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Predictors of Health-Related Quality of Life and Adherence in Crohn’s Disease and Ulcerative Colitis: Implications for Clinical Management

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Abstract

Background and Aims

Inflammatory bowel disease (IBD) is associated with impaired health-related quality of life (HRQOL) and adherence. Our aim was to identify demographic, clinical, and psychosocial predictors of impaired HRQOL and non-adherence to provider recommendations.

Methods

Adults with Crohn’s disease (CD) or ulcerative colitis (UC) residing within the USA were recruited from online IBD support groups for participation in this cross-sectional study. Data were collected online through standardized instruments, including the Inflammatory Bowel Disease Questionnaire and the Medical Outcomes Study (MOS) general adherence scale. Bivariate analyses and multivariate linear regression were used to assess predictors of HRQOL and adherence.

Results

We recruited 136 individuals, among whom median age was 35 years (range 18–75), and 82 % were female. 57 % had CD, and 43 % had UC. Predictors of lower HRQOL among CD patients were perceived stress (p < 0.0001), number of CD relapses (p < 0.0001), and female gender (p = 0.0015), while among UC patients they were perceived stress (p < 0.0001) and number of UC relapses (p = 0.0017). Predictors of lower adherence to provider recommendations in CD were perceived stress (p = 0.0007) and older age (p = 0.041), while in UC, perceived stress was the only predictor of lower adherence (p = 0.022).

Conclusions

Among patients with IBD, a higher level of perceived stress is a strong predictor of lower HRQOL and lower adherence to provider recommendations. Additionally, females with CD and patients with higher number of IBD relapses may be at risk of lower HRQOL. Psychological interventions, including physician-facilitated conversations, psychological screeners, and a multidisciplinary approach, may help address impaired HRQOL and adherence and merit further study.

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Acknowledgments

We would like to thank Jayne Eaden, M.D., for her permission to use the CCKNOW.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Anilga Tabibian

  2. California School of Professional Psychology, Alhambra, CA, USA

    Anilga Tabibian & Linda J. Beckman

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    James H. Tabibian, Laura L. Raffals, Konstantinos A. Papadakis & Sunanda V. Kane

Authors
  1. Anilga Tabibian
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  2. James H. Tabibian
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  3. Linda J. Beckman
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  4. Laura L. Raffals
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  5. Konstantinos A. Papadakis
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  6. Sunanda V. Kane
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Corresponding author

Correspondence to Sunanda V. Kane.

Additional information

Anilga Tabibian and James H. Tabibian are co-first authors.

Appendix

Appendix

Medical Outcomes Study General Adherence Items (MOS)

This questionnaire is about your tendency to follow doctor’s recommendations. Please circle one answer choice below.

How often was each of the following statements true for you during the past 4 weeks? (Circle one number on each line)

  1. 1.

    I had a hard time doing what the doctor suggested I do…

    1. (a)

      None of the time

    2. (b)

      A little of the time

    3. (c)

      Some of the time

    4. (d)

      A good bit of the time

    5. (e)

      Most of the time

    6. (f)

      All of the time

  2. 2.

    I followed my doctor’s suggestions exactly…

    1. (a)

      None of the time

    2. (b)

      A little of the time

    3. (c)

      Some of the time

    4. (d)

      A good bit of the time

    5. (e)

      Most of the time

    6. (f)

      All of the time

  3. 3.

    I was unable to do what was necessary to follow my doctor’s treatment plans…

    1. (a)

      None of the time

    2. (b)

      A little of the time

    3. (c)

      Some of the time

    4. (d)

      A good bit of the time

    5. (e)

      Most of the time

    6. (f)

      All of the time

  4. 4.

    I found it easy to do the things my doctor suggested I do

    1. (a)

      None of the time

    2. (b)

      A little of the time

    3. (c)

      Some of the time

    4. (d)

      A good bit of the time

    5. (e)

      Most of the time

    6. (f)

      All of the time

  5. 5.

    Generally speaking, how often during the past 4 weeks were you able to do what the doctor told you?

    1. (a)

      None of the time

    2. (b)

      A little of the time

    3. (c)

      Some of the time

    4. (d)

      A good bit of the time

    5. (e)

      Most of the time

    6. (f)

      All of the time

Perceived Stress Scale-10 (PSS-10)

The questions in this scale ask you about your feelings and thoughts during the last month. In each case, you will be asked to indicate by circling how often you felt or thought a certain way.

0 = never 1 = almost never 2 = sometimes 3 = fairly often 4 = very often

1. In the last month, how often have you been upset because of something that happened unexpectedly?

0 1 2 3 4

2. In the last month, how often have you felt that you were unable to control the important things in your life?

0 1 2 3 4

3. In the last month, how often have you felt nervous and “stressed”?

0 1 2 3 4

4. In the last month, how often have you felt confident about your ability to handle your personal problems?

0 1 2 3 4

5. In the last month, how often have you felt that things were going your way?

0 1 2 3 4

6. In the last month, how often have you found that you could not cope with all the things that you had to do?

0 1 2 3 4

7. In the last month, how often have you been able to control irritations in your life?

0 1 2 3 4

8. In the last month, how often have you felt that you were on top of things?

0 1 2 3 4

9. In the last month, how often have you been angered because of things that were outside of your control?

0 1 2 3 4

10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?

0 1 2 3 4

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Tabibian, A., Tabibian, J.H., Beckman, L.J. et al. Predictors of Health-Related Quality of Life and Adherence in Crohn’s Disease and Ulcerative Colitis: Implications for Clinical Management. Dig Dis Sci 60, 1366–1374 (2015). https://doi.org/10.1007/s10620-014-3471-1

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  • DOI: https://doi.org/10.1007/s10620-014-3471-1

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