
==== Front
BMC Gastroenterol
BMC Gastroenterol
BMC Gastroenterology
1471-230X
BioMed Central London

39285342
3418
10.1186/s12876-024-03418-1
Research
The impact of the COVID-19 surge after the end of China's Zero-COVID policy on the health-related quality of life of IBD patients
Wang Runnan 1
Liu Peizhao 2
Fan Chaogang 1
Liu Juanhan 2
Jiang Haiyang 1
Ren Jianan jiananr@nju.edu.cn

12
Zhao Yun zhaoyun056@gmail.com

1
Zheng Tao jefferyzheng@yeah.net

1
1 grid.89957.3a 0000 0000 9255 8984 Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
2 grid.41156.37 0000 0001 2314 964X Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, China
16 9 2024
16 9 2024
2024
24 3124 1 2024
11 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Introduction

In December 2019, COVID-19 emerged in Wuhan, Hubei Province, China, and rapidly spread worldwide. On December 2022, the Chinese government ended the zero-COVID policy, leading to a surge in cases and significantly impacting daily life. IBD patients face heightened infection risks and substantial effects on their quality of life during the pandemic.

Methods

This cross-sectional study collected demographic, COVID-19-related, and HRQoL data from 224 IBD patients who had previously received treatment at Nanjing BenQ Medical Center. Participants completed an online survey between January 9, 2023, and January 23, 2023. The SIBDQ was used to assess HRQoL. Statistical analysis was performed using SPSS version 26.

Results

The study found that UC patients reported higher HRQoL compared to CD patients (p = 0.037). Patients who perceived themselves as less susceptible to COVID-19 had higher scores (p = 0.006 and p = 0.009). Those whose work or study was unaffected also had higher scores (p < 0.001 and p = 0.002). Additionally, irregular medication adherence was associated with lower HRQoL scores (p = 0.014 and p = 0.007). Multivariate linear regression results showed that IBD patients whose work or study was affected during the COVID-19 pandemic scored lower than those who were not affected (p = 0.038; 95% CI, -7.96 to -0.25). Patients who discontinued IBD medication scored higher than those with irregular medication use (p = 0.020; 95% CI, 1.00 to 10.90).

Conclusions

This study highlights the significant impact of the COVID-19 pandemic on the HRQoL of IBD patients. The findings emphasize the need for integrated care addressing both the physical and psychological aspects of IBD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-024-03418-1.

Keywords

Inflammatory bowel disease
COVID-19
Health-related Quality of Life
Short Inflammatory Bowel Disease Questionnaire
Cross-sectional survey
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcIntroduction

In December 2019, COVID-19 emerged in Wuhan, Hubei Province, China, primarily spreading through respiratory droplets and resulting in severe symptoms and deaths [1, 2]. Initially, China adopted strict "dynamic zero-COVID policy" to suppress the widespread spread of the disease in mainland China [3]. On December 7, 2022, the Chinese government announced the end of the zero-COVID policy, concluding three years of stringent epidemic prevention and control [4, 5]. This decision precipitated a sudden and widespread outbreak of COVID-19, leading to a surge in hospital visits and severely disrupting social production, work, and daily life [4, 5]. China's public health response to the COVID-19 pandemic has been unprecedented and unique, differing from other countries and regions [6].

Compared to the general population, the COVID-19 outbreak in China had a more significant impact on IBD patients [7, 8]. Due to the bidirectional communication of the brain-gut axis and the chronic nature of IBD, these patients are more susceptible to anxiety and depression, which diminishes their quality of life and impairs social function [9–11]. Additionally, IBD patients are at a heightened risk of contracting COVID-19 because they often require immunosuppressive treatments [12]. The economic and social disruptions caused by the pandemic profoundly affected the lives of IBD patients, exacerbating uncertainties in healthcare services, employment, education, and housing, thereby further impacting their mental health and quality of life.

This study aims to assess the health-related quality of life (HRQoL) of IBD patients during the COVID-19 outbreak following the Chinese government's policy change.

Methods

Study design

This cross-sectional study collected demographic information, COVID-19-related data, and HRQoL assessments from IBD patients who voluntarily participated in an online survey between January 9, 2023, and January 23, 2023 (The full questionnaire is available in Supplementary Material). All participants had received prior treatment at Nanjing BenQ Medical Center. The survey questionnaire was designed to avoid involving personal privacy and to ensure that personal information remained confidential. We obtained ethical approval for this study from Nanjing BenQ Medical Center (approval number 2023-KL022).

