Mechanisms of Quality of Life and Social Support in Inflammatory Bowel Disease

  • Laura KatzEmail author
  • Dean A. Tripp
  • Mark Ropeleski
  • William Depew
  • J. Curtis Nickel
  • Stephen Vanner
  • Michael J. Beyak


Cognitive and social factors are essential considerations in inflammatory bowel disease (IBD) patient management, but existing research is limited. This study aims to expand the IBD literature by examining the relationship between social supports and QoL, while examining mechanisms in these relationships. Consenting patients attending an IBD outpatient clinic were provided a survey package (N = 164). Regressions evaluated predictors of IBD-QoL, and catastrophizing and optimism were examined as mediators between social support and IBD-QoL. Diminished IBD-QoL was predicted by younger age, greater negative spousal responses, and less perceived spousal support. Mediation models showed helplessness catastrophizing to be the lone mediator, acting as a mechanism between both negative spousal responses and perceived spousal support with IBD-QoL. Social interaction variables are associated with IBD-QoL, but patients’ experience of helplessness acts to reduce their ability to benefit from social support. Patient care should consider supportive social and cognitive factors to improve IBD-QoL.


Inflammatory bowel disease Quality of life Social support Catastrophizing Pain 



Michael Beyak is supported by an award by the Clinical Teaching Association of Queen’s University—Endowment Fund Career Development Award. Stephen Vanner is supported by an operating grant from the Crohn’s and Colitis Foundation of Canada (CCFC).

Compliance with Ethical Standards

Conflict of Interest

Laura Katz, Dean A. Tripp, Mark Ropeleski, William Depew, J. Curtis Nickel, Stephen Vanner and Michael J. Beyak declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.


