Influence of the COVID-19 Outbreak on Health-Related Quality of Life in Inflammatory Bowel Disease Patients in China: A Cross-Sectional Questionnaire-Based Study

doi:10.21203/rs.3.rs-3811583/v1

Background

Following the Chinese government's announcement that the zero-COVID policy had ended, there was a rapid and widespread outbreak of COVID-19. In this context, the condition and psychological impact on IBD patients were unknown, and prior literature lacked reports on the health-related quality of life (HRQoL) of IBD patients during large COVID-19 outbreaks in China. Therefore, our study aimed to investigate the HRQoL of IBD patients during the COVID-19 outbreak in China.

Methods

We employed a cross-sectional survey via web-based questionnaires. The participants were IBD patients who had previously received treatment at Nanjing BenQ Medical Center. They completed the questionnaire between January 9, 2023, and January 23, 2023. We primarily assessed the HRQoL of IBD patients using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores, and statistical analyses included the Chi-square and Mann-Whitney U tests.

Results

According to our survey, significant differences were observed in the following groups based on SIBDQ scores: types of IBD (p = 0.037), usage of medication after COVID-19 infection (p = 0.028), whether IBD patients felt more susceptible to COVID-19 than the general population (p < 0.05), whether their study or work had been negatively affected by COVID-19 in the past month (p < 0.05), and whether IBD patients had taken medication regularly according to medical advice within the past month (p < 0.05).

Conclusions

During the COVID-19 pandemic, the overall HRQoL of IBD patients was affected. Patients with ulcerative colitis (UC) exhibited higher HRQoL than those with Crohn's disease (CD). Furthermore, IBD patients who maintained a positive attitude during the epidemic experienced higher HRQoL.

Inflammatory Bowel Disease (IBD)

COVID-19

Health-related Quality of Life (HRQoL)

Short Inflammatory Bowel Disease Questionnaire (SIBDQ)

Cross-sectional survey

In December 2019, a novel coronavirus, COVID-19, emerged in Wuhan, Hubei Province. It primarily spread through respiratory droplets and resulted in severe symptoms and even fatalities [1, 2]. However, in December 2022, the Chinese government announced the end of the zero-COVID policy, marking the conclusion of three years of epidemic prevention and control. This decision triggered a sudden and widespread outbreak of COVID-19, leading to an unprecedented surge in hospital visits. Simultaneously, it severely impacted social production, work, and daily life for the general population. This situation necessitated adjustments in the treatment strategies for patients with various diseases, including those with IBD.

Compared to the general population, the COVID-19 outbreak in China had a more significant impact on IBD patients [3, 4]. Due to the bidirectional communication between the brain-gut axis and the chronic course of the disease, IBD patients are more prone to experiencing psychological symptoms such as anxiety and depression, which lead to a reduced quality of life and impaired social function [5–7]. Additionally, IBD patients have a higher probability of contracting COVID-19, primarily because they require immunosuppressive treatments [8]. The economic and social disruptions caused by the rapid COVID-19 outbreak profoundly affected the lives of many IBD patients, introducing uncertainties in healthcare services, employment, education, and housing. These changes had an unknown impact on their mental health and quality of life. IBD patients had to quickly adapt to the rapidly changing disease and medication environment [3]. Managing the psychological well-being of patients with chronic diseases has always been a clinical challenge. Given the high incidence of emotional disorders, especially in novel circumstances like the rapid COVID-19 outbreak in China, the complexity of managing these patients increased, leading to significant pressure and an impact on their quality of life and disease course [9]. The current large-scale COVID-19 outbreak in China is attributed to the Omicron strain, which differs from previous strains [10]. Consequently, the psychological and quality of life impact on IBD patients from the Omicron strain may vary from previous strain types. Omicron is highly contagious and spreads more rapidly than any previous strain, with a potential six-fold increase in the number of infected individuals compared to the Delta variant [11, 12]. Moreover, Omicron exhibits more mutations than previous strains, increasing its capacity to evade immunity [11, 14]. The effectiveness of COVID-19 vaccines against Omicron is also limited, resulting in a heightened risk of reinfection [11, 13]. These characteristics of Omicron have induced widespread panic among the general population, particularly among IBD patients [3]. Unfortunately, there is a lack of relevant literature addressing the impact of the Omicron strain on the quality of life of IBD patients in China.

