Abstract
Objective: The present preliminary cross-sectional study aimed to investigate the extent to which health-related quality of life of patients with inflammatory bowel disease (IBD) was influenced by the outbreak of Covid-19 while controlling for disease activity.Methods: Two samples of 195 (recruited before Covid-19 outbreak) and 707 patients (recruited during the Covid-19-related lockdown) were included. Psychological distress (Hospital Anxiety and Depression Scale, HADS), quality of life (Inflammatory Bowel Disease Questionnaire, IBDQ), and somatization (Patient Health Questionnaire, PHQ-12) were concurrently assessed.Results: Patients with active IBD were more prevalently affected by ulcerative colitis (60.2%, η2 = 0.12) and, expectedly, showed higher psychological distress (HADS, d = 0.34) and somatization (PHQ-12, d = 0.39), as well as poorer disease-specific health-related quality of life (effect sizes for the total and subscale IBDQ scores in the large range of d > 0.50). Hierarchical regression models revealed that setting (pre-Covid-19 outbreak vs. during lockdown) (p < 0.001) explained only a small portion (8%) of the IBDQ variance. IBD-related factors (ulcerative colitis and disease activity) and psychological factors (psychological distress and somatization) added a significant amount of 25 and 27%, respectively, to the explained IBDQ variance. The final model predicted 59% of the explained IBDQ variance.Conclusion: Clinical and psychological manifestations seem to be major impairments in IBD patients both before and during the Covid-19 outbreak. Furthermore, the quality of life of IBD patients seem to be more influenced by psychological and somatizing distressing symptoms than the pandemic-related living conditions.
Highlights
The WHO-declared Covid-19 pandemic in March 2020 [1] is affecting severely the health, safety, and well-being of individuals, of the fragile population [2]
Patients in the second online group were included if they received a specialistic visit by their gastroenterologist within the last 6 months and their disease activity index score was available in their medical record
Score for psychological distress (d = 0.34) and PHQ-12 score for somatization (d = 0.39), as well as poorer disease-specific health-related quality of life (HRQL) (IBDQ, effect sizes for the total and subscale scores were in the large range of d > 0.50) (Table 1)
Summary
The WHO-declared Covid-19 pandemic in March 2020 [1] is affecting severely the health, safety, and well-being of individuals, of the fragile population (e.g., poor, chronically ill, elderly, health-care workers) [2]. Acute as well as chronic psychological stress may trigger disease relapses through neuroendocrine and inflammatory mechanisms [4], and, from the other side, chronic disease may represent a stable stressful condition that activates subjective distress and health concerns through allostatic overload [5]. Inflammatory bowel disease (IBD) includes a set of chronic intestinal diseases of unknown etiology (probably a combination of genetic predisposition and an abnormal immune response) consist of ulcerative colitis (UC) and Crohn’s disease (CD) as more common conditions. It is characterized by intermittent severe relapses (the predominant clinical symptoms being acute abdominal pain, blood in the stools, and acute diarrhea) and periods of quiescence. A large 2-years longitudinal study on 405 IBD patients showed a 6-fold increase of later anxiety in patients with baseline disease activity and, in turn, patients with higher baseline anxiety had a 2-fold increase of later flares-up [11]
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