{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:02:21Z","timestamp":1790074941282,"version":"4.0.1"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"abstract":"ABSTRACT<\/jats:title>\n \n Aim<\/jats:title>\n To examine whether psychological distress and self\u2010efficacy serially mediate the relationship between disease activity and quality of life in patients with ulcerative colitis and Crohn's disease.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A cross\u2010sectional study.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We included 525 hospitalized patients with inflammatory bowel disease (224 with ulcerative colitis, 301 with Crohn's disease). Disease activity was assessed using the Mayo Score for ulcerative colitis and the Crohn's Disease Activity Index for Crohn's disease. Psychological distress was measured using the 7\u2010item Generalized Anxiety Disorder scale and the 9\u2010item Patient Health Questionnaire. Self\u2010efficacy was measured using the Inflammatory Bowel Disease Self\u2010Efficacy Scale, and quality of life using the 32\u2010item Inflammatory Bowel Disease Questionnaire. Serial mediation models with bias\u2010corrected bootstrapping were constructed separately for each disease subtype, adjusting for covariates.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Higher disease activity was associated with worse quality of life in both groups. Self\u2010efficacy mediated this association in both diseases. Psychological distress was a mediator in ulcerative colitis only. Replacing clinical scores with C\u2010reactive protein and faecal calprotectin rendered all indirect effects non\u2010significant.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Self\u2010efficacy is a universal mediator across inflammatory bowel disease subtypes. Psychological distress is disease\u2010specific to ulcerative colitis. The pathway is driven by subjective symptom perception, not objective inflammation.<\/jats:p>\n <\/jats:sec>\n \n Implications for the Profession and\/or Patient Care<\/jats:title>\n Nurses should enhance self\u2010efficacy through self\u2010management support for all patients, and assess anxiety and depression in those with ulcerative colitis.<\/jats:p>\n <\/jats:sec>\n \n Impact<\/jats:title>\n This study clarifies distinct psychological pathways from disease activity to quality of life in ulcerative colitis and Crohn's disease, providing evidence for subtype\u2010tailored nursing interventions.<\/jats:p>\n \n Reporting Method<\/jats:title>\n This study is reported in accordance with STROBE guidelines.<\/jats:p>\n <\/jats:sec>\n <\/jats:sec>\n \n Patient or Public Contribution<\/jats:title>\n No patient or public involvement.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jocn.70551","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:05:41Z","timestamp":1790071541000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological Pathways From Disease Activity to Quality of Life in Ulcerative Colitis and Crohn's Disease: A Cross\u2010Sectional Serial Mediation Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3583-5940","authenticated-orcid":false,"given":"Qiuxia","family":"Jiang","sequence":"first","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xie","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3617-2037","authenticated-orcid":false,"given":"Yue","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5940-3837","authenticated-orcid":false,"given":"Yan","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of Life Sciences and Medicine, Department of Gastroenterology, the First Affiliated Hospital of USTC University of Science and Technology of China Hefei Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S2468-1253(19)30333-4","article-title":"The Global, Regional, and National Burden of Inflammatory Bowel Disease in 195 Countries and Territories, 1990\u20132017: A Systematic Analysis for the Global Burden of Disease Study 2017","volume":"5","author":"Alatab S.","year":"2020","journal-title":"Lancet Gastroenterology & 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