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Journal of Psychosomatic Re
The influence of personality factors on health-related quality of life of
patients with inflammatory bowel disease
Bernardo Moreno-Jimenez4, Balbina Lopez Blanco, Alfredo Rodrıguez-Munoz,
Eva Garrosa Hernandez
Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
Received 31 January 2006; received in revised form 10 July 2006; accepted 31 July 2006
Abstract
Objective: The aim of the study was to examine the influence of
personality factors on health-related quality of life (HRQOL) in
patients with inflammatory bowel disease (IBD).Methods:A total of
120 individuals, 60 with ulcerative colitis and 60 with Crohn’s
disease, filled out the InflammatoryBowelDiseaseQuestionnaire, the
Rosenberg Self-Esteem Scale, the Neuroticism scale of the Eysenck
Personality Inventory, and a scale about difficulty describing feelings
to other people. Sociodemographic and clinical information was also
collected. Results: Results of hierarchical regression analysis, after
controlling for possible confounder effects of demographic and
clinical variables, showed the predictive power of the block of
0022-3999/07/$ – see front matter D 2007 Published by Elsevier Inc.
doi:10.1016/j.jpsychores.2006.07.026
4 Corresponding author. Department of Biological and Health Psy-
chology, Faculty of Psychology, Universidad Autonoma de Madrid, Ciudad
Universitaria de Cantoblanco, Carretera de Colmenar Viejo, Km. 15.
28049, Madrid, Spain. Tel.: +34 91 497 5185; fax: +34 91 497 5215.
E-mail address: [email protected] (B. Moreno-Jimenez).
personality variables, accounting for significant amounts (13–22%)
of variance across the four HRQOLmeasures. Except for self-esteem,
which was the factor most closely related to social functioning,
neuroticism seemed to be the most closely related to the four
indicators of quality of life. It was also found that greater difficulty in
describing feelings was linked to poorer HRQOL. Conclusion: In
summary, some personality factors are useful for understanding the
process of HRQOL in patients with IBD. Recognizing these
differences may enrich clinical research and may be crucial when
designing interventions aimed at treatment effectiveness.
D 2007 Published by Elsevier Inc.
Keywords: Inflammatory bowel disease; Health-related quality of life; Personality factors
Introduction
Crohn’s disease (CD) and ulcerative colitis (UC) are
inflammatory bowel diseases (IBDs) of unknown etiology,
which affect approximately 2 out of 1000 and 1 out of 1500
individuals, for UC and CD, respectively, in Western
populations [1]. These diseases are characterized by
exacerbations and remissions of several symptoms such as
abdominal pain and diarrhea. Furthermore, the chronicity of
IBD, the effects of the treatments, and the consequences of
its complications (e.g., hospitalizations) affect the daily lives
of these patients and impair their health-related quality of
life (HRQOL) [2]. In recent years, the importance of
HRQOL in chronic diseases has been increasingly recog-
nized because of its implications for patients’ psychological
well-being, their social adjustment to the illness, and the use
of health resources [3,4]. In this sense, both clinicians and
researchers emphasize the importance of integrating
HRQOL in the assessment of chronic disease outcomes
and the impact of interventions.
The relationship between sociodemographic and clinical
factors and these patients’ HRQOL has been investigated
in several studies [5–7]. Some of them have suggested that
variables related to disease activity, such as the presence of
inflammatory activity or the need of hospitalization, were
the most important variables for predicting HRQOL [8].
Other studies have indicated the importance of sociodemo-
graphic variables, such as age or educational level, with
regard to HRQOL in IBD processes [4,9]. Apart from
search 62 (2007) 39–46
B. Moreno-Jimenez et al. / Journal of Psychosomatic Research 62 (2007) 39–4640
these variables, in the last few years, there has been
growing interest in identifying psychological factors
associated with patients with IBD [10–12], hypothesized
as risk factors in the course of the disease, mediating its
occurrence and development.
One of them is neuroticism, considered as a broad
dimension of individual differences in the tendency to
experience negative, distressing emotions [13]. Findings
suggest that neuroticism is related to a broad range of
dysfunctions and diseases, such as depression, psychoso-
matic complaints, or pain syndromes [14–16], and with
reduced psychological well-being [17]. Accordingly, some
studies have highlighted that neuroticism scores were more
prevalent in patients with IBD than in controls [18] and that
this personality characteristic was similar in patients with
CD or UC [19]. Neuroticism may influence psychological
well-being through its impact on the way individuals react
to a stressful situation [20]. In fact, a possible explanation
for the effects of neuroticism in IBDs is that it may increase
an individual’s susceptibility or exposure to stimuli that
generate negative emotions [21], which, in turn, may
exacerbate the IBD symptoms [18]. Moreover, individuals
high in neuroticism tend to report more health complaints
and to be more sensitive to aversive bodily symptoms than
control groups [15].