This study aims to assess the health-related quality of life (HRQoL) of IBD patients during the COVID-19 outbreak following the Chinese government's policy change.

Study Design

This cross-sectional study collected demographic information, COVID-19-related data, and health-related quality of life assessments from IBD patients who voluntarily participated in an online survey between January 9, 2023, and January 23, 2023. A total of 224 valid questionnaires were completed. All participants had received prior treatment at Nanjing BenQ Medical Center. The survey questionnaire we designed will not involve the personal privacy of patients, and their personal information will not be disclosed. The study included a diverse group of IBD patients in terms of regions, genders, and ages to ensure the universality and representativeness of the findings. The primary outcome was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores [15, 16]. A total of 207 patients were included in the analysis after excluding participants with uncertain COVID-19 infection status (17 patients). When we analyzed the indicator of IBD type, we additionally excluded 13 patients with unclear IBD diagnosis. Furthermore, for specific analyses related to the impact of COVID-19 infection and medication usage, additional exclusions were made, resulting in a sample size of 172 patients (see Fig. 1).

COVID-19 Related Questions

We designed a set of questions related to COVID-19 for the surveyed IBD patients. These questions covered their COVID-19 vaccination status (not vaccinated, partially vaccinated, fully vaccinated, with full vaccination indicating receipt of at least three doses), COVID-19 infection status, post-infection symptoms, and treatment methods after COVID-19 infection, including the use of antipyretics, hormones, antiviral drugs, traditional Chinese medicines, baritinib, tozumab, or no treatment. These questions aimed to gain insight into the experiences of IBD patients who had contracted COVID-19, particularly in the context of the post-zero-COVID policy era in China.

Short Inflammatory Bowel Disease Questionnaire (SIBDQ)

Health-related quality of life (HRQoL) encompasses an individual's perception of their physical and mental health and how illness and treatment impact this perception [16]. While the Inflammatory Bowel Disease Questionnaire (IBDQ) is often used to evaluate HRQoL, the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) offers the advantage of greater ease of completion and higher survey efficiency. SIBDQ also promotes better compliance among participants and reduces the burden on both respondents and investigators [16]. Therefore, we employed SIBDQ to assess HRQoL among IBD patients. Previous research has demonstrated the high reliability and validity of SIBDQ [17]. SIBDQ comprises 10 questions categorized into four dimensions: social, bowel, emotional, and systemic [7]. Each question employs a 7-point Likert scale, ranging from 1 (indicating a severe problem) to 7 (indicating no problem at all). The lowest possible score is 10, reflecting poor HRQoL, while the highest score is 70, signifying the greatest HRQoL [18, 19].

Statistical Analysis

Statistical analyses were conducted using SPSS version 26. We employed the Chi-square test to analyze the relationship between demographic characteristics of IBD patients (including gender, age, IBD type, surgical history, use of biological agents for IBD treatment, presence of complications, and COVID-19 vaccination status) and COVID-19 infection. Additionally, we utilized the non-parametric Mann-Whitney U test to examine differences between groups based on SIBDQ scores. These groups encompassed gender, age, IBD type, history of IBD surgery, use of biological agents for IBD treatment, presence of complications, COVID-19 vaccination, COVID-19 infection status, post-infection symptoms, medication use post-infection, perceived susceptibility to COVID-19 compared to the general population, reluctance to engage with others, reduced physical activity, and regularity of IBD medication usage. A p value < 0.05 is considered as statistical significance.

This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Demographics

From January 9, 2023, to January 23, 2023, a total of 224 IBD patients completed the questionnaire. Among these patients, 134 (59.82%) were male, and 90 (40.18%) were female. The age range was primarily between 17 and 40 years old (46.43%), with the majority of patients diagnosed with IBD falling into the age group of 17–40 years old (54.46%). Among the IBD patients, 197 (87.95%) were diagnosed with Crohn's disease (CD), 14 (6.25%) were diagnosed with ulcerative colitis (UC), and 13 (5.8%) had an uncertain diagnosis. Surgical treatment for IBD had been undergone by 96 (42.86%) patients. Medication had been used by 214 (95.54%) of the IBD patients, with mesalazine (57.59%) being the most commonly prescribed. Additionally, 38 (16.96%) patients reported having one or more comorbidities (Refer to Table 1 for demographics).

