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©The Author(s) 2015.
World J Gastroenterol. Jun 7, 2015; 21(21): 6713-6727
Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6713
Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6713
Table 1 Socio-demographic profile, clinical variables, sense of coherence, anxiety and depression symptoms and health-related quality of life in inflammatory bowel disease patients and comparisons between Crohn’s disease and ulcerative colitis n (%)
Total (n =147) | CD (n = 64) | UC (n = 83) | CD vs UC (P value) | |
Demographic | ||||
Sex | 0.8851 | |||
Male | 63 (42.9) | 27 (42.2) | 36 (43.4) | |
Female | 84 (57.1) | 37 (57.8) | 47 (56.6) | |
Race | 0.2181 | |||
Latin/Mixed-race | 96 (65.3) | 44 (68.8) | 52 (62.7) | |
White | 36 (24.5) | 16 (25.0) | 20 (24.1) | |
Black | 9 (6.1) | 3 (4.7) | 6 (7.2) | |
Asian | 5 (3.4) | 0 (0) | 5 (6.0) | |
Indian | 1 (0.7) | 1 (1.6) | 0 (0) | |
Age | 45.1 ± 14.1 | 43.9 ± 14.9 | 46.1 ± 13.9 | 0.3502 |
Years of education | 8.4 ± 4.9 | 8.1 ± 4.9 | 8.5 ± 5.1 | 0.6272 |
Marital status | ||||
With spouse/partner | 98 (66.7) | 46 (71.9) | 52 (62.7) | 0.2391 |
Gross monthly Income (USD) | 482.9 ± 560.0 | 487.6 ± 665.2 | 479.3 ± 467.4 | 0.9302 |
Clinical | ||||
Time since diagnosis (mo) | 80.5 ± 71.8 | 79.7 ± 73.9 | 81.0 ± 70.6 | 0.9142 |
Relapse rate | 0.0231 | |||
Low (0-2 in 2 yr) | 53 (36.3) | 23 (36.5) | 30 (36.1) | |
Moderate (3-5 in 2 yr) | 61 (41.8) | 20 (31.7) | 41 (49.4) | |
High (≥ 6 in 2 yr) | 32 (21.9) | 20 (31.7) | 12 (14.5) | |
Surgery for IBD | 26 (17.7) | 20 (31.3) | 6 (7.2) | < 0.0011 |
CDAI, mean ± SD | NA | 64.75 ± 43.57 | NA | |
TWT, mean ± SD | NA | NA | 7.53 ± 1.61 | |
Disease in remission | 90 (61.2) | 62 (96.9) | 28 (33.7) | < 0.0011 |
Psychological | ||||
SOC | 138.4 ± 24.8 | 138.6 ± 23.2 | 138.2 ± 26.1 | 0.9232 |
Anxiety symptoms (HADS-A) | 5.58 ± 4.30 | 6.00 ± 4.06 | 5.26 ± 4.47 | 0.3022 |
Depressive symptoms (HADS-D) | 5.27 ± 3.78 | 5.00 ± 3.83 | 5.48 ± 3.74 | 0.4452 |
HADS-A ≥ 8 (anxiety) | 37 (25.2) | 21 (32.8) | 16 (19.3) | 0.0611 |
HADS-D ≥ 8 (depression) | 36 (24.5) | 15 (23.4) | 21 (25.3) | 0.7941 |
HRQoL | ||||
Overall HRQoL | 3.88 ± 0.81 | 3.94 ± 0.75 | 3.84 ± 0.85 | 0.4852 |
Satisfaction with Health | 3.59 ± 0.96 | 3.34 ± 1.10 | 3.78 ± 0.80 | 0.0082 |
Physical HRQoL | 3.48 ± 0.64 | 3.42 ± 0.60 | 3.54 ± 0.67 | 0.2722 |
Mental HRQoL | 3.82 ± 0.67 | 3.68 ± 0.61 | 3.92 ± 0.71 | 0.0302 |
Social Relations HRQoL | 3.90 ± 0.74 | 3.98 ± 0.74 | 3.83 ± 0.74 | 0.2342 |
Environment HRQoL | 3.38 ± 0.53 | 3.41 ± 0.54 | 3.36 ± 0.53 | 0.5542 |
Table 2 Univariable associations of demographic, clinical and psychological variables with anxiety, depression and health-related quality of life (n =147)
Anxiety symptoms | Depressive symptoms | Overall HRQoL | Satisfaction with Health | Physical HRQoL | Mental HRQoL | Social Relations HRQoL | Environment HRQoL | |
