The mediating role of psychological adjustment in predicting quality of life in Iranian female with ulcerative colitis

Background: Adjustment to chronic disease is a complex and multidimensional construct which can help the patients deal with profound changes in their personal life resulting from illness. Ulcerative Colitis (UC) with unpredictable and disabling course, among chronic diseases, can be challenging and little is known about the role of psychological adjustment of the patients toward it. The aims of this study were to identify determinants of psychological adjustment in UC patients, to examine its mediational role and the role of other predictors in predicting quality of life (QOL). Methods: Participants were 58 female UC patients consecutively attending an outpatient gastroenterology clinic. All participants completed a set of questionnaires assessing illness perception, disease activity, QOL and psychological adjustment. Psychological adjustment was measured as a composite of depression, anxiety, perceived stress, neuroticism and emotion-focused coping strategies. Results: The confirmatory factor analysis indicated that the constructed model of psychological adjustment to depression, anxiety, perceived stress, neuroticism and emotion-focused coping, filled the data. The difference between psychological adjustment of UC patients and normal subjects was significant (F=33.88 P<0.01). Then direct and indirect effects of age, level of education, disease activity, and cognitive representations of illness with mediating psychological adjustment on QOL were examined. In the final model, the mediating role of psychological adjustment was confirmed and among other variables cognitive representations of illness was the strongest predictor of QOL. Conclusions: The results accentuate on the importance of psychological adjustment in dealing with the chronic conditions such as ulcerative colitis and help to better understand illness perceptions and develop appropriate complementary interventions for these patients.