Introduction

Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), given their course and variety of complications, require, as well as medical interventions, psychosocial support [1]. The pathogenesis of these conditions is polyetiological in nature, and early detection is a crucial factor in the effectiveness of therapy [2–5].

The disease management is directed at achieving and maintaining clinical, endoscopic, and histopathological remission. However, patients’ general well-being is also a vital aspect of treatment. IBD patients should be treated as partners in the therapeutic process, and their life situation as well as psychological status should be taken into consideration, leading to personalized therapy [4].

In the case of CD, the inflammatory process may involve each segment of the digestive system. The highest incidence is observed in subjects between 16 and 30 years of age, and with a similar incidence in female and male subjects. The most common characteristic CD symptoms include abdominal pain and cramping, persistent diarrhoea, bowel urgency, fatigue, weight loss, anaemia, or fever [4, 6]. The pharmacological treatment primarily inhibits the inflammatory process; some patients may require surgical interventions [4, 7].

It is estimated that 30% to 50% of CD patients require surgical interventions in the first decade after diagnosis, while up to 35% of them will need repeated surgery [8, 9].

In UC, the inflammatory process involves solely the mucous membrane, extends continuously from the rectum to the caecum, and may involve the entire large intestine. Just like CD, UC is a disease with an onset between the second and third decades of life, although there are also cases in patients aged more than 60 years [5, 10, 11].

The characteristic clinical symptoms of UC include bloody diarrhoea, frequent, urgent bowel movements, fatigue, and weight loss. The less typical signs include abdominal pain primarily located in the left hypogastrium, fever, or tenesmus [5, 6]. UC may also be accompanied by constipation, and then the only sign of the disease can be the presence of blood in the stool [5]. Surgery may be necessary for UC patients with treatment-resistant disease, life-threatening complications, long-term side effects from medications, or a high risk of colon cancer after many years of disease [5]. In addition to digestive tract symptoms, up to 50% of patients with IBD develop extraintestinal symptoms, the most common of which affect the joints (inflammation of the peripheral and axial joints), skin (pyoderma gangrenosum, erythema nodosum), and eyes (uveitis) [4, 9]. The patients can also suffer from numerous side effects caused by medications used in IBD treatment.

The strategy of long-term IBD therapy aims initially at achieving complete clinical remission and subsequently endoscopic remission, together with transmural healing employing thorough, appropriately modified pharmacotherapy. The objective of subsequent management is to maintain long-term remission without exacerbation periods, thus allowing the patient to restore their ability to lead an everyday life without any restrictions in the personal, social, and professional spheres [5, 10–12].

Studies on the effect of IBD on various aspects of quality of life show that patients derive the greatest benefits to health and wellbeing when interventions take both clinical and psychological factors into consideration. Consequently, as well as medical interventions, patients also require psychosocial support [1, 12, 13].

This need arises in part because the disease often begins between the ages of 20 and 40 years, a time of active social and professional engagement. Chronic ailments result in a decrease in quality of life, as measured in areas such as life satisfaction, social functioning, and professional activity. In earlier studies, the patients reported their quality of life to be unsatisfactory concerning social functioning, as well as economic uncertainty resulting from recurrent exacerbation episodes of the disease, which necessitated their giving up professional activities [14–16]. International scientific publications presented numerous analyses of the relationship between the presence of IBD and selected socio-demographic indices [17, 18].

Numerous earlier publications from Poland have described the effect of IBD on various aspects of quality of life [14, 18–24]. However, studies that aimed at evaluating these issues concerning selected socio-demographic and socio-professional factors have been relatively rare within the past 20 years [1, 25–27].

Polish literature lacks comparative research on the similarities or differences between UC and CD patients in terms of their level of life satisfaction. Bridging this gap could provide additional knowledge on the psychosocial effect of IBD, the chronic and recurrent character of these ailments, and how they may affect significant areas such as the patient’s social contacts, professional activity, and economic situation.

Aim

The study aimed to assess the relationship between the type of IBD and the level of professional activity, economic situation, and the quality of social interactions, as well as to evaluate whether the level of life satisfaction could be dependent on selected socio-demographic indices and socio-professional activity.