COVID-19 Related Questions

Among the IBD patients who completed the questionnaires, 35 (15.63%) reported no history of COVID-19 infection, while 172 (76.79%) had been infected with COVID-19. Additionally, 17 (7.59%) patients were unsure about their COVID-19 infection status. A total of 154 (68.75%) IBD patients had received the COVID-19 vaccine. Among them, 75 (33.48%) patients had received the full vaccination regimen (three or more doses), while 79 (35.27%) had received only partial vaccination (one or two doses). Excluding the 35 uninfected patients and the 17 patients with uncertain infection status, among the 172 infected patients, 167 (97.09%) reported experiencing one or more symptoms following COVID-19 infection, with fever being the most common symptom (140, 81.40%). Out of the 172 patients, 119 (69.19%) used one or more drugs to treat COVID-19, with antipyretics (106, 61.63%) being the most commonly utilized medication. We conducted an analysis of gender, age, IBD type (excluding 13 patients with an unclear diagnosis), surgical history, complications, and COVID-19 vaccination in relation to COVID-19 infection. These results indicated no statistically significant differences in these factors with regard to COVID-19 infection status (p > 0.05) (Refer to Tables 2 and 3).

Risk Factors Associated with SIBDQ Scores

We calculated a comparison of SIBDQ scores between different groups. These groups included gender, age, types of IBD, history of IBD surgery, use of biological agents for IBD treatment, presence of complications, COVID-19 vaccination status, COVID-19 infection status, presence of post-infection symptoms, use of post-infection medications, perception of susceptibility to COVID-19 compared to the general population, reluctance to interact with others, reduction in physical activity, and regular use of IBD medications. Notably, a significant difference was observed in IBD types(we excluded 13 patients with unclear IBD diagnosis) (p = 0.037), with patients diagnosed with ulcerative colitis (UC) reporting higher SIBDQ scores (mean rank = 132.41 > 95.94). A significant difference was also noted in the decision to use medication following COVID-19 infection (p = 0.028), with patients who did not use medication reported higher SIBDQ scores (mean rank = 99.19 > 81.00). Regarding the perception of susceptibility to COVID-19 infection compared to the general population, differences were observed between patients who answered yes and no (p = 0.006), as well as between those who answered no and uncertain (p = 0.009). Patients who answered no reported higher SIBDQ scores (mean rank = 57.93 > 42.12, mean rank = 93.15 > 73.74). Additionally, patients who reported negative effects on their study or work due to COVID-19 in the last month demonstrated differences between those who answered yes and no (p < 0.001), as well as those who answered no and uncertain (p = 0.002). Patients who answered no had higher SIBDQ scores (mean rank = 97.98 > 69.57, mean rank = 59.09 > 41.02). Furthermore, differences were observed in patients' adherence to their doctor's advice on medication use in the past month (p = 0.014). Patients who stopped taking medication or used it irregularly had lower SIBDQ scores (mean rank = 27.89 < 40.33, mean rank = 75.44 < 100.93). No significant differences were found in the other groups (p > 0.05) (Refer to Table 4).

This study investigated the impact of the COVID-19 pandemic on the health- related quality of life of 224 IBD patients. Among them, 197 were diagnosed with Crohn's disease (CD), 14 with ulcerative colitis (UC), and 13 were undiagnosed. Notably, CD patients represented the majority of our survey participants. Previous research has examined the influence of COVID-19 on the health of patients with chronic diseases, including IBD. The relationship between chronic illnesses and psychological disorders is multifaceted. On one hand, psychological stress can exacerbate organic diseases through neuroendocrine and inflammatory mechanisms. On the other hand, chronic illnesses can act as a source of stress, leading to subjective stress and excessive health problems due to sustained overload [20]. IBD patients are particularly susceptible to psychological symptoms such as anxiety, fear, and depression when compared to the general population [21, 22]. Consequently, the COVID-19 pandemic appears to have had a significant impact on IBD patients [23]. In our survey, only 97 (43.3%) IBD patients reported never feeling discouraged, while the remaining 127 (56.7%) experienced varying degrees of negative psychological responses. Similarly, only 21 (9.38%) IBD patients reported never feeling nervous, while the majority of 203 (90.62%) IBD patients frequently experienced tension. Therefore, intervening in the emotional well-being of IBD patients is crucial to enhancing their HRQoL during the COVID-19 pandemic.