  1. Allison, P. J., Guichard, C., & Gilain, L. (2000). A prospective investigation of dispositional optimism as a predictor of health-related quality of life in head and neck cancer patients. Quality of Life Research, 9(8), 951–960. doi: 10.1023/A:1008931906253.CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  3. Bernstein, C. N., Kraut, A., Blanchard, J. F., Rawsthorne, P., Yu, N., & Walld, R. (2001). The relationship between inflammatory bowel disease and socioeconomic variables. American Journal of Gastroenterology, 96(7), 2117–2125. doi: 10.1111/j.1572-0241.2001.03946.x.CrossRefPubMedGoogle Scholar
  4. Bernstein, C. N., Wajda, A., Svenson, L. W., MacKenzie, A., Koehoorn, M., Jackson, M., … Blanchard, J. F. (2006). The epidemiology of inflammatory bowel disease in Canada: A population-based study. American Journal of Gastroenterology, 101(7), 1559–1568. doi:  10.1111/j.1572-0241.2006.00603.x.
  5. Bielefeldt, K., Davis, B., & Binion, D. G. (2009). Pain and inflammatory bowel disease. Inflammatory Bowel Disease, 15(5), 778–788. doi: 10.1002/ibd.20848.CrossRefGoogle Scholar
  6. Blondel-Kucharski, F., Chircop, C., Marquis, P., Cortot, A., Baron, F., Gendre, J., … GETAI., (2001). Health-related quality of life in Crohn’s Disease: A prospective longitudinal study in 231 patients. The American Journal of Gastroenterology, 96(10), 2915–2920. doi:  10.1111/j.1572-0241.2001.4681_b.x.
  7. Boye, B., Lundin, K. E. A., Jantschek, G., Leganger, S., Mokleby, K., Tangen, T., … Jahnsen, J. (2011). INSPIRE Study: Does stress management improve the course of inflammatory bowel disease and disease-specific quality of life in distressed patients with ulcerative colitis or crohn’s disease? A randomized controlled trial. Inflammatory Bowel Disease, 17(9), 1863–1873. doi:  10.1002/ibd.21575.
  8. Canavan, C., Abrans, K. R., Hawthorne, B., Drossman, D., & Mayberry, J. F. (2006). Long-term prognosis in Crohn’s disease: Factors that affect quality of life. Ailmentary Pharmacology & Therapeutics, 23(3), 377–385. doi: 10.1111/j.1365-2036.2006.02753.x.CrossRefGoogle Scholar
  9. Cano, A., Leong, L., Heller, J. B., & Lutz, J. R. (2009). Perceived entitlement to pain-related support and pain catastrophizing: Associations with perceived and observed support. Pain, 147(1–3), 249–254. doi: 10.1016/j.pain.2009.09.023.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Crohn’s and Colitis Foundation of Canada. (2012). The impact of inflammatory bowel disease in Canada: 2012 final report and recommendations. Toronto: Crohn’s and Colitis Foundation of Canada.Google Scholar
  11. DiStefano, C., Zhu, M., & Mindrila, D. (2009). Understanding and using factor scores: Considerations for the applied researcher. Practical Assessment, Research & Evaluation, 14(20), 1–11.Google Scholar
  12. Drossman, D. A., Lesserman, J., Li, Z., Keefe, F., Hu, Y. J. B., & Toomey, T. C. (2000). Effects of coping on health outcome among women with gastrointestinal disorders. Psychosomatic Medicine, 62, 309–317. doi: 10.1097/00006842-200005000-00004.CrossRefPubMedGoogle Scholar
  13. Faust, A. H., Halpern, L. F., Danoff-Burg, S., & Cross, R. K. (2012). Psychosocial factors contributing to inflammatory bowel disease activity and health-related quality of life. Gastroenterology & Hepatology, 8(3), 173–181.Google Scholar
  14. Fordyce, W. E. (1976). Behavioral methods for chronic pain and illness. St. Louis, MO: Mosby.Google Scholar
  15. Fuller-Thomson, E., & Sullman, J. (2006). Depression and inflammatory bowel disease: Finds from two nationally representative Canadian surveys. Inflammatory Bowel Disease, 12, 697–707. doi: 10.1097/00054725-200608000-00005.CrossRefGoogle Scholar
  16. Gallant, M. P. (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Education & Behavior, 30(2), 170–195. doi: 10.1177/1090198102251030.CrossRefGoogle Scholar
  17. Geers, A. L., Reilley, S. P., & Dember, W. N. (1998). Optimism, pessimism, and friendship. Current Psychology, 17(1), 3–19. doi: 10.1007/s12144-998-1017-4.CrossRefGoogle Scholar