Another personality variable that has been hypothesized
to play a role in the IBD process is alexithymia [22,23], a
construct that is considered to reflect a deficit in the
cognitive processing and regulation of emotions [24,25].
In a comparative study between IBD patients and a control
group of healthy participants, a higher rate of alexithymia
was found among IBD patients [26]. One of the few
attempts that have been made to investigate alexithymia as
predictor of HRQOL revealed that it plays an important role
in predicting HRQOL in patients with IBD [27] and that it is
a stable personality characteristic [28]. One of its most
important components refers to a limited ability to verbalize
one’s own emotions [25,29]. The concept has been widely
studied because it is seen as a risk factor for a variety of
psychosomatic problems [30,31].
Although there has been some research focusing on
neuroticism and alexithymia in HRQOL of patients with
IBD, the effects of self-esteem have practically not been
studied previously, although it also appears to be an
important aspect in need of empirical examination. Only
one recent study has focused on this topic, where it was
found that, among adolescents with IBD, self-esteem was an
important predictor of HRQOL [32].
However, despite these investigations, the relative
importance of psychological factors in HRQOL of patients
with IBD has not been systematically established and needs
to be studied in depth [33,34]. Furthermore, although the
abovementioned studies have explored the influence of
different psychological variables, an integrative model that
includes different positive and negative personality varia-
bles at the same time is still lacking.
Thus, the aim of the present study was to investigate the
influence of personality factors such as neuroticism, self-
esteem, and difficulty describing one’s feelings to other
people on the HRQOL of patients with IBD by means of
multivariate analysis. It was hypothesized that personality
variables, after controlling for the effect of sociodemographic
and clinical variables, would predict perceived HRQOL.
Methods
Participants and procedure
One hundred twenty participants meeting diagnostic
criteria for IBD were recruited from the outpatient clinic
at the Digestive Diseases Department of two public
hospitals from the city of Madrid (Spain). Both centers
have an adequate sample of the IBD population in this city.
The diagnosis was established by a physician using
conventional clinical, endoscopic, radiological, and histo-
logical criteria. Among the exclusion criteria were a history
of psychiatric pathology and depression as a consequence of
the disease. All patients were under 75 years of age. In the
initial design of the study, we wanted to obtain homoge-
neous groups, matching the sample in disease and type of
treatment. Thus, the total sample comprised 30 patients with
CD and medical treatment, 30 with CD and surgical
treatment, 30 with UC and medical treatment, and 30 with
UC and surgical treatment. Once a physician had confirmed
the diagnosis and the clinical history of IBD, the patients
were informed about the aim of the research and asked to
collaborate in the study, following the pertinent ethical
recommendations. Of these patients, almost all of them who
were asked agreed to participate; only 17% refused to
participate in the study. After obtaining informed consent,
participants then proceeded to complete the questionnaires.
The assessment instruments used were administered by a
specialist trained in these tasks. The different phases of the
study took place from January 1999 to June 2003.
Measures
Health-related quality of life
HRQOL was assessed using the Inflammatory Bowel
Disease Questionnaire (IBDQ), a disease-specific instru-
ment to measure HRQOL in patients with IBD. The IBDQ
used was a Spanish version of the 32-item self-administered
version of Guyatt et al. [35]. The questionnaire is divided
into four health subdimensions: bowel symptoms (e.g.,
loose stools, abdominal pain; 10 items), systemic symptoms
(e.g., fatigue, sleeping problems; 5 items), social function-
ing (e.g., limited social activity, school or work attendance;
5 items), and emotional function (e.g., irritability, anger,
depression; 12 items). The instrument also provides an
overall IBDQ score. Responses are scored on a 7-point
Likert scale where 7 corresponds to the best function and 1
B. Moreno-Jimenez et al. / Journal of Psychosomatic Research 62 (2007) 39–46 41
to the worst. The reliability and validity of the scale are well
established [36,37].
Self-esteem
The Rosenberg Self-Esteem (RSE) Scale was used to
measure self-esteem [38]. The RSE is a 10-item scale
measuring feelings of self-deprecation and self-worth.
