Digestive Diseases and Sciences

, Volume 60, Issue 5, pp 1366–1374 | Cite as

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

  • Anilga Tabibian
  • James H. Tabibian
  • Linda J. Beckman
  • Laura L. Raffals
  • Konstantinos A. Papadakis
  • Sunanda V. KaneEmail author
Original Article


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.


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.


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).


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.


Inflammatory bowel disease Perceived stress Integrated care Patient education 



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

Conflict of interest



  1. 1.
    De Schepper HU, De Man JG, Moreels TG, Pelckmans PA, De Winter BY. Review article: gastrointestinal sensory and motor disturbances in inflammatory bowel disease—clinical relevance and pathophysiological mechanisms. Aliment Pharmacol Ther. 2008;27:621–637.CrossRefPubMedGoogle Scholar
  2. 2.
    Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007;369:1641–1657.CrossRefPubMedGoogle Scholar
  3. 3.
    Devlen J, Beusterien K, Yen L, Ahmed A, Cheifetz AS, Moss AC. The burden of inflammatory bowel disease: a patient-reported qualitative analysis and development of a conceptual model. Inflamm Bowel Dis. 2014;20:545–552.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Dudley-Brown S. Prevention of psychological distress in persons with inflammatory bowel disease. Issues Ment Health Nurs. 2002;23:403–422.CrossRefPubMedGoogle Scholar
  5. 5.
    Sainsbury A, Heatley RV. Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2005;21:499–508.CrossRefPubMedGoogle Scholar
  6. 6.
    Van der Have M, van der Aalst KS, Kaptein AA, et al. Determinants of health-related quality of life in Crohn’s disease: a systematic review and meta-analysis. J Crohns Colitis. 2014;8:93–106.CrossRefPubMedGoogle Scholar
  7. 7.
    Casellas F, López-Vivancos J, Casado A, et al. Factors affecting health related quality of life of patients with inflammatory bowel disease. Qual Life Res. 2002;11:775–781.CrossRefPubMedGoogle Scholar
  8. 8.
    Robinson A. Review article: improving adherence to medication in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2008;27:9–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Devlen J, Beusterien K, Yen L, Ahmed A, Cheifetz AS, Moss AC. Barriers to mesalamine adherence in patients with inflammatory bowel disease: a qualitative analysis. J Manag Care Pharm. 2014;20:309–314.Google Scholar
  10. 10.
    Van der Eijk I, Stockbrügger R, Russel M. Influence of quality of care on quality of life in inflammatory bowel disease (IBD): literature review and studies planned. Eur J Intern Med. 2000;11:228–234.CrossRefPubMedGoogle Scholar
  11. 11.
    Irvine EJ. Quality of life issues in patients with inflammatory bowel disease. Am J Gastroenterol. 1997;92:18S–24S.PubMedGoogle Scholar
  12. 12.
    Drossman DA, Patrick DL, Mitchell CM, et al. Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns. Dig Dis Sci. 1989;34:1379–1386.CrossRefPubMedGoogle Scholar
  13. 13.
    Moradkhani A, Beckman LJ, Tabibian JH. Health-related quality of life in inflammatory bowel disease: psychosocial, clinical, socioeconomic, and demographic predictors. J Crohns Colitis. 2013;7:467–473.CrossRefPubMedGoogle Scholar
  14. 14.
    Jaghult S, Saboonchi F, Johansson U, Wredling R, Kapraali M. Identifying predictors of low health related quality of life among patients with inflammatory bowel disease: comparison between Crohn’s disease and ulcerative colitis with disease duration. J Clin Nurs. 2011;20:1578–1587.CrossRefPubMedGoogle Scholar
  15. 15.
    Rubin G, Hungin AP, Chinn D, et al. Long-term aminosalicylate therapy is under-used in patients with ulcerative colitis: a cross-sectional survey. Aliment Pharmacol Ther. 2002;16:1889–1893.CrossRefPubMedGoogle Scholar
  16. 16.
    Bernal I, Domènech E, Garcia-Planella E, et al. Medication-taking behaviour in a cohort of patients with inflammatory bowel disease. Dig Dis Sci. 2006;51:2165–2169.CrossRefPubMedGoogle Scholar
  17. 17.
    San-Román AL, Bermejo F, Carrera E, Pérez-Abad M, Boixeda D. Adherence to treatment in inflammatory bowel disease. Rev Esp Enferm Dig. 2005;97:249–257.Google Scholar
  18. 18.
    Selinger CP, Eaden J, Jones DB, et al. Modifiable factors associated with nonadherence to maintenance medication for inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:2199–2206.CrossRefPubMedGoogle Scholar
  19. 19.
    Hawthorne AB, Rubin G, Ghosh S. Review article: medication non-adherence in ulcerative colitis—strategies to improve adherence with mesalazine and other maintenance therapies. Aliment Pharmacol Ther. 2008;27:1157–1166.CrossRefPubMedGoogle Scholar
  20. 20.
    Shale MJ, Riley SA. Studies of compliance with delayed-release mesalazine therapy in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2003;18:191–198.CrossRefPubMedGoogle Scholar
  21. 21.
    Thia K, Faubion WA, Loftus EV, Persson T, Persson A, Sandborn WJ. Short CDAI: development and validation of a shortened and simplified Crohn’s Disease Activity Index. Inflamm Bowel Dis. 2011;17:105–111.CrossRefPubMedGoogle Scholar