  18. Ginting, J. V., Tripp, D. A., Nickel, J. C., Fitzgerald, M. P., & Mayer, R. (2011). Spousal support decreases the negative impact of pain on mental quality of life in women with interstitial cystitis/painful bladder syndrome. British Journal of Urology International, 108(5), 713–717. doi: 10.1111/j.1464-410X.2010.09846.x.Google Scholar
  19. Graff, L. A., Walker, J. R., & Bernstein, C. N. (2009). Depression and anxiety in inflammatory bowel disease: A review of comorbidity and management. Inflammatory Bowel Disease, 15(7), 1105–1118. doi: 10.1002/ibd.20873.CrossRefGoogle Scholar
  20. Graff, L. A., Walker, J. R., Lix, L., Clara, I., Rawsthorne, P., Rogala, L., … Bernstein, C. N. (2006). The relationship of inflammatory bowel disease type and activity to psychological fuctioning and quality of life. Clinical Gastroenterology & Hepatology, 4(12), 1491–1501. doi:  10.1016/j.cgh.2006.09.027.
  21. House, J. S., Landis, J. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540–545. doi: 10.1126/science.3399889.CrossRefPubMedGoogle Scholar
  22. IBM Corp. (2012). IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: Author.Google Scholar
  23. Irvine, E. J., Zhou, Q., & Thompson, A. K. (1996). The short inflammatory bowel disease questionnaire: A quality of life instrument for community physicians managing inflammatory bowel disease. American Journal of Gastroenterology, 91(8), 1571–1578.PubMedGoogle Scholar
  24. Jensen, M. P., Moore, M. R., Bockow, T. B., Ehde, D. M., & Engel, J. M. (2011). Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: A systematic review. Archives of Physical Medicine and Rehabilitation, 92(1), 146–160. doi: 10.1016/j.apmr.2010.09.021.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Jones, M. P., Wessinger, S., & Crowell, M. D. (2006). Coping strategies and interpersonal support in patients with irritable bowel syndromes and inflammatory bowel disease. Clinical Gastroenterology and Hepatology, 4, 474–481. doi: 10.1016/j.cgh.2005.12.012.CrossRefPubMedGoogle Scholar
  26. Katz, J., & Melzack, R. (2011). The McGill pain questionnaire. In D. C. Turk & R. Melzack (Eds.), Handbook of pain assessment (3rd ed.). New York: The Guilford Press.Google Scholar
  27. Katz, L., Tripp, D. A., Nickel, J. C., Mayer, R., Reimann, M., & van Ophoven, A. (2013). Disability in women suffering from interstitial cystitis/bladder pain syndrome. British Journal of Urology International, 111(1), 114–121. doi: 10.1111/j.1464-410X.2012.11238.x.CrossRefGoogle Scholar
  28. Keefe, F. J., Blumenthal, J., Baucom, D., Affleck, G., Waugh, R., Caldwell, D. S., … Lefebvre, J. (2004). Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: A randomized controlled study. Pain, 110(3), 539–549. doi:  10.1016/j.pain.2004.03.022.
  29. Kerns, R. D., Haythornthwaite, J. A., Southwick, S., & Giller, E. L. (1990). The role of marital interaction in chronic pain and depressive symptom severity. Journal of Psychosomatic Research, 34, 401–408. doi: 10.1016/0022-3999(90)90063-a.CrossRefPubMedGoogle Scholar
  30. Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The West- Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain, 23(4), 345–356. doi: 10.1016/0304-3959(85)90004-1.CrossRefPubMedGoogle Scholar
  31. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Leonard, M. T., Cano, A., & Johansen, A. B. (2006). Chronic pain in a couples context: A review and integration of theoretical models and empirical evidence. Journal of Pain, 7(6), 377–390. doi: 10.1016/j.jpain.2006.01.442.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Lix, L. M., Graff, L. A., Walker, J. R., Clara, I., Rawsthorne, P., Rogala, L., … Bernstein, C. N. (2008). Longitudinal study of quality of life and psychological functioning for active, fluctuating, and inactive disease patterns in inflammatory bowel disease. Inflammatory Bowel Disease, 14(11), 1575–1584. doi:  10.1002/ibd.20511.
