Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease

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

Data are presented as mean ± SD for continuous variables and as n (%) for categorical variables; remission was defined according to CDAI (< 150) and TWT (≤ 6) scores, accordingly;

¹χ² test;

²Two-tailed t-test. NA: Not applicable; CDAI: Crohn's disease activity index; TWT: Truelove-Witts ulcerative colitis severity index; HRQoL: Health-related quality of life; SOC: Sense of coherence; UC: Ulcerative Colitis; CD: Crohn’s disease.

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

¹Two-tailed t-test;

²One-way ANOVA;

³Pearson correlation coefficient;

⁴Spearman correlation coefficient);

⁵Sense of Coherence.

^dP < 0.01,

^bP < 0.01,

^aP < 0.05 vs control. IBD: Inflammatory bowel disease; CD: Crohn's disease; UC: Ulcerative colitis; NA: Not applicable; HRQoL: Health-related quality of life.

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

Values shown are standardized beta regression coefficients.

^dP < 0.01,

^bP < 0.01,

^aP < 0.05 vs control.

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

Values shown are standardized beta regression coefficients adjusted for sex, race, age, education, marital status, income, disease type, surgery for Inflammatory bowel disease, relapse rate, and disease in remission.

^dP < 0.01,

^bP < 0.01 vs control.

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

Values shown are standardized beta regression coefficients.

^dP < 0.01,

^bP < 0.01,

^aP < 0.05 vs control. IBD: Inflammatory bowel disease; CD: Crohn's disease; UC: Ulcerative colitis; HRQoL: Health-related quality of life.

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

Direct effect represents the independent effect of the predictor on the outcome after controlling for potential mediators; predictor: SOC; mediators: anxiety symptoms, depressive symptoms; control variables: sex, race, age, education, marital status, income, disease type, time since IBD diagnosis, surgery for IBD, relapse rate, and disease in remission.

^dP < 0.01,

^bP < 0.01,

^aP < 0.05 vs control. HRQoL: Health-related quality of life.