Coping strategies, satisfaction with life, and quality of life in Crohn's disease: A gender perspective using structural equation modeling analysis.

Orly Sarid ,Nava Gaspar ,Vered Slonim‐Nevo ,Vitaly Dizengof ,Alexander Fich ,Michael Friger ,Alex Rozental ,Avihu Pereg ,Amiel Segal ,Elena Chernin ,Leslie Eidelman ,Dan Greenberg ,Ruslan Sergienko ,Daniella Munteanu ,Hillel Vardi ,Gil Ben Yakov ,Alexander Mushkalo ,Doron Schwartz ,Ilana Shahar ,Naim Abu‐Freha ,Shmuel Odes

doi:10.1371/journal.pone.0172779

Abstract

ObjectiveTo identify coping strategies and socio-demographics impacting satisfaction with life and quality of life in Crohn’s disease (CD).Methods402 patients completed the Patient Harvey-Bradshaw Index, Brief COPE Inventory, Satisfaction with Life Scale (SWLS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We performed structural equation modeling (SEM) of mediators of quality of life and satisfaction with life.ResultsThe cohort comprised: men 39.3%, women 60.1%; P-HBI 4.75 and 5.74 (p = 0.01). In inactive CD (P-HBI≤4), both genders had SWLS score 23.8; men had SIBDQ score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men. In active CD, SWLS and SIBDQ scores were reduced, without gender differences; men and women used coping strategies equally. A SEM model (all patients) had a very good fit (X2(6) = 6.68, p = 0.351, X2/df = 1.114, SRMR = 0.045, RMSEA = 0.023, CFI = 0.965). In direct paths, economic status impacted SWLS (β = 0.39) and SIBDQ (β = 0.12), number of children impacted SWLS (β = 0.10), emotion-focused coping impacted SWLS (β = 0.11), dysfunctional coping impacted SWLS (β = –0.25). In an indirect path, economic status impacted dysfunctional coping (β = –0.26), dysfunctional coping impacted SIBDQ (β = –0.36). A model split by gender and disease activity showed that in active CD economic status impacted SIBDQ in men (β = 0.43) more than women (β = 0.26); emotional coping impacted SWLS in women (β = 0.36) more than men (β = 0.14).ConclusionsGender differences in coping and the impacts of economic status and emotion-focused coping vary with activity of CD. Psychological treatment in the clinic setting might improve satisfaction with life and quality of life in CD patients.

Highlights

Crohn’s disease (CD) is a chronic illness with onset usually in young adulthood and a fluctuating, unpredictable clinical course characterized by exacerbations and remissions.[1]
In inactive CD (P-HBI 4), both genders had Satisfaction with Life Scale (SWLS) score 23.8; men had Short Inflammatory Bowel Disease Questionnaire (SIBDQ) score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men
In individuals with inactive disease, the SIBDQ was higher in men compared to women, but the SWLS was similar in the genders

Summary

Introduction

Crohn’s disease (CD) is a chronic illness with onset usually in young adulthood and a fluctuating, unpredictable clinical course characterized by exacerbations and remissions.[1] Symptoms include abdominal pain, diarrhea, weight loss, presence of an abdominal mass, fever, malaise, and in many patients arthralgia and other extra-abdominal complications. The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) is a specific health-related quality of life instrument used very often in studies of CD.[3,4] The SIBDQ is objective and measures the impact of CD on physical, social and emotional domains in a broad range of problems encountered by the patient. The SWLS has been used in healthy persons and in a variety of illnesses, but not, to our knowledge, in CD patients

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Conclusion