Sex1 | ||||||||
Male | 5.01 ± 4.17 | 4.40 ± 3.2a | 4.02 ± 0.66 | 3.65 ± 0.99 | 3.65 ± 0.59b | 3.93 ± 0.47 | 3.96 ± 0.71 | 3.40 ± 0.54 |
Female | 6.01 ± 4.37 | 5.93 ± 4.0 | 3.79 ± 0.89 | 3.55 ± 0.95 | 3.36 ± 0.65 | 3.73 ± 0.78 | 3.85 ± 0.77 | 3.36 ± 0.53 |
Race2 | ||||||||
Latin/Mixed-race | 5.40 ± 4.00 | 5.02 ± 3.62 | 3.95 ± 0.81 | 3.63 ± 0.93 | 3.50 ± 0.62 | 3.84 ± 0.67 | 3.92 ± 0.73 | 3.39 ± 0.55 |
White | 5.80 ± 4.35 | 5.86 ± 3.98 | 3.66 ± 0.72 | 3.43 ± 1.01 | 3.47 ± 0.65 | 3.77 ± 0.72 | 3.70 ± 0.83 | 3.39 ± 0.48 |
Other | 6.19 ± 5.91 | 5.50 ± 4.35 | 4.00 ± 0.89 | 3.75 ± 1.06 | 3.39 ± 0.77 | 3.75 ± 0.60 | 4.17 ± 0.58 | 3.29 ± 0.54 |
Age3 | 0.125 | 0.188a | -0.181a | 0.081 | -0.196a | -0.036 | -0.244d | -0.078 |
Education (yr)3 | 0.016 | -0.156 | 0.166a | 0.006 | 0.132 | 0.038 | 0.166a | 0.212a |
Marital status1 | ||||||||
Living alone | 5.40 ± 4.52 | 5.39 ± 4.30 | 3.86 ± 0.89 | 3.45 ± 0.96 | 3.47 ± 0.70 | 3.85 ± 0.82 | 3.87 ± 0.70 | 3.35 ± 0.59 |
Living with spouse | 5.67 ± 4.21 | 5.21 ± 3.51 | 3.90 ± 0.77 | 3.66 ± 0.96 | 3.49 ± 0.62 | 3.80 ± 0.59 | 3.91 ± 0.77 | 3.39 ± 0.50 |
Income3 | -0.022 | -0.123 | 0.045 | -0.060 | 0.107 | 0.087 | 0.116 | 0.252b |
Disease1 | ||||||||
CD | 6.00 ± 4.06 | 5.00 ± 3.83 | 3.94 ± 0.75 | 3.34 ± 1.10b | 3.42 ± 0.60 | 3.68 ± 0.61a | 3.98 ± 0.74 | 3.41 ± 0.54 |
UC | 5.26 ± 4.47 | 5.48 ± 3.74 | 3.84 ± 0.85 | 3.78 ± 0.80 | 3.54 ± 0.67 | 3.92 ± 0.71 | 3.83 ± 0.74 | 3.36 ± 0.53 |
Time since diagnosis3 | 0.274d | 0.259b | -0.1116 | -0.097 | -0.177a | -0.217b | -0.202a | 0.019 |
Surgery for IBD1 | ||||||||
No | 5.56 ± 4.38 | 5.50 ± 3.73 | 3.84 ± 0.82 | 3.59 ± 0.97 | 3.48 ± 0.63 | 3.82 ± 0.66 | 3.87 ± 0.73 | 3.34 ± 0.52 |
Yes | 5.69 ± 4.00 | 4.23 ± 3.88 | 4.08 ± 0.74 | 3.62 ± 0.94 | 3.50 ± 0.70 | 3.81 ± 0.73 | 4.03 ± 0.80 | 3.56 ± 0.58 |
Relapse rate4 | 0.141 | 0.057 | -0.040 | -0.077 | -0.228b | -0.136 | 0.009 | -0.212a |
Disease activity1 | ||||||||
In Remission | 5.71 ± 4.60 | 5.13 ± 3.97 | 3.90 ± 0.81 | 3.52 ± 1.03 | 3.50 ± 0.62 | 3.77 ± 0.63 | 3.95 ± 0.78 | 3.43 ± 0.57 |
Active | 5.39 ± 3.81 | 5.49 ± 3.48 | 3.86 ± 0.81 | 3.70 ± 0.84 | 3.47 ± 0.68 | 3.89 ± 0.74 | 3.81 ± 0.69 | 3.29 ± 0.47 |
SOC5 | -0.398d | -0.458d | 0.271d | 0.232b | 0.313d | 0.341d | 0.266b | 0.266b |
Anxiety symptoms3 | N/A | 0.551d | -0.424d | -0.431d | -0.567d | -0.503d | -0.500d | -0.341d |
Depressive symptoms3 | 0.551d | N/A | -0.327d | -0.272d | -0.463d | -0.473d | -0.459d | -0.375d |
Table 3 Hierarchical Regression analyses to assess the variables independently associated with depressive and anxiety symptoms, as measured by the Hospital Anxiety and Depression scale (n =147)
Depressive symptoms | Anxiety symptoms | |||||
Model 1 | Model 2 | Model 3 | Model 1 | Model 2 | Model 3 | |