The study included a diverse group of IBD patients in terms of region, gender, and age to ensure the universality and representativeness of the findings. The primary endpoint of the study was to assess the impact of the COVID-19 pandemic on the HRQoL of IBD patients, evaluated using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores [13, 14]. The secondary endpoint was to explore factors related to COVID-19 infection.

We excluded IBD patients whose COVID-19 infection status was uncertain (Fig. 1). COVID-19 infection was defined as a positive nucleic acid test for the novel coronavirus, while a negative test indicated no infection. Patients who had not been tested but exhibited symptoms such as cough, nasal congestion, runny nose, or fever were classified as having an uncertain COVID-19 infection status.Fig. 1 Patients flowchart

COVID-19 related questions

We designed a set of questions related to COVID-19 for the surveyed IBD patients. These questions covered their COVID-19 vaccination status (not vaccinated, partially vaccinated, fully vaccinated, with full vaccination indicating receipt of at least three doses), COVID-19 infection status, post-infection symptoms, and treatment methods after COVID-19 infection, including the use of antipyretics, hormones, antiviral drugs, traditional Chinese medicines, baritinib, tocilizumab, or no treatment. These questions aimed to gain insight into the experiences of IBD patients who contracted COVID-19, particularly in the context of the post-zero-COVID policy era in China.

Short Inflammatory Bowel Disease Questionnaire (SIBDQ)

HRQoL encompasses an individual's perception of their physical and mental health and how illness and treatment impact this perception [14]. While the Inflammatory Bowel Disease Questionnaire (IBDQ) is often used to evaluate HRQoL, the SIBDQ offers the advantage of greater ease of completion and higher survey efficiency. SIBDQ also promotes better compliance among participants and reduces the burden on both respondents and investigators [14]. Therefore, we employed SIBDQ to assess HRQoL among IBD patients. Previous research has demonstrated the high reliability and validity of SIBDQ [15]. SIBDQ comprises 10 questions categorized into four dimensions: social, bowel, emotional, and systemic [11]. Each question employs a 7-point Likert scale, ranging from 1 (indicating a severe problem) to 7 (indicating no problem at all). The lowest possible score is 10, reflecting poor HRQoL, while the highest score is 70, signifying the greatest HRQoL [16, 17].

Statistical analysis

Statistical analyses were conducted using SPSS version 26. We employed the Chi-square test to analyze the relationship between the demographic characteristics of IBD patients and COVID-19 infection status. Additionally, we utilized the Mann-Whitney U test to examine differences between groups based on SIBDQ scores. A p-value of less than 0.05 was considered statistically significant. To enhance the reliability of our conclusions, we also conducted linear regression analysis to account for factors that may affect HRQoL. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

Results

Demographics

From January 9, 2023, to January 23, 2023, a total of 224 IBD patients completed the questionnaire. Among these patients, 134 (59.82%) were male and 90 (40.18%) were female. The age range was primarily between 17 and 40 years old (n=104, 46.43%), with the majority of patients diagnosed with IBD falling into this age group (n=122, 54.46%). Among the IBD patients, 197 (87.95%) were diagnosed with Crohn's disease (CD), 14 (6.25%) were diagnosed with ulcerative colitis (UC), and 13 (5.80%) had an unclear diagnosis. Surgical treatment for IBD had been undergone by 96 (42.86%) patients. Medication had been used by 214 (95.54%) of the IBD patients, with mesalazine (n=129, 57.59%) being the most commonly prescribed. Additionally, 38 (16.96%) patients reported having one or more comorbidities. In our survey, only 97 (43.30%) IBD patients reported never feeling discouraged, while the remaining 127 (56.70%) experienced varying degrees of negative psychological responses. Similarly, only 21 (9.38%) IBD patients reported never feeling nervous, while the majority (n=203, 90.62%) frequently experienced tension (Table 1).Table 1 Demographics of IBD patients (N=224)