Response categories comprise a 4-point Likert scale of
agreement, ranging from 1 (strongly disagree) to 4 (strongly
agree). The maximum score is 40, with higher scores
reflecting more positive self-esteem. This scale has been
widely used in clinical practice, providing a reliable,
internally consistent measure of global self-esteem [39].
Neuroticism
The Neuroticism scale from the Eysenck Personality
Inventory (EPI) [40], which has a yes/no format, was used
to assess negative trait emotionality due to its assumed link
to the IBD process. The Lie subscale, which was developed
as part of the EPI in order to assess social desirability, was
also included in the current study. As to validity, the scale
has shown suitable psychometric properties in the Spanish
validation [41] and has been used in past studies carried out
in Spain to measure these traits [42,43].
Difficulty describing feelings
This scale was based on the Schalling–Sifneos Person-
ality Scale [44] and the Toronto Alexithymia Scale (TAS-
20) [45]. Participants were asked to rate their responses
along a 4-point Likert scale ranging from 1 (never) to
4 (always). Higher scores indicate higher levels of difficulty
describing one’s feelings. A principal components factor
analysis showed that the six items could be included in a
single scale, with a coefficient alpha reliability of .73, and
which contains items such as bI have difficulty describing
what I am feeling to othersQ and bIt is difficult for me to find
the right words to describe my feelings.Q Confirmatory
factor analysis for the proposed scale yielded a good fit to
the data: v2/df ratio=2.61, comparative fit index=0.92,
goodness-of-fit index=0.95, root mean square error of
approximation=.06. For the purposes of our study, we only
wanted to evaluate the influence of difficulty describing
one’s feelings. Although the TAS-20 [42] is the most widely
used instrument for assessing alexithymia and its compo-
nents (difficulty describing one’s feelings, in our study), as
Peck and Shapiro [46] pointed out, the use of complemen-
tary assessment techniques and instruments should be
promoted whenever possible.
Sociodemographic and clinical information
In the present study, sociodemographic and clinical
information was also collected: Patients were asked to report,
among other things, their gender, age, educational level,
marital status, work situation, diagnosis, treatment, disease
duration, smoking status, extraintestinal manifestations,
number of relapses per year (total number of clinical relapses
divided by the disease duration in years), need of psycho-
logical support, and satisfaction with surgical intervention.
Statistical analyses
The study variables were initially described in terms of
means, standard deviations, and correlation coefficients. To
test the influence of personality on HRQOL, we performed
four hierarchical regression analyses. The demographic and
clinical variables that reached significance in a prior
multivariate analysis [multivariate analysis of variance
(MANOVA)] were entered in Step 1 as control variables.
Personality variables (neuroticism, difficulty describing
one’s feelings, and self-esteem) were entered in Step 2.
The IBDQ scores (bowel symptoms, systemic symptoms,
social functioning, and emotional functioning) served as
criterion variables. The magnitude of the R2 change at each
step of the hierarchical regression analysis was used to
determine the variance explained by each set of variables.
All analyses were carried out using the SPSS statistical
package, version 12.5. A level of .05 was considered
statistically significant.
Results
Patients’ characteristics
The sociodemographic and clinical characteristics of
patients included in the study, as a function of type, are
summarized in Table 1.
Of the total sample, 64 were men (53%) and 56 were
women (47%), with more women in the CD group of
patients. Average age was similar in both groups. Mean
disease duration was also similar in the groups, with no
significant differences. As regards smoking, significant
differences were found: Most of the patients with UC were
nonsmokers, whereas a high percentage (69%) of CD
patients were active smokers (Pb.01). No significant differ-
ences in extraintestinal symptoms suffered in the groups
were found, with both groups presenting a similar number of
dermatological, ophthalmic, and osteoarthropathic symp-
toms. The number of relapses in the past year also showed a
similar pattern: Although patients with CD had a slightly
higher mean, the difference was not significant. The educa-
tional level was similar for both groups, with secondary
studies predominating among the patients with UC and
primary studies among the CD patients. Of the patients who
underwent surgery, those from the CD group were more
satisfied with the intervention than patients with UC (83%
vs. 67%), albeit without reaching significance. As regards
the need for psychological support as a result of the suffering
from the disease, no significant differences were observed
(33% and 38% of the patients required such support, for the
CD and UC groups, respectively).
Table 2
Descriptive statistics for personality and HRQOL scales, by group
CD (n=60) UC (n=60)
Mean S.D. Mean S.D.
