Supported in part by NIDDK K23 DK079037, PHS Grant P30 DK 078392, Procter and Gamble Pharmaceuticals, Prometheus Laboratories, Inc., and Institutional Clinical and Translational Science Award NIH/NCRR Grant Number 1UL1RR026314.
Disease activity, behavioral dysfunction, and health-related quality of life in adolescents with inflammatory bowel disease†
Version of Record online: 4 NOV 2010
Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 17, Issue 7, pages 1581–1586, July 2011
How to Cite
Gray, W. N., Denson, L. A., Baldassano, R. N. and Hommel, K. A. (2011), Disease activity, behavioral dysfunction, and health-related quality of life in adolescents with inflammatory bowel disease. Inflamm Bowel Dis, 17: 1581–1586. doi: 10.1002/ibd.21520
- Issue online: 14 JUN 2011
- Version of Record online: 4 NOV 2010
- Manuscript Accepted: 8 SEP 2010
- Manuscript Received: 3 SEP 2010
- inflammatory bowel disease;
- quality of life;
- behavioral dysfunction
Approximately 20%–25% of all inflammatory bowel disease (IBD) cases have an onset in childhood or adolescence. Beyond disease severity, little is known regarding determinants of health-related quality of life (HRQOL) in this population. This study aimed to identify behavioral correlates of HRQOL and examine behavioral/emotional dysfunction (e.g., internalizing/externalizing symptoms) as the mechanism through which disease severity impacts HRQOL.
In all, 62 adolescents (mean = 15.47 years, standard deviation [SD] = 1.42) with IBD (79% Crohn's disease) and their parents were recruited from one of two pediatric IBD specialty clinics located in the Midwest or Northeast region of the United States. Participants completed a demographic questionnaire, the Youth Self-Report version of the Child Behavior Checklist, and the IMPACT-III. Disease severity was calculated for Crohn's disease and ulcerative colitis using standardized measures.
Greater disease severity, externalizing symptoms, and internalizing symptoms were all independently associated with lower HRQOL. Furthermore, internalizing symptoms partially mediated the relationship between disease activity and HRQOL, reducing the effect of disease severity on HRQOL from 22% to 9% in the mediation model. A Sobel test examining the significance of the indirect effect of disease severity on HRQOL via behavioral dysfunction was marginally nonsignificant (P =.053).
Nondisease-specific variables (e.g., behavioral dysfunction) play an important role in impacting HRQOL. Behavioral dysfunction serves as the mechanism through which disease severity partially impacts HRQOL. Continued research to identify other predictors of HRQOL in pediatric IBD will greatly enhance our future ability to design interventions to improve HRQOL and maximize health outcomes. (Inflamm Bowel Dis 2010;)