Parameter	Value, n (%)	
Gender	
 Male	134 (59.82%)	
 Female	90 (40.18%)	
Age,years	
 ≤16	55 (24.55%)	
 17-40	104 (46.43%)	
 >40	65 (29.02%)	
Age at diagnosis of IBD, years	
 ≤16	67 (29.91%)	
 17-40	122 (54.46%)	
 >40	35 (15.63%)	
Type of IBD	
 CD	197 (87.95%)	
 UC	14 (6.25%)	
 Unclear diagnosis	13 (5.80%)	
Operated	
 Yes	96 (42.86%)	
 No	128 (57.14%)	
Medications for IBD	
 No	10 (4.46%)	
 Enteral nutrition	113 (50.45%)	
 Parenteral nutrition	12 (5.36%)	
 5-ASA (Mesalazine)	129 (57.59%)	
 Glucocorticoid	3 (1.34%)	
 Immunosuppressants (azathioprine, methotrexate)	16 (7.14%)	
 Adalimumab	20 (8.93%)	
 Infliximab	26 (11.61%)	
 Ulinuzumab	7 (3.13%)	
 Vitolizumab	11 (4.91%)	
Complications	
 Yes	38(16.96%)	
 No	186(83.04%)	
Feeling discouraged	
 Yes	127 (56.70%)	
 No	97 (43.30%)	
Feeling tension	
 Yes	203 (90.62%)	
 No	21 (9.38%)	

Symptom distribution during the COVID-19 pandemic

Among the IBD patients who were infected or uninfected with COVID-19 (N=207), 35 (16.91%) reported no history of COVID-19 infection, while 172 (83.09%) had been infected with COVID-19. A total of 139 (67.15%) IBD patients had received the COVID-19 vaccine. Among them, 67 (32.37%) patients had received the full vaccination regimen, while 72 (34.78%) had received only partial vaccination (one or two doses). Among the 172 infected IBD patients, 167 (97.09%) reported experiencing one or more symptoms following COVID-19 infection, with fever being the most common symptom (n=140, 81.40%). Additionally, 119 (69.19%) used one or more drugs to treat the disease, with antipyretics (n=106, 61.63%) being the most commonly utilized medication (Table 2).Table 2 COVID-19 related questions (N=207)

Parameter	Value, n (%)	
Infected with COVID-19	
 No	35 (16.91%)	
 Yes	172 (83.09%)	
Vaccination	
 No	68 (32.85%)	
 Partial vaccination	72 (34.78%)	
 Full vaccination	67 (32.37%)	
Symptoms of COVID-19	
 Fever	140 (81.40%)	
 Dry cough	84 (48.84%)	
 Fatigue	91 (52.91%)	
 Loss of smell	29 (16.86%)	
 Loss of taste	40 (23.26%)	
 Nasal congestion and runny nose	58 (33.72%)	
 Pharyngeal pain	65 (37.79%)	
 Conjunctivitis	1 (0.58%)	
 Muscle pain	50 (29.07%)	
 Diarrhea	36 (20.93%)	
 Asymptomatic	5 (2.91%)	
Drugs for COVID-19	
 Antipyretic drugs	106 (61.63%)	
 Hormone	3 (1.74%)	
 Antiviral	20 (11.63%)	
 Traditional Chinese medicines	24 (13.95%)	
 Baritinib	0	
 Tocilizumab	0	
 None	53 (30.81%)	
Symptoms of COVID-19 and drugs for COVID-19 were based on infected patients (N=172)

Factors related to COVID-19 infection

An analysis of gender, age, IBD type, surgical history, complications, and COVID-19 vaccination in relation to COVID-19 infection indicated no statistically significant differences in these factors (p > 0.05) (Table 3).Table 3 Factors Related to COVID-19 Infection

Parameter	Infected group (N, %)	Uninfected group (N, %)	P value	
Age			0.707	
 ≤ 16	43 (20.8%)	8 (3.9%)		
 17- 40	82 (39.6%)	15 (7.2%)		
 >40	47 (22.7%)	12 (5.8%)		
Gender			0.171	
 Male	105 (50.7%)	17 (8.2%)		
 Female	67 (32.4%)	18 (8.7%)		
Type of IBD			0.453	
 CD	151 (72.9%)	33 (15.9%)		
 UC	10 (4.8%)	1 (0.5%)		
 Unclear	11 (5.3%)	1 (0.5%)		
Operated			0.355	
 Yes	69 (33.3%)	17 (8.2%)		
 No	103 (49.8%)	18 (8.7%)		
Complications			0.101	
 Yes	35 (16.9%)	3 (1.4%)		
 No	137 (66.2%)	32 (15.5%)		
Vaccination			0.569	
 No	58 (28.0%)	10 (4.8%)		
 Partial vaccination	61 (29.5%)	11 (5.3%)		
 Full vaccination	53 (25.6%)	14 (6.8%)		

