Predictors of Quality of Life in Coeliac Disease:
A 10 Year InvestigationPredictors of Quality of Life in Coeliac Disease: A 10 Year Investigation
THANK YOU so much for participating! We had over 1,700 responses for the baseline data collection.
Investigators:
Mr Stephan Moller, Swinburne University of Technology.
Associate Professor Simon R. Knowles, Swinburne University of Technology (sknowles@swin.edu.au)
Associate Professor Jason Tye-Din, Walter and Eliza Hall Institute of Medical Research
Summary of publications that have come from this research to date:
Möller, S. P., Apputhurai, P., Tye-Din, J. A., & Knowles, S. R. (2021) Quality of life in coeliac disease: Relationship between psychosocial processes and quality of life in a sample of 1,697 adults living with coeliac disease. Journal of Psychosomatic Research, 151, 110652.
Abstract:
Background: Coeliac disease is a chronic gastrointestinal condition associated with an increased risk of psychiatric comorbidity, and diminished quality of life. Ongoing gastrointestinal symptomatology is frequently reported post-diagnosis, despite undertaking a gluten-free diet.
Purpose: To examine the role of psychosocial factors in mediating the relationship between gastrointestinal symptoms and quality of life, using a cross-sectional structural equation modelling mediation analysis guided by the Common-Sense Model.
Methods: 1697 adults with coeliac disease (83.1% female, mean age = 55.79, SD = 14.98 years) completed an online questionnaire. Measures included gluten-free diet adherence, gastrointestinal symptoms, illness perceptions, coping, gastrointestinal-specific anxiety, pain catastrophising, psychological flexibility, psychological distress, and quality of life.
Results: A structural equation model was developed explaining 50.6% of the variation in quality of life and demonstrating good fit (χ2 (2) = 8.54, p = .014, χ2/N = 4.27, RMSEA = 0.04, SRMR = 0.01, CFI = 0.999, TLI = 0.98, GFI = 0.999). Gastrointestinal symptoms directly affected quality of life, and indirectly, via negative illness perceptions, maladaptive coping, pain catastrophising, and psychological distress.
Conclusion: Psychosocial processes may affect adjustment in coeliac disease by mediating the relationship between gastrointestinal symptoms and quality of life. Individuals living with coeliac disease may benefit from interventions targeting maladaptive psychosocial factors.
URL: https://doi.org/10.1016/j.jpsychores.2021.110652
Möller, S. P., Hayes, B., Wilding, H., Apputhurai, P., Tye-Din, J. A., & Knowles, S. R. (2021). Systematic review: Exploration of the impact of psychosocial factors on quality of life in adults living with coeliac disease. Journal of Psychosomatic Research, 147, 110537.
Background: Individuals living with coeliac disease generally experience a remission of symptoms after adopting the gluten-free diet but often report substantial treatment burden and ongoing quality of life issues. Psychosocial factors have been suggested to play a significant role in post-diagnosis quality of life but have yet to be systematically reviewed.
Aim: To review the evidence for psychosocial factors associated with quality of life in adult coeliac disease cohorts.
Methods: Studies were identified via systematic searches of eight databases (MEDLINE, Embase, Emcare, PsycINFO, Ovid Nursing, CINAHL, Informit Health Collection, Cochrane Library) in May 2019.
Results: Fourteen studies were included involving 3372 participants (80.2% female, mean age = 46.4 years). Symptoms of depression and anxiety were the most examined psychosocial factors across all studies. Quality of life was differentially associated with psychological distress, illness perceptions, coping, and attitudes/behaviours regarding food and the gluten-free diet.
Conclusion: Several psychosocial factors are associated with quality of life in adults living with coeliac disease. Current evidence suggests these factors are interrelated and may influence quality of life directly, via reduced psychological well-being, and indirectly, via reduced adherence to the gluten-free diet. Future research is needed to examine these processes concurrently, with the aim of elucidating the psychosocial mechanisms underlying post-diagnosis well-being and identifying potential targets for psychosocial intervention.
URL: https://doi.org/10.1016/j.jpsychores.2021.110537
Möller, S.P., Apputhurai, P., Tye-Din, J.A., & Knowles, S.R. (2022). Longitudinal assessment of the common sense model before and during the COVID-19 pandemic: A large coeliac disease cohort study. Journal of Psychosomatic Research, 153, 110711.
Abstract:
Objective: Psychosocial factors likely play a substantial role in the well-being of those living with coeliac disease, especially during the COVID-19 pandemic, however, little research has examined well-being in this cohort using an integrated socio-cognitive model. This study had two aims: (1) Examine changes in gastrointestinal symptoms, psychosocial factors, and well-being outcomes (i.e., psychological distress, quality of life [QoL]) associated with the pandemic, (2) Examine the interrelationship of these variables across timepoints using the Common Sense Model (CSM).
Methods: 1697 adults with coeliac disease (Time 1, pre-pandemic; 83.1% female, mean age = 55.8, SD = 15.0 years) and 674 follow-up participants (Time 2, pandemic; 82.8% female, mean age = 57.0, SD = 14.4 years) completed an online questionnaire. Hypotheses were tested using repeated measures MANOVA and cross-lagged panel model analyses.
Results: Participants reported improved QoL, and reduced gastrointestinal symptoms, negative illness perceptions and maladaptive coping from pre-pandemic to during the pandemic. There was no significant change in pain catastrophising or psychological distress. Cross-lagged effects showed gastrointestinal symptoms to predict negative illness perceptions, which in turn were predictive of poorer outcomes across all variables except pain catastrophising. Consistent with the CSM, there was a reciprocal relationship between illness perceptions and QoL over time. Maladaptive coping and pain catastrophising demonstrated limited predictive utility.
Conclusion: The COVID-19 pandemic appears to have had a small beneficial effect across several indices of well-being among adults with coeliac disease. Cross-lagged relationships highlight illness perceptions as a predictor of well-being outcomes and a potential target for psychosocial interventions.