Material and methods

The study was carried out between July 2018 and December 2023 on 210 individuals; the total group included 109 (51.9%) patients with CD and 101 (48.1%) UC subjects. The mean age of the CD patients was 34.1 years (SD = 12.4), whereas in the UC group, it was 37.0 years (SD = 14.2) (p = 0.174). The participants in the study were recruited from patients hospitalized in the Clinical Department of Gastroenterology and Hepatology at the University Hospital of Krakow, as well as those who were followed up by the Outpatient Department. The interviews were conducted with patients who had provided their written consent. All subsequent patients treated in the aforementioned clinical centre were invited to participate in the study. The inclusion criteria included a diagnosis of CD or UC and an age range of 18 to 85 years. The subjects were asked to complete the questionnaire. The socio-demographic characteristics of the investigated groups are presented in Table I.

The research results presented in the paper are based on the analysis of data collected for the statutory research project entitled “The effect of the character and quality of the physician-patient relation on the course of the therapeutic process as exemplified by selected diseases of the circulatory system and gastroenterological conditions” carried out in the Jagiellonian University Medical College in Krakow; the project was approved by the decision of the Jagiellonian University Bioethics Committee numbered 1072.6120.174.2017 and issued on October 26, 2017.

The researchers used the Polish adaptation of the Satisfaction with Life Scale (SWLS), which includes 5 statements referring to the patients’ present life, as disclosed through respondents’ degree of satisfaction with their achievements. The authors of the scale based it on the assumption that one’s life satisfaction assessment results from comparing one’s situation with the standards one has established. The responders indicate the degree to which they agree with each of the 5 statements on a 7-point scale, where 1 point denotes “I totally disagree” and 7 points means “I totally agree”. When the assessment points are summed, the result reflects the degree of one’s life satisfaction. The result falls within the range of 5 to 35 points, and the higher the score, the greater the sense of satisfaction experienced by the responder. The interpretation of the SWLS scale results is as follows: 1 to 4 sten score – low; 5 to 6 sten score – average; and 7 to 10 scores – high [28, 29].

The patients also completed a questionnaire developed by the present authors, including socio-demographic data such as sex, age, marital status, education, and place of residence. The effects that IBD exerted upon the patient’s sphere of socio-professional activity were measured using questions that asked whether the diagnosed disease resulted in the following: a) necessity of limiting one’s professional life, b) necessity of withdrawing from professional life, c) limitation of contact with family members, d) severing contact with the family, e) limitation of contact with friends and acquaintances, f) severing contact with friends and acquaintances, g) concerns about the future, h) deterioration of one’s economic situation, i) deterioration of social standing.

Results

The study did not demonstrate any differences in the mean level of life satisfaction between the CD and UC patients; the level was approximately 20 points (CD: 19.6 ±5.7 vs. UC: 19.8 ±6.6, p = 0.430), which is average according to the SWLS scale. No significant differences were noted between the CD and UC patients regarding the impact of IBD on professional activities. In both conditions, the responders most often expressed their fear for the future and the necessity of limiting their professional activities. In turn, the necessity of withdrawing from professional life and severing contact with friends and acquaintances was the least common phenomenon in both groups. The disease did not result in any patients in either of the two analysed groups severing contact with family members. The complete characterisation of the effect of IBD on the patients’ socio-professional activity is presented in Table II.

The study demonstrated that in the group of responders with CD, patients for whom the diagnosis had resulted in the necessity of restricting their professional life, limiting contacts with family members, deterioration of the economic situation and social standing demonstrated a lower level of life satisfaction as compared to individuals in whom the disease had not resulted in similar restrictions. The complete characterisation of life satisfaction in CD patients as dependent on the variables that characterise their socio-professional activity is presented in Table III.

The study demonstrated statistically significant differences in life satisfaction among CD patients, depending on their educational level (p = 0.035). While performing the pairwise comparison, the investigators noted that patients with secondary education were characterised by a lower satisfaction level (mean = 17.9 ±5.3) as compared to patients with university education (mean = 20.8 ±5.5) (p = 0.039). The investigation also showed that variables such as the place of residence, sex, and marital status did not affect the level of satisfaction in CD patients. The study results indicated that the age of patients with CD was not significantly correlated with the level of life satisfaction (Rho = –0.08, p = 0.379).

In the group of UC patients, individuals whose disease limited their contact with friends reported lower levels of life satisfaction compared to responders whose disease did not result in such restrictions (p = 0.007). Patients whose diagnosis deteriorated their social standing experienced lower life satisfaction than those whose ailments did not lead to such limitations (p < 0.001). The mean life satisfaction results in patients with UC, dependent on variables that characterise the socio-personal activity, are presented in Table IV.