In our study, the majority of IBD patients (129) were being treated with mesalazine (5-ASA). There are reports in the literature suggesting that medications used to treat IBD can influence the immune system, modulate immunity, and potentially increase the susceptibility of IBD patients to COVID-19 infection [24]. Specifically, IBD patients using steroids and 5-ASA are considered to be at a higher risk of contracting COVID-19 [25]. Conversely, biological agents (anti-TNF-α) are considered a protective factor against severe COVID-19, possibly due to the overexpression of TNF-α in COVID-19 [24]. Among the 224 IBD patients in our survey, 172 were found to have contracted COVID-19, representing 77% of the participants. Some studies indicate that IBD patients are indeed more vulnerable to COVID-19 [20]. Several factors contribute to this susceptibility. Firstly, medications used to treat IBD, such as steroids and 5-ASA, may heighten the risk of COVID-19 infection among IBD patients [25]. On the other hand, some biological agents may offer protection [24]. However, the mechanisms of these medications are not yet fully understood, necessitating further research to comprehensively assess the risk of COVID-19 infection in IBD patients and the efficacy and risks associated with immunomodulators. This research will guide clinicians in making informed decisions regarding drug selection. Additionally, studies have demonstrated variations in the rate of COVID-19 infection among IBD patients both in China and abroad. In China, the incidence of IBD is significantly lower than in Europe and the United States. Furthermore, the Chinese IBD Society released guidelines for managing IBD in early 2020, offering recommendations from gastroenterologists on home isolation, dietary choices, personal protection, and the use of immunosuppressants, biological agents, and cytokine blockers to prevent COVID-19 [21].

Our findings also reveal that COVID-19 infection is unrelated to gender, age, IBD type, surgical history, comorbidities, COVID-19 vaccination, or the use of biological agents. Furthermore, we observed that patients with UC generally exhibit a better HRQoL when compared to CD patients. Optimism throughout the pandemic is associated with a higher HRQoL among IBD patients. Consistently following medical recommendations and adhering to IBD treatment regimens is also correlated with improved HRQoL in comparison to patients who inconsistently use IBD treatment drugs.

Our study underscores the observation that UC patients generally report a higher HRQoL than CD patients. This discrepancy may be attributed to several factors. Firstly, CD and UC have different pathogenic mechanisms. CD can affect various segments of the gastrointestinal tract, has the potential for transmural involvement, and can lead to complications such as intestinal perforation and fistulas. In contrast, UC primarily affects the mucosal layer of the rectum and colon and is typically associated with fewer systemic symptoms when compared to CD [26]. Moreover, delayed diagnosis of IBD, particularly in CD, is common and associated with adverse outcomes, contributing to the lower HRQoL among CD patients [27]. It is worth noting that previous literature reports have yielded inconsistent findings regarding the relationship between IBD type and HRQoL. While some studies suggest no significant differences in HRQoL based on IBD type [21, 23, 28], others report worse HRQoL in UC patients [25]. Nevertheless, certain studies align with our findings, indicating improved HRQoL in UC patients [29]. We speculate that the discrepancies in reported outcomes across different literatures may be attributed to variations in sample sizes and differences in statistical methods employed in various studies. Our research further illustrates that IBD patients who maintain a positive outlook during the COVID-19 pandemic exhibit higher HRQoL compared to those who experience depression. Relevant literature indicates that the COVID-19 pandemic has had a substantial impact on the physical and mental well-being of individuals [30, 31]. During the pandemic, the general public in many countries reported elevated levels of depression, anxiety, psychological distress, and post-traumatic stress disorder [31–33]. Furthermore, the prevalence of anxiety and depression among IBD patients is at least twice as high as that of the general population. Previous reports indicate that during the COVID-19 pandemic, IBD patients experiencing depression and anxiety are more likely to report reduced sleep quality and a diminished quality of life compared to those who maintain an optimistic outlook [34]. This aligns with our study's findings.

