Coping behavior and social support contribute independently to quality of life after surgery for inflammatory bowel disease

PURPOSE: The purpose of this study was to examine the association between c oping behavior at the time of surgery and inflammatory bowel disease-relate d quality of life after surgery. We also investigated the relationship betw een perceived social support and both coping style and postsurgical quality of life. Finally, the value of the Medical Outcomes Study Social Support S cale for preoperative screening was assessed. METHODS: Eighty-six subjects who had surgery during a 12-month period completed the Inflammatory Bowel D isease Questionnaire, the Ways of Coping, a measure of inflammatory bowel d isease symptom severity, and the Medical Outcomes Study Social Support Scal e. Analysis of variance was used to test an association between Ways of Cop ing score and membership in a high quality of life (Inflammatory Bowel Dise ase Questionnaire > mean) or low quality of life (Inflammatory Bowel Diseas e Questionnaire < mean) cohort. Comparison of group means between the high quality of life and low quality of life cohorts identified Ways of Coping b ehavior scales that differed between the high quality of life and low quali ty of life cohorts. Stepwise linear regression analysis was then used to de termine the independent contribution of 1) current inflammatory bowel disea se symptoms, 2) current perceived social support and 3) identified coping b ehaviors (self-control, self-blame, and escape, summed as a single index na med ''maladaptive coping") to postsurgical quality of life. The sensitivity , specificity, and negative predictive value of the Medical Outcomes Study Social Support Scale were assessed. RESULTS:The lower quality of life group distinguished itself by more frequent use of maladaptive coping. Regressio n analysis revealed that current inflammatory bowel disease-related symptom s, current perceived social support, and maladaptive coping behaviors at th e time of surgery each made a highly significant independent contribution t o postsurgical quality of life. The sensitivity of the Medical Outcomes Stu dy Social Support Scale in identifying patients with poor postsurgical qual ity of life was 81 percent, and the specificity was 77 percent. The negativ e predictive value was 93 percent. CONCLUSIONS: Three coping behaviors whic h seem to be maladaptive (self-control, self-blame, and escape) are associa ted with lower quality of life after surgery for inflammatory bowel disease . These coping behaviors make a contribution to postsurgical quality of lif e independent of the negative effect on quality of life of inflammatory bow el disease symptoms. Perceived social support is a third factor that makes an independent contribution to postsurgical quality of life. The Medical Ou tcomes Study Social Support Scale has properties associated with an effecti ve screening tool and merits further investigation as an instrument to scre en presurgically for individuals at higher risk of poor subjective outcome of inflammatory bowel disease surgery.