It was also demonstrated that only the place of residence had a significant effect on the satisfaction level of the UC patients (p = 0.032). However, the pairwise comparison did not reveal any statistically significant differences between townships of varying sizes. The study revealed that variables such as education, sex, and marital status did not significantly impact the satisfaction level of patients diagnosed with UC. The age of UC patients was not significantly correlated with the level of life satisfaction (Rho = 0.12, p = 0.227). The authors also analysed the multiple regression model, which demonstrated that, among the limitations experienced by patients as a result of their IBD, the most significant effect on decreasing their life satisfaction, amounting to almost 4 points, was exerted by deterioration of social standing (B = –3.64, p < 0.001). In the model above, patients’ fear for the future decreased life satisfaction by more than 2 points (B = –2.11, p = 0.031). The weakest among significant dependencies was demonstrated regarding the necessity of limiting one’s professional life (B = –1.81, p = 0.029).

The authors did not observe that the type of disease affected the mean level of life satisfaction; thus, the variable was not included in the final regression model. No statistically significant dependence was observed between education and life satisfaction. The multiple regression model is presented in Table V.

Discussion

Crohn’s disease and UC are chronic inflammatory states, which negatively affect the patient’s quality of life, as confirmed by numerous international systematic reviews and meta-analyses [30, 31]. As the age of IBD onset is the period of full social activity and professional life, the occurrence of recurrent ailments and complications as well as surgical interventions, and dysfunctions at this time can result in reduced life satisfaction in some patients [4, 8, 10, 14–16].

Despite numerous studies performed in Poland to date, which concentrate on the effect of IBD on the evaluation of multiple parameters of the quality of life of the affected patients [14, 18–24], only a few studies have addressed socio-demographic indices and/or socio-professional activity [1, 25–27, 32].

In the present study, no differences in life satisfaction were observed between patients with CD and those with UC. This result is consistent with the findings of previous studies conducted by Ilias et al. [33], which did not reveal significant differences in life satisfaction levels between patients with CD and UC.

As demonstrated in the present study, the level of life satisfaction in both groups, comprising females and males, was approximately 20 points, which is an average result according to the SWLS scale. These findings are similar to those presented by Zielińska-Więczkowska et al., who observed that the life satisfaction scale was dominated by average and low results in patients with IBD; the authors also did not find differences between the two diseases in question [1]. The values are consistent with the study by Sarid et al. [34], which found that the level of life satisfaction in patients with CD was the same for both males and females. When measured using the SWLS scale, the scores were 20 points for subjects with active disease and 23.8 points for those in remission.

Another dependence observed by the present authors was the correlation between the disease and the professional activity of the patients with CD and UC. The most common consequence was fear for the future, which was mentioned by more than 3/4 of the responders with CD and UC, and the necessity of limiting one’s professional life (37.6% – CD, 48% – UC). Almost one-third of the patients reported a deterioration of their economic situation, and nearly 20% reported a decline of their social standing; every tenth patient in the two groups indicated the necessity of withdrawing from professional activity. The above results align with the outcome of earlier research by Bernklev et al. [16], which demonstrated that a substantial number of IBD patients (18% of UC and 23% of CD) face restrictions in professional activity due to sick leave. Moreover, 5 years after the initial diagnosis of IBD, 5.4% of UC and 14.9% of CD patients transitioned to disability pension. The study by Bernklev et al. [16] also revealed that in the analysed group, almost 12% of responders had been unemployed for the preceding 5 years (UC – 13.2% and CD – 8.7%).

The study conducted by Chrobak-Bień et al. [35] showed that in 22% of the subjects, UC affected the type of work performed, and in 22% it necessitated a job change. In turn, Bazaliński et al. [36] researched patients with stomas and observed the necessity to quit work in 12.5% of them. Within this study the dominant group were patients with colon cancer, and then patients with IBD.

The present research study also revealed the relationship between the disease and the social activity of the patients. The results obtained in both groups were highly similar. In 11% of responders suffering from CD or UC, the disease resulted in limiting contact with family members, while 40% reported limiting relations with friends and acquaintances. In both the study groups, the breaking of contacts with friends and acquaintances was indicated by approximately 1% of the subjects. The previously mentioned Polish study by Bazaliński et al. [36] showed that in more than half of the responders (56.5%), including patients with IBD, stoma implantation negatively affected their functioning at both personal and social levels. In turn, Chrobak-Bień et al. [35] demonstrated that among patients with UC, nearly half of the subjects reported the disease’s impact on their relationships with others, and a total of 18% described this effect as strong or very strong. On the other hand, the negative impact of the disease on family relations was described as weak in 42% of the responders, and none of them defined it as significant. The above results share some similarities with our observations, as we demonstrated that the disease did not lead to severing contacts with the family for any of the responders. However, in some subjects, such contacts became limited.

