Multi-factor Analysis of Psychological Disorders in IBD Patients

Patients with IBD self-reported their disease activity using validated patient-based measures. For those with CD, the Harvey-Bradshaw Index (HBI) was utilized, and for patients with UC, the Patient-based Simple Clinical Colitis Activity Index (P-SSCAI) was employed. An HBI score greater than 4 or a P-SSCAI score of 5 or higher was classified as active disease, while an HBI score of 4 or lower or a P-SSCAI score below 5 indicated disease remission.

To assess health-related quality of life (HRQOL), participants completed the Short Health Scale (SHS), a 4-item self-management questionnaire validated for use in adult IBD patients. Each item corresponds to specific dimensions of HRQOL: symptoms, social function, disease-related worry, and general well-being. Responses were graded on a 100-mm visual analog scale, with scores ranging from 0 to 100, where higher scores represented worse HRQOL.

Participants' anxiety and depression levels were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9)20,21. Each scale comprises 7 and 9 self-assessment items to gauge anxiety and depression, respectively. A score of GAD-7 ≥10 indicated severe anxiety symptoms, while a score of PHQ-9 ≥ 10 indicated severe depression symptoms.

The Pittsburgh Sleep Quality Index scale (PSQI) was employed to assess sleep quality, encompassing subjective sleep quality, latency, duration, efficiency, persistence, use of sleep drugs, and daytime dysfunction22. The total scores on this scale range from 0 to 21, with higher scores indicating poorer sleep quality.

Statistical analysis The survey data were collected and analyzed using IBM SPSS statistical software (version 25.0, Chicago, Illinois, USA). Quantitative data were expressed as mean and standard deviation or inter-quartile range, and group differences were compared using t-tests for normally distributed data or the Wilcoxon test for non-normally distributed data. Categorical data were presented as frequencies or percentages, and differences in frequencies between groups were assessed using the χ2 test or Fisher's exact test. The correlation between scores of GAD-7 or PHQ-9 and SHS total scores was examined using simple linear regression, and the results were presented with the coefficient R2. To study the independent effect of various variables on the quality of life (QOL), multiple regression analysis was applied. Initially, correlations between demographic and clinical variables such as age, gender, living conditions, disease status, employment, marital status, family history of IBD, GAD-7 scores, PHQ-9 scores, and SDS scores were explored using simple regression. Variables with a p-value of ≤ 0.05 in the simple regression analyses were then included in the multiple regression analysis. Odds ratios (OR), 95% confidence intervals (95% CI), and p-values were calculated for each independent variable. For all statistical tests, a two-sided p-value of 0.05 was considered the threshold for defining the level of significance.