Our research results underscore that IBD patients who adhere to medical advice and consistently take prescribed medications for their condition report a higher HRQoL compared to patients who do not consistently follow their treatment regimen. Earlier literature has also yielded consistent findings, suggesting that the decrease in HRQoL is linked to discontinuation of medication during the COVID-19 pandemic [21]. Additionally, studies have shown that the COVID-19 pandemic has had multifaceted effects on IBD patients [24]. Due to the pandemic, many IBD patients may encounter challenges in seeking medical care or resort to online consultations, making it difficult to obtain prescription medications, such as biologics and immunosuppressants. The pandemic may also lead to shortages of these medications [20, 21, 24]. Consequently, some IBD patients may struggle to adhere to their prescribed medication regimens, particularly for IBD patients who during periods of remission and relapse, if they discontinue taking medicine in such cases could exacerbate their condition and reduce their HRQoL [21, 24]. Our recommendation is that all IBD patients should continue taking their prescribed medications for IBD as directed by their healthcare providers during the COVID-19 pandemic and strive to avoid discontinuing their IBD medications. Medication management is a critical measure for controlling IBD symptoms and maintaining remission [28].

This study provides valuable insights into the impact of the COVID-19 pandemic on the HRQoL of IBD patients, particularly during the post-zero-COVID policy era in China. The findings underscore the need for continued support and psychological care for IBD patients in challenging circumstances. However, it is important to note that while this study offers significant insights, there are limitations that should be considered. First, the data were collected through web-based questionnaires, which may introduce selection bias, as participants may not be representative of all IBD patients, and, there is an imbalance in the proportion of CD and UC patients within our study sample, with a higher percentage of CD patients. Therefore, this is one of the potential reasons causing a potential bias in our study results Additionally, self-reporting in questionnaires may lead to recall bias and inaccuracies in responses. Moreover, the cross-sectional design of this study does not allow for the establishment of causal relationships between variables. Longitudinal studies could provide a more comprehensive understanding of the dynamic changes in HRQoL among IBD patients during the pandemic. Furthermore, the survey was conducted in a specific region of China, and the results may not be fully generalizable to other regions or countries with different healthcare systems and policies.

Despite these limitations, this study contributes to the limited body of literature on the impact of the COVID-19 pandemic on HRQoL of IBD patients, especially in the context of policy changes in China. The findings suggest that healthcare providers should pay attention to the psychological well-being of IBD patients during pandemic situations and provide appropriate support and interventions to help them maintain a positive attitude and adhere to treatment regimens.

Due to the limited availability of relevant literature, this study is exceptionally valuable, innovative, and irreplaceable, offering valuable insights into the HRQoL of IBD patients during COVID-19 outbreaks worldwide. Future research in this area could explore the effectiveness of psychological interventions, such as counseling and support groups, in improving the HRQoL of IBD patients during times of crisis. Additionally, investigating the impact of different COVID-19 variants on the experiences of IBD patients and outcomes could provide valuable insights into the evolving nature of the pandemic.

The COVID-19 pandemic has posed unique challenges for IBD patients, impacting their HRQoL. This study highlights the importance of addressing the psychological well-being of IBD patients and the need for tailored support and interventions during times of crisis. Further research in this area can contribute to our understanding of how best to support this vulnerable population in the face of future challenges.

Ethics approval and consent to participate

Our research has been approved by the Ethics Committee of Nanjing BenQ Medical Center, with the ethical approval number: 2023-KL022.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

Not applicable.

Authors’ contributions

Study concept and design: T. Z.，P.L. and R. W. . Data acquisition, analysis and interpretation: F. G., R. W., J. L., H. J., and T.Z.. Drafting of the Manuscript: T. Z. and R. W. . Critical revision of the manuscript for important intellectual content: J. R., T. Z., and Y.Z.. All authors read and approved the final manuscript.