Sex (female) | 0.151 | 0.130 | 0.176a | 0.093 | 0.038 | 0.078 |
Race (white) | 0.091 | 0.064 | 0.164a | 0.004 | -0.047 | 0.040 |
Race (other) | 0.052 | 0.029 | 0.060 | 0.021 | 0.023 | 0.050 |
Age | 0.162 | 0.099 | 0.165 | 0.158 | 0.120 | 0.178 |
Education | -0.055 | -0.085 | -0.087 | 0.135 | 0.124 | 0.122 |
Living with spouse | -0.063 | -0.030 | 0.018 | -0.009 | 0.008 | 0.049 |
Income | -0.098 | -0.108 | -0.007 | -0.061 | -0.096 | -0.008 |
Disease (CD = 1, UC = 2) | - | 0.046 | 0.052 | - | -0.106 | -0.101 |
Time since diagnosis | - | 0.235b | 0.100 | - | 0.282b | 0.165 |
Surgery for IBD | - | -0.137 | -0.129 | - | -0.057 | -0.050 |
Relapse rate | - | 0.057 | 0.039 | - | 0.177a | 0.161a |
Disease in Remission | - | 0.044 | 0.048 | - | -0.030 | -0.027 |
SOC score | - | - | -0.504d | - | - | -0.438d |
Regression statistics | ||||||
Adjusted R2 | 0.047 | 0.080 | 0.314 | -0.011 | 0.062 | 0.236 |
Incremental adjusted R2 | 0.047 | 0.033 | 0.234 | -0.011 | 0.073 | 0.174 |
Significance of F change | 0.058 | 0.088 | < 0.001 | 0.599 | 0.011 | < 0.001 |
Table 4 Hierarchical multiple regression analyses to assess whether sense of coherence is a moderator of the relationship between time since diagnosis and psychological distress symptoms (i.e., depressive and anxiety symptoms) (n = 147)
Depressive symptoms | Anxiety symptoms | |||||
model 1 | model 2 | model 3 | model 1 | model 2 | model 3 | |
(z) Time since diagnosis | 0.235b | 0.100 | 0.068 | 0.282b | 0.165 | 0.135 |
(z) SOC | - | -0.504d | -0.500d | - | -0.438d | -0.434d |
(z) Time since diagnosis × SOC | - | - | -0.191d | - | - | -0.172d |
Adjusted R2 of the model | 0.080 | 0.314 | 0.344 | 0.062 | 0.236 | 0.260 |
Significance of F change | 0.026 | < 0.001 | 0.009 | 0.056 | < 0.001 | 0.026 |
Table 5 Hierarchical multiple regression analyses to assess variables independently associated with overall health-related quality of life and satisfaction with health (n = 147)
Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |
Overall HRQoL | Satisfaction with Health | |||||||||
Sex (female) | -0.119 | -0.120 | -0.152 | -0.136 | -0.135 | -0.101 | -0.080 | -0.102 | -0.062 | -0.061 |
Race (white) | -0.153 | -0.162 | -0.233b | -0.218a | -0.229b | -0.101 | -0.096 | -0.146 | -0.109 | -0.121 |
Race (other) | 0.017 | 0.033 | 0.011 | 0.016 | 0.025 | 0.017 | -0.021 | -0.036 | -0.023 | -0.013 |
Age | -0.125 | -0.115 | -0.163 | -0.148 | -0.108 | 0.143 | 0.128 | 0.095 | 0.132 | 0.176 |
Education | -0.103 | 0.127 | 0.129 | 0.121 | 0.180 | 0.105 | 0.081 | 0.082 | 0.063 | 0.127 |
Living with spouse | 0.060 | 0.042 | 0.008 | 0.010 | 0.025 | 0.087 | 0.095 | 0.071 | 0.075 | 0.092 |
Income | 0.013 | 0.001 | -0.071 | -0.072 | -0.074 | -0.125 | -0.120 | -0.170 | -0.172 | -0.174a |
Disease (CD = 1, UC = 2) | - | -0.096 | -0.100 | -0.096 | -0.141 | - | 0.326b | 0.323b | 0.335b | 0.285b |