Risk factors associated with SIBDQ scores

We compared SIBDQ scores between different groups. Notably, a significant difference was observed in IBD types: UC patients reported higher SIBDQ scores than CD patients (p = 0.037, mean rank = 132.41 vs. 95.94). Regarding psychological factors, IBD patients who did not perceive themselves as more susceptible to COVID-19 compared to the general population scored higher than those who believed they were more susceptible or were uncertain about their susceptibility (p = 0.006, mean rank = 57.93 vs. 42.12; p = 0.009, mean rank = 94.15 vs. 73.74). Additionally, patients who did not believe their work or study was negatively affected by the COVID-19 pandemic scored higher than those who believed or were uncertain that they were negatively affected (p < 0.001, mean rank = 97.98 vs. 69.57; p = 0.002, mean rank = 59.09 vs. 41.02). Furthermore, there were differences in medication adherence among IBD patients: those with irregular medication usage scored lower compared to those who discontinued medication (p = 0.014, mean rank = 27.89 vs. 40.33), and patients with irregular medication adherence scored lower compared to those with regular medication adherence (p = 0.007, mean rank = 75.44 vs. 100.93). No significant differences were found in other groups (p > 0.05) (Table 4).Table 4 Comparing group difference based on SIBDQ scores

Parameter	P value	Mean rank	
Gender	0.373		
 Male		100.91	
 Female		108.44	
Age	0.078		
 ≤ 16		119.31	
 17- 40		102.09	
 >40		93.91	
Operation for IBD	0.062		
 Yes		94.80	
 No		110.54	
Type of IBD			
 CD VS UC	0.037	95.94 VS 132.41	
 CD VS Unclear	0.003	101.60 VS 50.96	
 UC VS Unclear	0.003	16.45 VS 7.92	
Using BA	0.824		
 Yes		102.53	
 No		104.58	
Complications	0.351		
 Yes		95.82	
 No		105.84	
COVID-19 infection	0.173		
 Yes		106.56	
 No		91.44	
Vaccination	0.694		
 No		100.85	
 Partial vaccination		102.26	
 Full vaccination		109.07	
Susceptible to COVID-19			
 Yes VS No	0.006	42.12 VS 57.93	
 No VS Not sure	0.009	94.15 VS 73.74	
 Yes VS Not sure	0.392	72.86 VS79.54	
Unwilling to interaction	0.145		
 No		117.76	
 Yes		99.38	
 Not sure		98.91	
Affecting study or work			
 No VS Yes	<0.001	97.98 VS 69.57	
 No VS Not sure	0.002	59.09 VS 41.02	
 Yes VS Not sure	0.997	81.01 VS 80.98	
Using IBD medicine			
 Irregular VS Regular	0.007	75.44 VS 100.93	
 Irregular VS Stop	0.014	27.89 VS 40.33	
 Regular VS Stop	0.264	93.71 VS 80.54	
Affecting outdoor exercise	0.437		
 No		118.29	
 Yes		101.20	
 Not sure		107.68	
BA Biological agents

Multivariate linear regression

Multivariate linear regression results showed that patients over 40 years old had lower SIBDQ scores compared to IBD patients aged 16 years or younger (β = -2.12, p = 0.035; 95% CI, -7.92 to -0.31). Patients without a definitive diagnosis of IBD scored lower than those with CD (β = -11.07, p < 0.001; 95% CI, -16.72 to -5.42). Patients whose work or study was affected during the COVID-19 pandemic scored lower than those who were not affected (β = -4.10, p = 0.038; 95% CI, -7.96 to -0.25). Patients who discontinued IBD medication during the COVID-19 pandemic scored higher than those with irregular medication use (β = 5.95, p = 0.020; 95% CI, 1.00 to 10.90) (Table 5).Table 5 Factors associated with HRQoL