Acknowledgements

Not applicable.

Ochani R, Asad A, Yasmin F, Shaikh S, Khalid H, Batra S, Sohail MR, Mahmood SF, Ochani R, Hussham Arshad M, et al. COVID-19 pandemic: from origins to outcomes. A comprehensive review of viral pathogenesis, clinical manifestations, diagnostic evaluation, and management. Infez Med. 2021;29(1):20–36.
Al-Ani AH, Prentice RE, Rentsch CA, Johnson D, Ardalan Z, Heerasing N, Garg M, Campbell S, Sasadeusz J, Macrae FA, et al. Review article: prevention, diagnosis and management of COVID-19 in the IBD patient. Aliment Pharmacol Ther. 2020;52(1):54–72.
Harris RJ, Downey L, Smith TR, Cummings JRF, Felwick R, Gwiggner M. Life in lockdown: experiences of patients with IBD during COVID-19. BMJ Open Gastroenterol 2020, 7(1).
Kim B, Chae J, Kim EH, Yang HI, Cheon JH, Kim TI, Kim WH, Jeon JY, Park SJ. Physical activity and quality of life of patients with inflammatory bowel disease. Med (Baltim). 2021;100(27):e26290.
Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359–70.
Gracie DJ, Hamlin PJ, Ford AC. The influence of the brain-gut axis in inflammatory bowel disease and possible implications for treatment. Lancet Gastroenterol Hepatol. 2019;4(8):632–42.
Liu R, Tang A, Wang X, Shen S. Assessment of Quality of Life in Chinese Patients With Inflammatory Bowel Disease and their Caregivers. Inflamm Bowel Dis. 2018;24(9):2039–47.
Zingone F, Siniscalchi M, Savarino EV, Barberio B, Cingolani L, D'Incà R, De Filippo FR, Camera S, Ciacci C. Perception of the COVID-19 Pandemic Among Patients With Inflammatory Bowel Disease in the Time of Telemedicine: Cross-Sectional Questionnaire Study. J Med Internet Res. 2020;22(11):e19574.
Refaie E, García Mateo S, Martínez Domínguez SJ, Gargallo-Puyuelo CJ, Lario Quilez L, Carrera-Lasfuentes P, Arroyo Villarino MT. Gomollón García F: Impact of the lockdown period due to the COVID-19 pandemic in patients with inflammatory bowel disease. Gastroenterol Hepatol. 2022;45(2):114–22.
Meo SA, Meo AS, Al-Jassir FF, Klonoff DC. Omicron SARS-CoV-2 new variant: global prevalence and biological and clinical characteristics. Eur Rev Med Pharmacol Sci. 2021;25(24):8012–8.
Ren SY, Wang WB, Gao RD, Zhou AM. Omicron variant (B.1.1.529) of SARS-CoV-2: Mutation, infectivity, transmission, and vaccine resistance. World J Clin Cases. 2022;10(1):1–11.
Fan Y, Li X, Zhang L, Wan S, Zhang L, Zhou F. SARS-CoV-2 Omicron variant: recent progress and future perspectives. Signal Transduct Target Ther. 2022;7(1):141.
Tian D, Sun Y, Xu H, Ye Q. The emergence and epidemic characteristics of the highly mutated SARS-CoV-2 Omicron variant. J Med Virol. 2022;94(6):2376–83.
Kannan S, Shaik Syed Ali P, Sheeza A. Omicron (B.1.1.529) - variant of concern - molecular profile and epidemiology: a mini review. Eur Rev Med Pharmacol Sci. 2021;25(24):8019–22.
Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn's disease. Dis Mon. 2018;64(2):20–57.
Sun D, Chi L, Liu J, Liang J, Guo S, Li S. Psychometric validation of the Chinese version of the Short Inflammatory Bowel Disease Questionnaire and evaluation of its measurement invariance across sex. Health Qual Life Outcomes. 2021;19(1):253.
Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn's Relapse Prevention Trial. Am J Gastroenterol. 1996;91(8):1571–8.
de Bock E, Filipe MD, Meij V, Oldenburg B, van Schaik FDM, Bastian OW, Fidder HF, Vriens MR, Richir MC. Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands. BMJ Open Gastroenterol 2021, 8(1).
