Maladaptive coping, low self-efficacy and disease activity are associated with poorer patient-reported outcomes in inflammatory bowel disease
Che-Yung Chao1, Carolyne Lemieux2, Sophie Restellini3, Waqqas Afif2, Alain Bitton2, Peter L Lakatos4, Gary Wild2, Talat Bessissow2
1 Division of Gastroenterology, McGill University Health Centre, Montreal, Canada; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
2 Division of Gastroenterology, McGill University Health Centre, Montreal, Canada
3 Division of Gastroenterology, McGill University Health Centre, Montreal, Canada; Department of Gastroenterology and Hepatology, Geneva University Hospitals and University of Geneva, Switzerland
4 Division of Gastroenterology, McGill University Health Centre, Montreal, Canada; Department of Gastroenterology, Semmelweis University, Budapest, Hungary
Dr. Talat Bessissow
Division of Gastroenterology, Montreal General Hospital, McGill University Health Center, 1650 Avenue Cedar C7-200, Montreal, Quebec, H3G 1A4
Source of Support: None, Conflict of Interest: None
Background/Aims: Patient-reported outcomes (PRO) are key aspects in the management of inflammatory bowel disease (IBD). This study aims to evaluate factors associated with adverse PRO, including modifiable social constructs of maladaptive coping and self-efficacy as well as physician–patient concordance on PRO.
Patients and Methods: This cross-sectional study was performed in patients with Crohn's disease (CD) or ulcerative colitis (UC) from September 2015 to March 2016. Validated questionnaires were used to assess quality of life (Short IBD Questionnaire), disability (IBD disability index), productivity (work productivity and activity impairment questionnaire), anxiety/depression (Hospital Anxiety and Depression Scale), coping strategies [Brief Coping Operations Preference Enquiry (Brief COPE)], and self-efficacy (General Self-Efficacy Scale). Independent physician assessment was used to compare concordance with patients.
Results: In all, 207 (CD: 144 and UC: 63) patients, with median age of 39 years, were included, with 42.5% males. Significant proportion of patients reported moderate/severe impairment of disability (30.5%), quality of life (29.4%), productivity (52.4%), anxiety (32.9%) and depression (23.3%). Disease activity and maladaptive coping were independently associated with unfavourable PRO, whereas self-efficacy had a positive effect in multivariate analysis. Physicians could accurately identify the magnitude of PRO impairment in standard clinical settings (r = 0.59–0.65, P < 0.001).
Conclusion: Disease activity and modifiable psychological constructs are associated with unfavorable PRO in patients with IBD. These factors could assist with identifying high-risk patients, many of whom may benefit from targeted interventions to improve health outcomes.