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Disease activity, behavioral dysfunction, and healthrelated quality of life in adolescents with inflammatory bowel disease

Gray, Wendy N. PhD1; Denson, Lee A. MD2,3; Baldassano, Robert N. MD4,5; Hommel, Kevin A. PhD1,3*

Inflammatory Bowel Diseases:
doi: 10.1002/ibd.21520
Original Clinical Articles

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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;)

Author Information

1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

2 Schubert‐Martin Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

3 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH

4 Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA

5 Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA

* Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self Management, 3333 Burnet Ave., MLC 7039, Cincinnati, OH 45229


Received 3 September 2010; Accepted 8 September 2010

Published online 4 November 2010 in Wiley Online Library (

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.

© Crohn's & Colitis Foundation of America, Inc.

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