Roseira J, Sousa HT, Marreiros A, Contente LF, Magro F. Short Inflammatory Bowel Disease Questionnaire: translation and validation to the Portuguese language. Health Qual Life Outcomes. 2021;19(1):59.
Gavrilescu O, Prelipcean CC, Dranga M, Popa IV, Mihai C. Impact of COVID-19 Pandemic on the Quality of Life of IBD Patients. Med (Kaunas) 2022, 58(5).
Wang H, Tu L, Li Y, Bai T, Zou K, Xiao F, Li J, Chen M, Zhang H, Li G et al. The Symptoms and Medications of Patients with Inflammatory Bowel Disease in Hubei Province after COVID-19 Epidemic. J Immunol Res 2020, 2020:2847316.
Rosa I, Conti C, Zito L, Efthymakis K, Neri M, Porcelli P. Has the COVID-19 Pandemic Worsened Health-Related Quality of Life of Patients with Inflammatory Bowel Disease? A Longitudinal Disease Activity-Controlled Study. Int J Environ Res Public Health 2023, 20(2).
Nass BYS, Dibbets P, Markus CR. Impact of the COVID-19 pandemic on inflammatory bowel disease: The role of emotional stress and social isolation. Stress Health. 2022;38(2):222–33.
Owsianko N, Romańczuk-Osenka N, Szczerbakow M, Pikora K, Sowa K, Daniluk U, Rogalski P, Świdnicka-Siergiejko A, Antonowicz S, Krzyżak M, et al. Questionnaire-Based Study of 81 Patients in Poland to Evaluate the Course of Inflammatory Bowel Disease and the Effects of the COVID-19 Pandemic on Quality of Life and Mental State from February to June 2021. Med Sci Monit. 2022;28:e938243.
Conti C, Rosa I, Zito L, Grossi L, Efthymakis K, Neri M, Porcelli P. Influence of the COVID-19 Outbreak on Disease Activity and Quality of Life in Inflammatory Bowel Disease Patients. Front Psychiatry. 2021;12:664088.
Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. 2019;12(2):113–22.
Agrawal M, Spencer EA, Colombel JF, Ungaro RC. Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User's Guide for Adult and Pediatric Gastroenterologists. Gastroenterology. 2021;161(1):47–65.
Yu M, Ye Z, Chen Y, Qin T, Kou J, Tian D, Xiao F. Questionnaire assessment helps the self-management of patients with inflammatory bowel disease during the outbreak of Coronavirus Disease 2019. Aging. 2020;12(13):12468–78.
Paulides E, Pasma A, Erler NS, van Eijk RLA, de Vries AC, van der Woude CJ. Impact of the Coronavirus Disease Pandemic on Health-Related Quality of Life of Patients with Inflammatory Bowel Disease. Dig Dis Sci. 2022;67(7):2849–56.
Cardi V, Albano G, Gentili C, Sudulich L. The impact of emotion regulation and mental health difficulties on health behaviours during COVID19. J Psychiatr Res. 2021;143:409–15.
Han Q, Zheng B, Agostini M, Bélanger JJ, Gützkow B, Kreienkamp J, Reitsema AM, van Breen JA, Collaboration P, Leander NP. Associations of risk perception of COVID-19 with emotion and mental health during the pandemic. J Affect Disord. 2021;284:247–55.
Jafri MR, Zaheer A, Fatima S, Saleem T, Sohail A. Mental health status of COVID-19 survivors: a cross sectional study. Virol J. 2022;19(1):3.
Low RST, Overall NC, Chang VT, Henderson AME, Sibley CG. Emotion regulation and psychological and physical health during a nationwide COVID-19 lockdown. Emotion. 2021;21(8):1671–90.
Gao X, Tang Y, Lei N, Luo Y, Chen P, Liang C, Duan S, Zhang Y. Symptoms of anxiety/depression is associated with more aggressive inflammatory bowel disease. Sci Rep. 2021;11(1):1440.