  34. Luger, T., Cotter, K. A., & Sherman, A. M. (2009). It’s all in how you view it: Pessimism, social relations, and life satisfaction in older adults with osteoarthritis. Aging and Mental Health, 13(5), 635–647. doi: 10.1080/13607860802534633.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Meeten, F., Dash, S. R., Scarlet, A. L., & Davey, G. C. (2012). Investigating the effect of intolerance of uncertainty on catastrophic worrying and mood. Behavior Research & Therapy, 50(11), 690–698. doi: 10.1016/j.brat.2012.08.003.CrossRefGoogle Scholar
  36. Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30(2), 191–197. doi: 10.1016/0304-3959(87)91074-8.CrossRefPubMedGoogle Scholar
  37. Moradkhani, A., Beckman, L. J., & Tabibian, J. H. (2013). Health-related quality of life in inflammatory bowel disease: Psychosocial, clinical, socioeconomic, and demographic predictors. Journal of Crohn’s and Colitis, 7(6), 467–473. doi: 10.1016/j.crohns.2012.07.012.CrossRefPubMedGoogle Scholar
  38. Moskovitz, D. N., Maunder, R. G., Cohen, Z., McLeod, R. S., & MacRae, H. (2000). Coping behavior and social support contribute independently to quality of life after surgery for inflammatory bowel disease. Diseases of the Colon and Rectum, 43(4), 517–521. doi: 10.1007/bf02237197.CrossRefPubMedGoogle Scholar
  39. Nickel, J. C., Tripp, D., Chuai, S., Litwin, M. S., McNaughton-Collins, M., Landis, J. R., … Kusek, J. (2008). Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome. British Journal of Urology International, 101(1), 59–64. doi:  10.1111/j.1464-410X.2007.07196.x.
  40. Norem, J. K., & Chang, E. C. (2002). The positive psychology of negative thinking. Journal of Clinical Psychology, 58, 993–1001. doi: 10.1002/jclp.10094.CrossRefPubMedGoogle Scholar
  41. Nurmi, E., Haapamaki, J., Paavilainen, E., Rantanen, A., Hillila, M., & Artkkila, P. (2013). The burden of inflammatory bowel disease on health care utilization and quality of life. Scandinavian Journal of Gastroenterology, 48, 51–57. doi: 10.3109/00365521.2012.685750.CrossRefPubMedGoogle Scholar
  42. Parikh, S. V., Lam R. W., & CANMAT Depression Work Group. (2001). Clinical guidelines for the treatment of depressive disorders, I. Definitions, prevalence, and health burden. Canadian Journal of Psychiatry, 46(Supp1), 13S–20S. doi:  10.1016/j.jad.2009.06.044.
  43. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi: 10.3758/brm.40.3.879.CrossRefPubMedGoogle Scholar
  44. Raichle, K. A., Hanley, M., Jensen, M. P., & Cardenas, D. D. (2007). Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury. The Journal of Pain, 8(9), 718–729. doi: 10.1016/j.jpain.2007.05.006.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67(6), 1063–1078. doi: 10.1037/0022-3514.67.6.1063.CrossRefPubMedGoogle Scholar
  46. Scheier, M. F., Carver, C. S., & Bridges, M. W. (2001). Optimism, pessimism, and psychological well-being. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  47. Schirbel, A., Reichert, A., Roll, S., Baumgart, D. C., Buning, C., Wittig, B., … Sturm, A. (2010). Impact of pain on health-related quality of life in patients with inflammatory bowel disease. World Journal of Gastroenterology, 16(25), 3168–3177. doi:  10.3748/wjg.v16.i25.3168.
  48. Scheier, M. F., Weintraub, J. K., & Carver, C. S. (1986). Coping with stress—Divergent strategies of optimists and pessimists. Journal of Personality and Social Psychology, 51(6), 1257–1264. doi: 10.1037/0022-3514.51.6.1257.CrossRefPubMedGoogle Scholar
  49. Seres, G., Kovacs, Z., Kovacs, A., Kerekgyarto, O., Sardi, K., Demeter, P., … Tury, F. (2008). Different associations of health related quality of life with pain, psychological distress and coping strategies in patients with irritable bowel syndrome and inflammatory bowel disorder. Journal of Clinical Psychology in Medical Settings, 15(287–295), 287. doi:  10.1007/s10880-008-9132-9.