  22. 22.
    Walmsley RS, Ayers RCS, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut. 1998;43:29–32.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Higgins PDR, Schwartz M, Mapili J, Krokos I, Leung J, Zimmermann EM. Patient defined dichotomous end points for remission clinical improvement in ulcerative colitis. Gut. 2005;54:782–788.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Guyatt G, Mitchell A, Irvine JE, et al. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989;96:804–810.PubMedGoogle Scholar
  25. 25.
    Kravitz RL, Hays RD, Sherbourne CD, et al. Recall of recommendations and adherence to advice among patients with chronic medical conditions. Arch Intern Med. 1993;153:1869–1878.CrossRefPubMedGoogle Scholar
  26. 26.
    Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, eds. The Social Psychology of Health. Newbury Park, CA: Sage; 1988.Google Scholar
  27. 27.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:386–396.CrossRefGoogle Scholar
  28. 28.
    Eaden JA, Abrams K, Mayberry JF. The Crohn’s and colitis knowledge score: a test for measuring patient knowledge in inflammatory bowel disease. Am J Gastroenterol. 1999;94:3560–3566.CrossRefPubMedGoogle Scholar
  29. 29.
    Duffy LC, Zielezny MA, Marshall JR, et al. Lag time between stress events and risk of recurrent episodes of inflammatory bowel disease. Epidemiology. 1991;2:141–145.CrossRefPubMedGoogle Scholar
  30. 30.
    Levenstein S, Prantera C, Varvo V, et al. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. 2000;95:1213–1220.CrossRefPubMedGoogle Scholar
  31. 31.
    Bitton A, Sewitch MJ, Peppercorn MA, et al. Psychosocial determinants of relapse in ulcerative colitis: a longitudinal study. Am J Gastroenterol. 2003;98:2203–2208.CrossRefPubMedGoogle Scholar
  32. 32.
    Bitton A, Dobkin P, Edwardes MD, et al. Predicting relapse in Crohn’s disease: a biopsychosocial model. Gut. 2008;57:1386–1392.CrossRefPubMedGoogle Scholar
  33. 33.
    Graff LA, Walker JR, Clara I, et al. Stress coping, distress, and health perceptions in inflammatory bowel disease and community controls. Am J Gastroenterol. 2009;104:2959–2969.CrossRefPubMedGoogle Scholar
  34. 34.
    Rogala L, Miller N, Graff LA, et al. Population-based controlled study of social support, self-perceived stress, activity and work issues, and access to health care in inflammatory bowel disease. Inflamm Bowel Dis. 2008;14:526–535.CrossRefPubMedGoogle Scholar
  35. 35.
    Drossman DA. The role of psychosocial factors in gastrointestinal illness. Scand J Gastroenterol. 1996;221:1–4.CrossRefGoogle Scholar
  36. 36.
    Duffy LC, Zielezny MA, Marshall JR, et al. Relevance of major stress events as an indicator of disease activity prevalence in 489 inflammatory bowel disease. Behav Med. 1991;17:101–110.CrossRefPubMedGoogle Scholar
  37. 37.
    Casellas F, López-Vivancos J, Badiac X, et al. Impact of surgery for Crohn’s disease on health-related quality of life. Am J Gastroenterol. 2000;95:177–182.CrossRefPubMedGoogle Scholar
  38. 38.
    Hjortswang H, Järnerot G, Curman B, et al. The influence of demographic and disease-related factors on health-related quality of life in patients with ulcerative colitis. Eur J Gastroenterol Hepatol. 2003;15:1011–1020.CrossRefPubMedGoogle Scholar
  39. 39.
    Thirlby RC, Land JC, Fenster LF, et al. Effect of surgery on health-related quality of life in patients with inflammatory bowel disease: a prospective study. Arch Surg. 1998;133:826–832.CrossRefPubMedGoogle Scholar
  40. 40.
    Cerveny P, Bortlík M, Kubena A, Vlcek J, Lakatos PL, Lukás M. Nonadherence in inflammatory bowel disease: results of factor analysis. Inflamm Bowel Dis. 2007;13:1244–1249.CrossRefPubMedGoogle Scholar
  41. 41.
    Kane SV. Strategies to improve adherence and outcomes in patients with ulcerative colitis. Drugs. 2008;68:2601–2609.CrossRefPubMedGoogle Scholar
  42. 42.
    Sajadinejad MS, Asgari K, Molavi H, Kalantari M, Adibi P. Psychological issues in inflammatory bowel disease: an overview. Gastroenterol Res Pract. 2012;2012:1–11. doi: 10.1155/2012/106502.
  43. 43.
    Rowlinson A. Inflammatory bowel disease 3: importance of partnership in care. Br J Nurs. 1999;8:1013–1018.CrossRefPubMedGoogle Scholar
  44. 44.
    Goldring AB, Taylor SE, Kemeny ME, Anton PA. Impact of health beliefs, quality of life, and the physician–patient relationship on the treatment intentions of inflammatory bowel disease patients. Health Psychol. 2002;21:219–228.CrossRefPubMedGoogle Scholar
  45. 45.
    Nguyen GC, LaVeist TA, Harris ML, Datta LW, Bayless TM, Brant SR. Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:1233–1239.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Anilga Tabibian
    • 1
    • 2
  • James H. Tabibian
    • 3
  • Linda J. Beckman
    • 2
  • Laura L. Raffals
    • 3
  • Konstantinos A. Papadakis
    • 3
  • Sunanda V. Kane
    • 3
    Email author
  1. 1.Department of Psychiatry and PsychologyMayo ClinicRochesterUSA
  2. 2.California School of Professional PsychologyAlhambraUSA
  3. 3.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA

Personalised recommendations