{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T18:23:10Z","timestamp":1787336590805,"version":"build-2736575974"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ulcerative colitis (UC) is chronic inflammatory bowel disease that significantly impairs both physical and psychological well-being. This study explores the prevalence of depression and its impact on quality-of-life (QoL) among UC patients in Pakistan, aiming to inform integrated care approaches in a setting where mental health often remains under-addressed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted at outpatient IBD clinics of Gastroenterology department of Holy Family Hospital, Rawalpindi, from February 2024 to May 2025. Data were collected using structured forms covering demographics, clinical history, and disease severity (assessed via Mayo Score and Montreal classification). Psychological status was evaluated using HADS and BDI-II, while QoL was assessed using the IBDQ-32.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Among 101 UC patients, anxiety was present in 21.8% and depression in 17.8% patients. The mean IBDQ score was 150\u2009\u00b1\u200932.9, with 12.9% reporting poor QoL, 60.4% good QoL, and 1% excellent QoL. Disease severity showed significant positive correlations with anxiety (\u03c1\u2009=\u20090.42,p\u2009=\u20090.001) and depression (\u03c1\u2009=\u20090.38,p\u2009=\u20090.002), and strong negative correlation with QoL (\u03c1\u2009=\u2009\u22120.51,p\u2009&lt;\u20090.001). Kruskal\u2013Wallis tests confirmed significant differences in psychological distress and QoL across severity groups (p\u2009&lt;\u20090.05). Multivariable regression identified Mayo score, HADS-A, HADS-D, and disease extent as significant negative predictors of IBDQ score (p\u2009&lt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study underscores strong correlation between higher Mayo scores, together with elevated levels of anxiety and depression, and poorer QoL as measured by IBDQ among patients with UC in Pakistan. Therefore, there is an important consideration to explore the psychological burden and QoL impairments faced by UC patients in Pakistan to inform holistic management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356531","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T17:23:11Z","timestamp":1787332991000},"page":"e0356531","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between Ulcerative Colitis, mental health, and Quality of Life in a Pakistani cohort: A cross-sectional analysis"],"prefix":"10.1371","volume":"21","author":[{"given":"Saima","family":"Mushtaq","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sehrish","family":"Saeed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6006-4159","authenticated-orcid":true,"given":"Amjad","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7914-4626","authenticated-orcid":true,"given":"Tayyab Saeed","family":"Akhtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameen","family":"Abbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Ashraf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalin","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiyi","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"issue":"2","key":"pone.0356531.ref001","article-title":"Ulcerative colitis-induced colorectal carcinoma: a deleterious concatenation","volume":"14","author":"AP Rivera","year":"2022","journal-title":"Cureus"},{"issue":"11","key":"pone.0356531.ref002","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1016\/j.mayocp.2014.07.002","article-title":"Ulcerative colitis: epidemiology, diagnosis, and management","volume":"89","author":"JD Feuerstein","year":"2014","journal-title":"Mayo Clin Proc"},{"issue":"7","key":"pone.0356531.ref003","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1586\/17474124.2015.1038241","article-title":"Symptom management in inflammatory bowel disease","volume":"9","author":"BP Abraham","year":"2015","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"pone.0356531.ref004","doi-asserted-by":"crossref","unstructured":"Preda C, Istr\u0103tescu D. Etiology of ulcerative colitis. In: Ulcerative colitis\u2014Etiology, diagnosis, diet, special populations, and the role of interventional endoscopy; 2022.","DOI":"10.5772\/intechopen.106842"},{"issue":"6","key":"pone.0356531.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5604\/01.3001.0012.1753","article-title":"The influence of socio-demographic and clinical factors on the process of acceptance of the disease among patients with ulcerative colitis","volume":"90","author":"J Chrobak-Bie\u0144","year":"2018","journal-title":"Pol Przegl Chir"},{"issue":"4","key":"pone.0356531.ref006","first-page":"612","article-title":"Impact of depression on health-related quality of life in ulcerative colitis patients-are we doing enough? A single tertiary center experience","volume":"15","author":"D Jaksic","year":"2025","journal-title":"Life (Basel)"},{"key":"pone.0356531.ref007","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.vhri.2020.11.007","article-title":"Similarities and differences in health-related quality-of-life concepts between the east and the west: a qualitative analysis of the content of health-related quality-of-life measures","volume":"24","author":"Z Mao","year":"2021","journal-title":"Value Health Reg Issues"},{"issue":"3","key":"pone.0356531.ref008","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1590\/S0004-28032014000300005","article-title":"Quality of life in patients with inflammatory bowel disease: importance of clinical, demographic and psychosocial factors","volume":"51","author":"J Magalh\u00e3es","year":"2014","journal-title":"Arq Gastroenterol"},{"issue":"6","key":"pone.0356531.ref009","article-title":"Advancements in inflammatory bowel disease: a narrative review of diagnostics, management, epidemiology, prevalence, patient outcomes, quality of life, and clinical presentation","volume":"15","author":"MA Muzammil","year":"2023","journal-title":"Cureus"},{"issue":"5","key":"pone.0356531.ref010","doi-asserted-by":"crossref","DOI":"10.1136\/gpsych-2020-100276","article-title":"Psychometric properties of the Urdu version of the Hospital Anxiety and Depression Scale (HADS) among pregnant women in Abbottabad, Pakistan","volume":"33","author":"FS Lodhi","year":"2020","journal-title":"Gen Psychiatr"},{"issue":"3","key":"pone.0356531.ref011","article-title":"Validity and reliability of Urdu version of Beck\u2019s depression inventory among students of madaris (Islamic institutes)","volume":"10","author":"SA Khaliq","year":"2018","journal-title":"Isra Med J"},{"issue":"2","key":"pone.0356531.ref012","doi-asserted-by":"crossref","first-page":"60","DOI":"10.17352\/2455-2283.000081","article-title":"Quality of life and symptoms of anxiety and depression in patients affected by ulcerative colitis","volume":"6","author":"ACS Fernandes","year":"2020","journal-title":"Arch Clin Gastroenterol"},{"issue":"4","key":"pone.0356531.ref013","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1159\/000538618","article-title":"Association between sense of coherence, disease-specific symptoms, and health-related quality of life among Japanese patients with ulcerative colitis: a cross-sectional study","volume":"105","author":"C Horanai","year":"2024","journal-title":"Digestion"},{"issue":"1","key":"pone.0356531.ref014","doi-asserted-by":"crossref","DOI":"10.1097\/PG9.0000000000000287","article-title":"Health-related quality of life, anxiety, and self-image in young patients with Crohn\u2019s disease and ulcerative colitis","volume":"4","author":"K Lund","year":"2023","journal-title":"JPGN Rep"},{"issue":"4","key":"pone.0356531.ref015","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.gtc.2020.07.005","article-title":"Epidemiology and pathogenesis of ulcerative colitis","volume":"49","author":"L Du","year":"2020","journal-title":"Gastroenterol Clin North Am"},{"issue":"5","key":"pone.0356531.ref016","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S2468-1253(21)00014-5","article-title":"Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis","volume":"6","author":"B Barberio","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"pone.0356531.ref017","doi-asserted-by":"crossref","first-page":"17562848211066439","DOI":"10.1177\/17562848211066439","article-title":"Keeping it simple: mental health assessment in the Gastroenterology Department - 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