  50. Sewitch, M. J., Abrahamowicz, M., Bitton, A., Daly, D., Wild, G., Cohen, A., … Dobkin, P. L. (2001). Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. The American Journal of Gastroenterology, 96(5), 1470–1479. doi:  10.1111/j.1572-0241.2001.03800.x.
  51. Smith, B. W., & Zautra, A. J. (2008). Vulnerability and resilience in women with arthritis: Test of a two-factor model. Journal of Consulting and Clinical Psychology, 76(5), 799–810. doi: 10.1037/0022-006X.76.5.799.CrossRefPubMedGoogle Scholar
  52. Srivastava, S., McGonigal, K. M., Richards, J. M., Butler, E. A., & Gross, J. J. (2006). Optimism in close relationships: How seeing things in a positive light makes them so. Journal of Personality and Social Psychology, 91, 143–153. doi: 10.1037/0022-3514.91.1.143.CrossRefPubMedGoogle Scholar
  53. Sullivan, M. J. (2012). The communical coping model of pain catastrophizing: Clinical and research implications. Canadian Psychology, 53(1), 43. doi: 10.1037/a0026726.CrossRefGoogle Scholar
  54. Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7(4), 524–532. doi: 10.1037/1040-3590.7.4.524.CrossRefGoogle Scholar
  55. Sullivan, M. J., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001). Theoretical perspectives on the relation between catastrophizing and pain. Clinical Journal of Pain, 17(1), 52–64. doi: 10.1097/00002508-200103000-00008.CrossRefPubMedGoogle Scholar
  56. Sullivan, M. J., Thorn, B., Rodgers, W., & Ward, L. C. (2004). Path model of psychological antecedents to pain experience: Experimental and clinical findings. The Clinical Journal of Pain, 20(3), 164–173. doi: 10.1097/00002508-200405000-00006.CrossRefPubMedGoogle Scholar
  57. Tabachnick, B. G., & Fidell, F. S. (2007). Using multivariate statistics (5th ed.). Boston: Pearson.Google Scholar
  58. Thorn, B. E., Ward, L. C., Sullivan, M. J. L., & Boothby, J. L. (2003). Communal coping model of catastrophizing: Conceptual model building. Pain, 106(1), 1–2. doi: 10.1016/s0304-3959(03)00228-8.CrossRefPubMedGoogle Scholar
  59. Tripp, D. A., Nickel, J. C., & Katz, L. (2011). A feasibility trial of a cognitive-behavioural symptom management program for chronic pelvic pain for men with refractory chronic prostatitis/chronic pelvic pain syndrome. Canadian Urological Association Journal, 5(5), 328–332. doi: 10.5489/cuaj.10201.CrossRefPubMedPubMedCentralGoogle Scholar
  60. Tripp, D. A., Nickel, J. C., Wang, Y., Litwin, M. S., McNaughton-Collins, M., Landis, J. R., … Kusek, J. W. (2006). Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome. The Journal of Pain, 7(10), 697–708. doi:  10.1016/j.jpain.2006.03.006.
  61. van der Eijk, I., Stockbrugger, R., & Russel, M. (2000). Influence of quality of care on quality of life in inflammatory bowel disease (IBD): Literature review and studies planned. European Journal of Internal Medicine, 11, 228–234. doi: 10.1016/s0953-6205(00)00095-9.CrossRefPubMedGoogle Scholar
  62. Wright, M. A., Wren, A. A., Somers, T. J., Goetz, M. C., Fras, A. M., Huh, B. K., … Keefe, F. (2011). Pain acceptance, hope, and optimism: Relationships to pain and adjustment in patients with chronic musculoskeletal pain. The Journal of Pain, 12(11), 1155–1162. doi:  10.1016/j.jpain.2011.06.002.
  63. Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30–41. doi: 10.1207/s15327752jpa5201_2.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Laura Katz
    • 1
    Email author
  • Dean A. Tripp
    • 2
  • Mark Ropeleski
    • 3
  • William Depew
    • 3
  • J. Curtis Nickel
    • 4
  • Stephen Vanner
    • 3
  • Michael J. Beyak
    • 3
  1. 1.Department of PsychologyQueen’s UniversityKingstonCanada
  2. 2.Departments of Psychology, Anesthesiology and UrologyQueen’s UniversityKingstonCanada
  3. 3.Department of Medicine, Gastrointestinal Diseases Research Unit (GIDRU)Queen’s UniversityKingstonCanada
  4. 4.Department of UrologyQueen’s UniversityKingstonCanada

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