The results of our study highlight the relationship between the presence of IBD and selected socio-demographic variables. We observed statistically significant differences in the life satisfaction among patients with CD, with education level playing an important role. It was found that patients with secondary education reported lower levels of satisfaction compared to those with higher education. In contrast, in patients with UC, only the place of residence was found to be associated with the level of life satisfaction. Furthermore, our study demonstrated that socio-demographic variables, such as sex and marital status, were not related to the level of life satisfaction in either patient group.

The present results correspond to the results of other studies, which demonstrated that the lower education level in patients with IBD was correlated with a higher level of concerns related to the course of the disease and a poorer quality of life [15, 37]. The previously mentioned Polish study showed that university-educated patients with diagnosed UC reported a better quality of life, as assessed using the SF-36v2 questionnaire, compared to patients with vocational or secondary education. The authors of the above study did not demonstrate a significant dependence between place of residence and sex of the responders, and the quality of life [35]. Similar conclusions can be drawn from analyses that have proven correlations exist solely between education level and quality of life in patients with UC treated surgically [38]. Another Polish study [1] demonstrated that sex, marital status, and age of IBD patients did not exert any significant effects on the results obtained using the SWLS scale.

Similarly, our research demonstrated that the patient’s age was not significantly correlated with the level of life satisfaction in either study group.

The multivariate regression model we analysed showed that, among the limitations experienced by patients, the most significant factor affecting the SWLS result was the deterioration of social standing. The impact of fears for the future was half as strong, and the lowest dependence was demonstrated for the necessity to limit one’s professional life. These results can be compared to those obtained in earlier studies based on the regression model, which, although using different measurement tools, can be referred to, given the correlation between professional activity and quality of life in patients with IBD. Such an example is found in the studies of Magalhães et al. [39], who used the multivariate regression model; they demonstrated that the predictors of deteriorated quality of life measured by IBD questionnaire (IBDQ-32) in patients with CD and UC included two factors: the individual’s perception of decreased support from co-workers and a reduced sense of professional fulfilment. Similar results were obtained by Ananthakrishnan et al. [40] who used multivariate logistic regression and demonstrated a correlation between a lower level of life quality in patients with CD, analysed using the Short IBD Questionnaire (SIBDQ), and their inability to work.

Summing up, it should be mentioned that numerous studies describe the entire spectrum of dependencies between the occurrence of IBD symptoms and social consequences, such as interfering with interpersonal contacts, and everyday activities, as well as a negative impact on the ability to work [30, 41, 42]. Moreover, some studies demonstrate that potent psychological distress evoked by IBD leads to changes in lifestyle, disrupting social relations and family life, and may also be a cause of social exclusion, isolation, blame, and health-related stigmatisation [43, 44]. In this context, the presented results of our studies require continued research to obtain comprehensive knowledge on various aspects of the psychological and socio-professional situation of patients with IBD. Such knowledge may provide a valuable hint for gastroenterologists, helping them develop individualised treatment plans, which in turn may have a beneficial effect on the effectiveness of treatment and the quality of life of IBD patients.

This analysis has several limitations that may impact the interpretation of the results. Firstly, this is a cross-sectional analysis, and the evaluation solely addresses satisfaction with life in patients who are suffering from the disease. We do not have any data available on the life satisfaction of patients before their diagnosis. Thus, we are uncertain whether their life satisfaction objectively changed. The conclusions are based on the subjective evaluation of the patients’ responses.

Secondly, no information was available describing the time lapse from the diagnosis in particular patients, and it cannot be ruled out that this is a factor that significantly differentiates the subjects concerning their evaluation of life satisfaction. Given that the patients surveyed were at different stages of IBD, ranging from severe flare-ups to remission, their current condition may also have affected their overall evaluation of the disease. Moreover, the research included patients from a single centre only. Although all subsequent patients diagnosed with CD and UC were invited to take part in the study, the group may not be representative of all IBD patients in Poland.

Conclusions

In both CD and UC patients, the level of life satisfaction and the impact of the disease on socio-professional activity are similar. Of all socio-demographic variables tested, only the education level of CD patients and the place of residence in the group of UC patients affect the level of life satisfaction. The effects of both diseases in the socio-professional sphere most often were manifest as fears for the future and the necessity of limiting or withdrawing from professional life. The limitations imposed by IBD significantly impact patients’ interpersonal relations, particularly in terms of restricting contacts with friends and acquaintances, and to a lesser extent, with family members. In this study the SWLS level was most significantly impacted by a deterioration of social standing, and least impacted by a necessity to limit professional life.