The results of this study focused on the psychological impact of IBD, demonstrating that although both men and women obtained high median scores according to the SIBDQ questionnaire, therefore having a general perception of an optimum QoL, the impact was higher for women, who obtained lower scores in comparison with men.
A study published in 2020 reports similar results: a lower QoL among women, compared to men diagnosed with IBD . This finding corresponds to data observed in the general population, more precisely a higher rate of absenteeism from work and a more frequent use of health care services among women compared to men [10, 11]. Another important aspect that contributes to a reduced QoL is the presence of physical asthenia. Compared to men, women report a higher frequency and intensity of physical asthenia. This symptom is independent from the activity of the disease and the presence or absence of anemia, one of the causal factors [12–14].
However, a surprising feature pointed out by this study was that more than one third of the patients (36.1%) are unemployed, because of various reasons. Even though they are predominantly young adults, living with IBD is definitely a challenge because work productivity and employment prospectors are diminished, both directly by the symptoms and complications of the disease, and, indirectly, by the psychological distress patients have to cope with, making it difficult to get and, especially, to keep a workplace.
A study conducted in Norway reports higher rates of unemployment and sick leave among patients diagnosed with IBD when compared to the general population . Moreover, the unemployment rate was slightly higher in women compared to men (12.4% vs. 11.1%) . The unemployment rate was higher in patients diagnosed with ulcerative colitis (13.2%) compared to those diagnosed with Crohn disease (8.7%) . The mean unemployment age in patients with ulcerative colitis was 55.3 years, compared with 42.2 years in those with Crohn disease .
Even if fatigue and tiredness are more and more present in the general population due to a constant need to keep up with each other, especially in the working environment, for IBD patients it represents a daily burden, regardless of their gender . According to the FACIT-F score, both women and men were severely affected, obtaining similar scores.
Numerous studies show that QoL is impaired in these patients in comparison with the general population. Also, psychological distress doesn’t always correlate with the activity and severity of the disease, because even during clinical remission patients may experience impairment on QoL [1–4].
Disease chronicity requires development of self-management and coping skills over time, therefore it is not surprising that IBD patients have an increased risk of mental health issues, including depression, which is an important problem patients often experience; therefore, it is essential for the caregiver to recognize these diseases in early phases. Recent studies show that the relationship between depression and chronic disease is bidirectional, with poor health leading to poor self-management, as well as poor self-management leading to poor health [17, 18].
The ongoing problem depression and anxiety pose in IBD patients is outlined by this study using the HADS anxiety and depression questionnaire, which showed that anxiety is more present in men than women, whereas depression was encountered more in women.
In addition to the huge impact that IBD has on QoL, people living with IBD face numerous other challenges. These include social stigma of having a chronic disease, affordability of medications, diminished employment prospects, difficulty with leisure time and travelling, limited community-based supports and inequitable access to health care specialists and services [16, 18]. Reducing these difficulties should be a priority for physicians and health care providers, to improve QoL of their patients.
During flares, symptoms of IBD (both gastrointestinal and systemic symptoms) disrupt immediate activities and cause worry and embarrassment to patients. These immediate effects result in a cascade of impacts on a patient’s life and psychological well-being, which continue to have consequences even during clinical remission of the disease, but to a lower grade .
A 2016 systematic review analyzed 171 studies including 158,371 individuals and showed a prevalence rate of anxiety of approximately 20% and a prevalence rate of depression of 15% in patients with IBD . Both mental disorders had a higher prevalence during the disease activity period compared to the remission period. The estimated anxiety prevalence in patients with IBD during the disease activity was 75.6%, compared to 20.5% in the general population. It is noteworthy that the anxiety prevalence has been shown to be higher in patients with active IBD compared to patients with diabetes or chronic obstructive pulmonary disease [20–22]. The estimated depression prevalence in patients with active disease was 40.7%, compared to 15.2% in the general population. Depressive disorders have also been diagnosed more frequently in patients with Crohn disease compared to those with ulcerative colitis .
Interestingly, we found that although both men and women obtained similar scores, men were more affected by anxiety, encountered more difficulties getting and, especially, keeping a workplace, which had a huge impact on their social life as well.
A key strength of this study was the evaluation of special issues women with IBD have, despite maintenance of remission under biologic agents. Moreover, by using accessible and easy to understand and answer questionnaires, we were able to obtain clinical data, as it is felt by each patient. An important limitation of this study is the small number of patients included, but the data obtained can be a starting point for further larger prospective multicentre studies.
Although women are more affected by depression and social stigma than men, they are more resilient and develop better coping mechanism, therefore obtaining a better QoL than men.
These results correspond to the existing data that highlight the development of better coping mechanisms in women, compared to men diagnosed with IBD [23, 24]. The data so far support a greater negative impact on the QoL of women with IBD compared to men diagnosed with the same conditions [25–27].
Nevertheless, we must highlight that, even during sustained clinical remission, these patients, regardless of gender, experience QoL impairment.