Personality
Self-esteem 18.53 4.27 18.97 4.15
Difficulty describing feelings 19.13 4.76 18.47 3.90
Neuroticism 13.02 4.48 12.10 4.56
Lie scale 5.60 1.79 5.87 2.17
HRQOL
Bowel symptoms 56.28 13.52 56.47 9.93
Systemic symptoms 26.52 7.45 28.43 5.82
Emotional functioning 64.57 16.57 68.35 13.13
Social functioning 29.72 7.52 29.88 6.41
Table 3
Correlations among measures of personality and HRQOL (as measured by
IBDQ)
1 2 3 4 5 6 7
1. Neuroticism –
2. Self-esteem �.50444 –
3. Difficulty
describing
feelings
.48444 �.47444 –
4. Bowel
symptoms
�.45444 .36444 �.17 –
5. Systemic
symptoms
�.52444 .44444 �.254 .80444 –
6. Emotional
functioning
�.62444 .56444 �.16 .72444 .79444 –
7. Social
functioning
�.41444 .49444 �.3044 .63444 .73444 .74444 –
4 Pb.05.
44 Pb.01.
444 Pb.001.
Table 1
Description of sociodemographic and clinical characteristics, by type of
disease
Sociodemographic
and clinical
characteristics CD (n=60) UC (n=60)
Total sample
(N=120)
Female gender, n (%) 31 (52) 25 (42) 56 (47)
Age, meanFS.D.
(range)
42F15 (18–75) 45F11 (29–68) 43F13 (18–75)
Disease duration,
meanFS.D.
(range)
8.17F8 (1–19) 8.78F6 (2–29) 8.48F6 (1–29)
Smoker4, n (%) 41 (69) 11 (31) 55 (46)
Extraintestinal
symptoms, n (%)
21 (35) 25 (42) 46 (38)
Mean number of
relapses per
year (range)
1.02 (0–5) 0.72 (0–3) 0.87 (0–5)
Satisfaction with
surgery, n (%)
25 (83) 20 (67) 45 (37)
Need for
psychological
support, n (%)
20 (33) 23 (38) 43 (36)
Educational
level, n (%)
Primary 27 (45) 19 (28) 46 (33)
Secondary 20 (33) 34 (58) 54 (49)
University 13 (22) 7 (14) 20 (18)
4 Pb.01.
B. Moreno-Jimenez et al. / Journal of Psychosomatic Research 62 (2007) 39–4642
Preliminary analysis
The means and standard deviations of the scales used in
this study are reported in Table 2.
According to Table 2, the means in the psychological
scales are similar in both groups. An independent t test was
performed on the psychological scales to determine whether
there were any statistical differences between the UC group
and the CD group; no significant differences were found.
Furthermore, to determine whether there were any differ-
ences in IBDQ scores depending on the disease type (UC vs.
CD), a MANOVA was performed on the scores of bowel
symptoms, systemic symptoms, social functioning, and
emotional functioning. Wilks’ criterion analysis revealed
that there was no multivariate main effect for disease type,
F(3, 116)=1.824, PN.05. As no significant differences were
found, statistical analysis was performed in the entire group
of 120 patients, independently of the type of disease.
However, the results of the multivariate analysis showed that
gender, treatment (medical vs. surgical), extraintestinal
manifestations, number of relapses per year, need of
psychological support, and satisfaction with surgical inter-
vention were all significantly associated with HRQOL. Age,
disease duration, smoking status, and educational level had
no significant effect on HRQOL.
Influence of personality variables on HRQOL
In Table 3, it can be seen that neuroticism had significant
and negative correlations with all four IBDQ dimensions,
especially with systemic symptoms (r=�.52, Pb.01) and
emotional functioning (r=�.62, Pb.01). Similarly, self-
esteem had significant and positive correlations with all
four IBDQ dimensions and was more closely related to
emotional (r=.56, Pb.01) and social functioning (r=.49,
Pb.01). Finally, difficulty describing one’s feelings was
negatively associated with systemic symptoms (r=�.25,Pb.05) and social functioning (r=�.30, Pb.01).
