Coping strategies, satisfaction with life, and quality of life in Crohn's disease: A gender perspective using structural equation modeling analysis

Objective To identify coping strategies and socio-demographics impacting satisfaction with life and quality of life in Crohn's disease (CD). Methods 402 patients completed the Patient Harvey-Bradshaw Index, Brief COPE Inventory, Satisfaction with Life Scale (SWLS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We performed structural equation modeling (SEM) of mediators of quality of life and satisfaction with life. Results The cohort comprised: men 39.3%, women 60.1%; P-HBI 4.75 and 5.74 (p = 0.01). In inactive CD (P-HBI <= 4), both genders had SWLS score 23.8; men had SIBDQ score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men. In active CD, SWLS and SIBDQ scores were reduced, without gender differences; men and women used coping strategies equally. A SEM model (all patients) had a very good fit (X-2(6) = 6.68, p = 0.351, X-2 /df = 1.114, SRMR = 0.045, RMSEA = 0.023, CFI = 0.965). In direct paths, economic status impacted SWLS (beta = 0.39) and SIBDQ (beta = 0.12), number of children impacted SWLS (beta = 0.10), emotion-focused coping impacted SWLS (beta = 0.11), dysfunctional coping impacted SWLS (beta = -0.25). In an indirect path, economic status impacted dysfunctional coping (beta = -0.26), dysfunctional coping impacted SIBDQ (beta = -0.36). A model split by gender and disease activity showed that in active CD economic status impacted SIBDQ in men (beta = 0.43) more than women (beta = 0.26); emotional coping impacted SWLS in women (beta = 0.36) more than men (beta = 0.14). Conclusions Gender differences in coping and the impacts of economic status and emotion-focused coping vary with activity of CD. Psychological treatment in the clinic setting might improve satisfaction with life and quality of life in CD patients.