Time since diagnosis | - | -0.051 | 0.045 | 0.054 | 0.099 | - | -0.092 | -0.024 | -0.002 | 0.048 |
Surgery for IBD | - | 0.117 | 0.111 | 0.099 | 0.101 | - | 0.121 | 0.117 | 0.087 | 0.089 |
Relapse rate | - | -0.074 | -0.061 | -0.057 | -0.004 | - | -0.041 | -0.032 | -0.023 | 0.036 |
Disease in Remission | - | -0.099 | -0.101 | -0.097 | -0.114 | - | 0.099 | 0.097 | 0.108 | 0.089 |
SOC score | - | - | 0.359d | 0.314b | 0.231a | - | - | 0.251b | 0.137 | 0.045 |
Depressive symptoms | - | - | - | -0.090 | 0.067 | - | - | - | -0.227a | -0.052 |
Anxiety symptoms | - | - | - | - | -0.369d | - | - | - | - | -0.409d |
Regression Statistics | ||||||||||
Adjusted R2 | 0.036 | 0.029 | 0.144 | 0.143 | 0.224 | -0.007 | 0.035 | 0.087 | 0.116 | 0.218 |
Incremental adjusted R2 | 0.036 | -0.007 | 0.115 | -0.001 | 0.081 | -0.007 | 0.042 | 0.042 | 0.029 | 0.102 |
Significance of F change | 0.102 | 0.539 | < 0.001 | 0.360 | < 0.001 | 0.547 | 0.058 | 0.004 | 0.025 | < 0.001 |
Physical HRQoL | Mental HRQoL | |||||||||
Sex (female) | -0.187a | -0.147 | -0.179a | -0.127 | -0.126 | -0.150 | -0.104 | -0.137 | -0.075 | -0.074 |
Race (white) | -0.007 | 0.017 | -0.054 | -0.005 | -0.017 | -0.041 | -0.001 | -0.073 | -0.015 | -0.023 |
Race (other) | -0.042 | -0.069 | -0.091 | -0.073 | -0.064 | -0.034 | -0.048 | -0.071 | -0.050 | -0.043 |
Age | -0.180 | -0.187 | -0.234a | -0.185a | -0.145 | -0.030 | -0.008 | -0.057 | 0.002 | 0.032 |
Education | 0.002 | -0.006 | -0.004 | -0.029 | 0.031 | -0.041 | -0.045 | -0.043 | -0.074 | -0.031 |
Living with spouse | 0.068 | 0.059 | 0.025 | 0.030 | 0.046 | -0.018 | -0.020 | -0.055 | -0.049 | -0.038 |
Income | 0.086 | 0.099 | 0.028 | 0.026 | 0.024 | 0.082 | 0.114 | 0.040 | 0.038 | 0.036 |
Disease (CD = 1, UC = 2) | - | 0.172 | 0.168 | 0.183 | 0.136 | - | 0.205 | 0.201 | 0.219a | 0.186 |
Time since diagnosis | - | -0.140 | -0.045 | -0.015 | 0.031 | - | -0.231a | -0.133 | -0.097 | -0.064 |
Surgery for IBD | - | 0.060 | 0.055 | 0.016 | 0.018 | - | 0.061 | 0.055 | 0.009 | 0.010 |
Relapse rate | - | -0.239b | -0.226b | -0.214b | -0.160a | - | -0.090 | -0.076 | -0.063 | -0.023 |
Disease in Remission | - | 0.112 | 0.110 | 0.124 | 0.106 | - | 0.038 | 0.036 | 0.053 | 0.040 |
SOC score | - | - | 0.356d | 0.208a | 0.123 | - | - | 0.368d | 0.188a | 0.128 |
Depressive symptoms | - | - | - | -0.295b | -0.134 | - | - | - | -0.357d | -0.241a |
Anxiety symptoms | - | - | - | - | -0.378d | - | - | - | - | -0.270b |
Regression Statistics | ||||||||||
Adjusted R2 | 0.047 | 0.105 | 0.219 | 0.273 | 0.360 | -0.012 | 0.039 | 0.159 | 0.241 | 0.282 |
Incremental adjusted R2 | 0.047 | 0.058 | 0.114 | 0.054 | 0.087 | -0.012 | 0.051 | 0.120 | 0.082 | 0.041 |
Significance of F change | 0.059 | 0.020 | < 0.001 | 0.001 | < 0.001 | 0.631 | 0.037 | < 0.001 | < 0.001 | 0.004 |
