss was associated with female gender (p=0.023), active disease (p=0.003) and CD stricturing phenotype (p=0.03). In contrast, self-efficacy was protective of disability (p<0.001) and productivity loss (p=0.016). Similarly, patients with active disease (p=0.005) and maladaptive coping (p=0.014) were at risk of anxiety (HADS ≥8), whereas the inverse relationship was found for self-efficacy (p=0.013) and older age (p=0.045). Finally, maladaptive coping (p=0.014), active disease (p=0.037) and stricturing phenotype (p=0.048) was associated with depression.
Conclusions: Unfavorable patient reported outcomes are significantly associated with maladaptive coping and disease activity while self-efficacy had a positive effect. These modifiable social constructs could assist with identifying high-risk patients, of whom may benefit from targeted intervention to improve health outcomes.