The regression models for the four IBDQ dimensions are
presented in Table 4. To test for possible presence of
multicollinearity, we followed the recommendations of
Kleinbaum et al. [47]. In this sense, variance inflation
factor values greater than 10 and tolerance values smaller
than .10 may indicate the presence of multicollinearity. The
results revealed no violations of assumptions underlying the
regressions. The models for all four dimensions of IBDQ
were significant: bowel symptoms, F(9, 110)=8.93, Pb.001;
systemic symptoms, F(9, 110)=10.83, Pb.001; emotional
functioning, F(9, 110)=14.91, Pb.001; and social function-
ing, F(9, 110)=7.57, Pb.001. Consistent with the hypoth-
esis, after statistically controlling for the variance explained
Table 4
Regression results predicting four aspects of HRQOL
Bowel symptoms Systemic symptoms Emotional functioning Social functioning
Steps and variablesa b Step 1 b Step 2 b Step 1 b Step 2 b Step 1 b Step 2 b Step 1 b Step 2
Controls
Gender �.10 �.05 �.174 �.08 �.204 �.07 �.13 �.03Treatment �.2544 �.33444 �.13 �.2144 �.01 �.07 �.09 �.14yExtraintestinal manifestations �.06 �.03 �.16y �.04 �.08 �.02 �.01 �.11Satisfaction with surgical intervention .06 .04 .10 .08 .06 .01 .194 .15y
Number of relapses per year �.31444 �.2644 �.29444 �.2244 �.32444 �.2344 �.2344 �.16yNeed of psychological support .10 .02 .07 .07 .2644 .06 .14 .02
Personality factors
Neuroticism �.46444 �.49444 �.48444 �.3344Self-esteem .09 .20* .2844 .35444
Difficulty describing feelings �.13 �.224 �.10 �.214R2 .29 .42 .29 .47 .33 .55 .22 .38
DR2 .29444 .13444 .2944 .18444 .33444 .22444 .22444 .16444
Gender was coded as 1=male, 2=female; treatment as 1=medical, 2=surgical; extraintestinal manifestations as 1=no, 2=yes; satisfaction with surgical
intervention as 1=yes, 2=no; need of psychological support as 1=yes, needed, 2=not needed.a b are the standardized regression coefficients.
4 Pb.05.
44 Pb.01.
444 Pb.001.y Pb.10.
B. Moreno-Jimenez et al. / Journal of Psychosomatic Research 62 (2007) 39–46 43
by the demographic and clinical factors, the personality
variables, entered in Step 2, explained an additional 13%,
18%, 22%, and 16% of the variance in bowel symptoms,
systemic symptoms, emotional functioning, and social
functioning, respectively (Pb.001 for all).
Except for self-esteem, which was the factor most
closely related to social functioning, neuroticism seemed to
be the most highly related to the four HRQOL dimensions.
Higher levels of neuroticism were associated with bowel
symptoms (b=�.46, Pb.001), systemic symptoms
(b=�.49, Pb.001), emotional functioning (b=�.48,Pb.001), and social functioning (b=�.33, Pb.001). Self-esteem was positively related to systemic symptoms
(b=.20, Pb.05), emotional functioning (b=.28, Pb.01),
and social functioning (b=.35, Pb.001). It can thus be
stated that a higher level of neuroticism was associated
with lower levels of HRQOL and that higher self-esteem
was associated with higher levels of HRQOL as measured
by the IBDQ dimensions of systemic symptoms, emotional
functioning, and social functioning. Regarding difficulty
describing one’s feelings, its effect was significant on two
dimensions: systemic symptoms and social functioning.
Difficulty describing one’s feelings negatively predicted
systemic symptoms (Pb.05) and social functioning
(Pb.05). In short, patients experiencing more difficulty
describing their feelings reported lower HRQOL, as
measured specifically in the systemic symptoms and social
functioning dimensions of the IBDQ. Moreover, clinical
variables (type of treatment and number of relapses per
year) were significantly associated with HRQOL (see
Table 4).
Discussion
The present study explored the influence of personality
factors on HRQOL in patients with IBD. As expected, in all
analyses, the inclusion of personality variables in Step 2
resulted in a significant 13–22% increase of explained
HRQOL variance. The significant contribution of person-
ality factors to HRQOL remains when the influence of
clinical and demographic variables is controlled. Our
approach in testing the impact of personality variables was
conservative in the sense that we statistically controlled
demographic and clinical variables and we matched the
groups for gender, disease type, and treatment. As for
clinical factors, the number of relapses per year was the
variable that was most significantly related to HRQOL.
Results from the hierarchical regression analyses show
that neuroticism was inversely associated with the four
indicators of quality of life. In line with this, some studies
have found an association between IBDQ scores and
neuroticism [18], whereas Barrett et al. [19] found that this
personality trait was similar in patients with CD or UC.