Table 1. Demographics of IBD patients(n=224)

Parameter

Value

n(%)

Gender

Male

Female

Age,years

≤16

17-40

＞40

Age at diagnosis of IBD, years

≤16

17-40

＞40

Type of IBD

Crohn’s disease(CD)

Ulcerative colitis(UC)

Unclear diagnosis

Operated

Yes

No

Medications for treating IBD

No

Enteral nutrition

Parenteral nutrition

5-ASA (Mesalazine)

Glucocorticoid

Immunosuppressants (azathioprine, methotrexate)

Adalimumab

Infliximab

Ulinuzumab

Vitolizumab

Complications

Yes

No

134(59.82%)

90(40.18%)

55(24.55%)

104(46.43%)

65(29.02%)

67(29.91%)

122(54.46%)

35(15.63%)

197(87.95%)

14(6.25%)

13(5.80%)

96(42.86%)

128(57.14%)

10(4.46%)

113(50.45%)

12(5.36%)

129(57.59%)

3(1.34%)

16(7.14%)

20(8.93%)

26(11.61%)

7(3.13%)

11(4.91%)

38(16.96%)

186(83.04%)

Table 2. COVID-19 related questions

Parameter

Value

n(%)

Infected with COVID-19

No

Yes

Not sure

Vaccination

No

Incomplete vaccination

Full vaccination

Symptoms of COVID-19

224

35(15.63%)

172(76.79%)

17(7.59%)

224

70(31.25%)

79(35.27%)

75(33.48%)

172

Fever

Dry cough

Fatigue

Loss of smell

Loss of taste

Nasal congestion and runny nose

Pharyngeal pain

Conjunctivitis

Muscle pain

Diarrhea

Asymptomatic

Drugs for COVID-19

Antipyretic drugs

Hormone

Antiviral

Traditional Chinese medicines

Baritinib

Tozumab

Not taking medication

140(81.40%)

84(48.84%)

91(52.91%)

29(16.86%)

40(23.26%)

58(33.72%)

65(37.79%)

1(0.58%)

50(29.07%)

36(20.93%)

5(2.91%)

172

106(61.63%)

3(1.74%)

20(11.63%)

24(13.95%)

0(0%)

53(30.81%)

Symptoms of COVID-19 and treatment drugs for COVID-19 exclude people who were not infected with COVID-19 and not sure whether they were infected. (n=172)

Table 3. Comparing the differences between groups according to whether they are infected with COVID-19

Parameter

P value

Age

Gender

Type of IBD

Operated

Complications

Vaccination

0.707

0.171

0.453

0.355

0.101

0.569

Table 4. Comparing multiple factors based on SIBDQ scores

Parameter

P value

Mean rank

Gender

Age

Operated

Type of IBD

CD VS UC

Using BA to treat IBD

Complications

Infected with COVID-19

Vaccination

Symptoms of COVID-19

Drugs for COVID-19

Yes VS No

Be more susceptible to COVID-19

Yes VS No

No VS Not sure

Yes VS Not sure

Unwilling to interact with others

Study or work have been affected by COVID-19

No VS Yes

No VS Not sure

Yes VS Not sure

Using IBD medicine regularly

No VS Yes

No VS Stop

Yes VS Stop

Reduced outdoor exercise

0.373

0.078

0.062

0.037

0.824

0.351

0.173

0.694

0.597

0.028

0.006

0.009

0.392

0.145

＜0.001

0.002

0.997

0.007

0.014

0.264

0.437

-

95.94 VS 132.41

-

81.00 VS 99.19

42.12 VS 57.93

94.15 VS 73.74

-

97.98 VS 69.57

59.09 VS 41.02

-

75.44 VS 100.93

27.89 VS 70.33

-

BA: biological agents

No competing interests reported.

Influence of the COVID-19 Outbreak on Health-Related Quality of Life in Inflammatory Bowel Disease Patients in China: A Cross-Sectional Questionnaire-Based Study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

Introduction

Methods

Study Design

COVID-19 Related Questions

Short Inflammatory Bowel Disease Questionnaire (SIBDQ)

Statistical Analysis

Results

Demographics

COVID-19 Related Questions

Risk Factors Associated with SIBDQ Scores

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

Status:

Version 1