Social relations HRQoL | Environmental HRQoL | |||||||||
Sex (female) | -0.003 | 0.015 | -0.012 | 0.042 | 0.043 | 0.008 | 0.013 | -0.015 | 0.029 | 0.029 |
Race (white) | -0.109 | -0.085 | -0.146 | -0.095 | -0.106 | 0.007 | -0.001 | -0.062 | -0.021 | -0.026 |
Race (other) | 0.110 | 0.137 | -0.118 | 0.136 | 0.146a | -0.052 | -0.068 | -0.087 | -0.072 | -0.068 |
Age | -0.279b | -0.233a | -0.274b | -0.222a | -0.181a | -0.140 | -0.154 | -0.195a | -0.154 | -0.137 |
Education | -0.008 | 0.022 | 0.023 | -0.004 | 0.057 | 0.005 | 0.006 | 0.007 | -0.014 | 0.012 |
Living with spouse | 0.063 | 0.037 | 0.008 | 0.013 | 0.029 | 0.095 | 0.076 | 0.046 | 0.050 | 0.057 |
Income | 0.157 | 0.169 | 0.107 | 0.105 | 0.103 | 0.264b | 0.245b | 0.183a | 0.181a | 0.181a |
Disease (CD = 1, UC = 2) | - | -0.136 | -0.139 | -0.123 | -0.170 | - | 0.024 | 0.020 | 0.033 | 0.013 |
Time since diagnosis | - | -0.162 | -0.080 | -0.048 | -0.002 | - | -0.003 | 0.080 | 0.105 | 0.125 |
Surgery for IBD | - | 0.046 | 0.042 | 0.001 | 0.003 | - | 0.083 | 0.078 | 0.046 | 0.047 |
Relapse rate | - | -0.082 | -0.071 | -0.059 | -0.004 | - | -0.214a | -0.203a | -0.194a | -0.170a |
Disease in Remission | - | -0.067 | -0.069 | -0.054 | -0.072 | - | 0.101 | 0.099 | 0.111 | 0.103 |
SOC score | - | - | 0.309d | 0.152 | 0.067 | - | - | 0.310d | 0.185 | 0.148 |
Depressive symptoms | - | - | - | -0.311b | -0.148 | - | - | - | -0.248a | -0.178 |
Anxiety symptoms | - | - | - | - | -0.383d | - | - | - | - | -0.164 |
Regression Statistics | ||||||||||
Adjusted R2 | 0.077 | 0.084 | 0.167 | 0.228 | 0.317 | 0.045 | 0.069 | 0.153 | 0.189 | 0.200 |
Incremental adjusted R2 | 0.077 | 0.007 | 0.083 | 0.061 | 0.089 | 0.045 | 0.024 | 0.084 | 0.036 | 0.011 |
Significance of F change | 0.012 | 0.303 | < 0.001 | 0.001 | < 0.001 | 0.066 | 0.136 | < 0.001 | 0.010 | 0.097 |
Table 6 Mediation analysis (Sobel test) to assess whether the effect of sense of coherence on health-related quality of life domains is mediated by depressive and/or anxiety symptoms
Specific indirect effects | |||
via depressive symptoms | via anxiety symptoms | ||
Direct effect | Indirecteffect; Z | Indirecteffect; Z | |
Overall HRQoL | 0.008a | -0.001; -0.648 | 0.005; 3.112b |
Satisfaction with Health | 0.002 | 0.001; 0.503 | 0.007; 3.325d |
Physical HRQoL | 0.003 | 0.002; 1.399 | 0.004; 3.372d |
Mental HRQoL | 0.004 | 0.003; 2.290a | 0.003; 2.546a |
Social relations HRQoL | 0.002 | 0.002; 1.488 | 0.005; 3.328d |
Environment HRQoL | 0.003 | 0.002; 1.650 | 0.001; 1.578 |
- Citation: Freitas TH, Andreoulakis E, Alves GS, Miranda HL, Braga LL, Hyphantis T, Carvalho AF. Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease. World J Gastroenterol 2015; 21(21): 6713-6727
- URL: https://www.wjgnet.com/1007-9327/full/v21/i21/6713.htm
- DOI: https://dx.doi.org/10.3748/wjg.v21.i21.6713