Furthermore, Robertson et al. [18] stated that IBD patients
believed that there was a close link between personality and
their disease, something that they called a bnervouspersonality.Q In a recent study on the effects of coping in
IBD patients, it was found that psychological variables,
particularly depressive coping, were more predictive than
medical variables of disease-related concerns and other
HRQOL variables [48].
This finding is consistent with prior studies that found
that neuroticism was associated with low psychological
well-being, independently of objective stressful life events,
B. Moreno-Jimenez et al. / Journal of Psychosomatic Research 62 (2007) 39–4644
such as a chronic disease [17,49]. It is a well-known fact
that personality may affect the way that people react when
they are in stressful situations; under stress, some people
may habitually cope ineffectively. In this sense, neuroticism
reflects feelings of distress and nervousness and underlies
chronic emotional experiences of guilt and frustration [50].
This association may be due to the fact that individuals
higher in neuroticism possess more negative views of
themselves and others [51]. In line with the above, it is
thus reasonable to hypothesize that individuals higher in
neuroticism are predisposed to perceive their situation more
negatively than individuals lower in neuroticism. Research
has indicated that individuals high in neuroticism think and
act in ways that encourage negative emotional experiences
across time and situations [16,52,53]. It has also been found
that individuals with high levels of neuroticism are prone to
misinterpretations of somatic symptoms as serious signs of
body pathology [54].
The present results show that HRQOL is related not only
to the presence of negative aspects such as negative
affectivity but also to the absence of positive personality
indicators. In this sense, this study highlights the importance
of self-esteem in the prediction of HRQOL. Self-esteem was
positively related to systemic symptoms and emotional and
social functioning. As mentioned in the Introduction,
whereas there has been some literature about the role of
neuroticism in IBD, the issue of self-esteem and IBD
patients’ HRQOL has practically not been addressed. This
finding is consistent with the only study that reports that
self-esteem is a predictor of HRQOL in adolescents with
IBD [32].
Also in line with previous research, we found that greater
difficulty in describing one’s feelings was linked to poorer
HRQOL. The construct of alexithymia has been associated
with IBD in earlier studies [26,27], and the current results
partially confirm these findings. A review article on
pathways linking alexithymia and illness stated that
alexithymia was associated with several unhealthy behav-
iors such as sedentary lifestyle and sleep loss [24]. This may
explain the association of the difficulty in describing one’s
feelings and the systemic dimension of the IBDQ. Fur-
thermore, difficulty in describing one’s feelings was related
to social functioning. It has also been found that alexithymia
is related to socially avoidant behaviors [55], fewer close
relationships, and poor social skills [56]. So far, the present
findings are consistent with previous studies that have
reported that poor HRQOL in IBD patients is related to
nondisease aspects such as personality and coping skills
[57]. In this line, Porcelli et al. [58] found that alexithymia
was a stable predictor of treatment outcome in patients with
functional gastrointestinal disorders.
The findings of this study should be viewed in the light
of its limitations. As is true for cross-sectional surveys and
correlational designs in general, we could neither com-
pletely rule out recall bias nor demonstrate causal directions.
Exploring the predictive power of personality factors would
require placing a greater emphasis on longitudinal designs.
Another limitation is that IBD patients were recruited from
an outpatient clinic and may therefore represent more severe
groups of IBD patients than those in the general community
and may not be representative of IBD patients in general.
Thus, the understanding of quality of life of these patients
may not reflect the experience of samples of community
studies, where higher levels of HRQOL have been found
[59–61]. Furthermore, the methodology of the study was
limited by the absence of clinical standard measures of
clinical activity, such as the Harvey–Bradshaw index [62] or
the Rachmilewitz index [63].
In summary, this study found that personality factors,
specifically neuroticism and, to a lesser degree, self-esteem
and difficulty in expressing one’s emotions, play an
important role in predicting HRQOL in patients with
IBD and are useful traits to aid in understanding the
process of IBD. These findings will add to the growing
body of literature about the influence of psychological
factors on HRQOL, which helps us to better understand
how to minimize the negative impact of IBD and improve
these individuals’ personal quality of life. Furthermore,
recognizing these differences may enrich clinical research
and is crucial when designing interventions aimed at
treatment effectiveness.
Acknowledgments
The authors wish to thank the University General
Hospital Gregorio Maranon and the Ramon y Cajal Hospital
for their assistance in the recruitment of IBD patients.
Thanks are also due to Crohn’s Disease and Ulcerative
Colitis Patients Association for their support in carrying out
this study. We also thank the participants of this study.
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