Variables	Simple		Multiple	
β	SE	t	P	β (95%CI)	β	SE	t	P	β (95%CI)	
Gender	
 Male					0.00 (Reference)					0.00 (Reference)	
 Female	0.89	1.34	0.66	0.509	0.89 (-1.74 ~ 3.51)	0.72	1.33	0.54	0.588	0.72 (-1.88 ~ 3.32)	
Age	
 ≤16					0.00 (Reference)					0.00 (Reference)	
 17-40	-2.62	1.63	-1.61	0.108	-2.62 (-5.81 ~ 0.57)	-2.99	1.73	-1.72	0.086	-2.99 (-6.38 ~ 0.41)	
 >40	-3.73	1.80	-2.07	0.040	-3.73 (-7.25 ~ -0.20)	-4.12	1.94	-2.12	0.035	-4.12 (-7.92 ~ -0.31)	
Type of IBD	
 CD					0.00 (Reference)					0.00 (Reference)	
 UC	5.50	2.81	1.95	0.052	5.50 (-0.02 ~ 11.01)	2.86	2.87	1.00	0.320	2.86 (-2.77 ~ 8.49)	
 Unclear	-10.81	2.70	-4.00	<.001	-10.81 (-16.10 ~ -5.52)	-11.07	2.88	-3.84	<.001	-11.07 (-16.72 ~ -5.42)	
Operation for IBD	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	-2.10	1.33	-1.58	0.117	-2.10 (-4.70 ~ 0.51)	-1.26	1.39	-0.90	0.367	-1.26 (-3.99 ~ 1.47)	
Using BA	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	0.29	1.46	0.20	0.841	0.29 (-2.57 ~ 3.16)	-0.96	1.50	-0.64	0.522	-0.96 (-3.90 ~ 1.98)	
Complications	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	-0.88	1.74	-0.50	0.615	-0.88 (-4.28 ~ 2.53)	-0.19	1.74	-0.11	0.911	-0.19 (-3.60 ~ 3.21)	
Vaccination	
 No					0.00 (Reference)					0.00 (Reference)	
 Partial vaccination	-0.50	1.60	-0.31	0.754	-0.50 (-3.64 ~ 2.64)	-1.53	1.67	-0.92	0.359	-1.53 (-4.80 ~ 1.73)	
 Full vaccination	1.35	1.63	0.83	0.409	1.35 (-1.85 ~ 4.55)	1.18	1.61	0.73	0.466	1.18 (-1.98 ~ 4.34)	
COVID-19 infection	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	2.97	1.75	1.70	0.091	2.97 (-0.46 ~ 6.39)	3.05	1.67	1.83	0.068	3.05 (-0.21 ~ 6.32)	
Susceptible to COVID-19	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	-5.70	1.86	-3.07	0.002	-5.70 (-9.35 ~ -2.06)	-3.00	2.01	-1.49	0.138	-3.00 (-6.95 ~ 0.95)	
 Not sure	-4.00	1.56	-2.57	0.011	-4.00 (-7.06 ~ -0.95)	-1.88	1.64	-1.15	0.251	-1.88 (-5.10 ~ 1.33)	
Unwilling to interaction	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	-3.11	1.67	-1.86	0.064	-3.11 (-6.39 ~ 0.16)	0.31	1.95	0.16	0.874	0.31 (-3.51 ~ 4.13)	
 Not sure	-3.02	1.68	-1.80	0.073	-3.02 (-6.31 ~ 0.26)	-0.32	1.88	-0.17	0.865	-0.32 (-4.00 ~ 3.36)	
Affecting study or work	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	-6.06	1.61	-3.75	<.001	-6.06 (-9.23 ~ -2.90)	-4.10	1.97	-2.09	0.038	-4.10 (-7.96 ~ -0.25)	
 Not sure	-5.55	1.86	-2.98	0.003	-5.55 (-9.19 ~ -1.90)	-3.21	2.21	-1.46	0.147	-3.21 (-7.54 ~ 1.11)	
Affecting outdoor exercise	
 No					0.00 (Reference)					0.00 (Reference)	
 Yes	-3.06	2.20	-1.39	0.167	-3.06 (-7.37 ~ 1.26)	0.33	2.35	0.14	0.890	0.33 (-4.29 ~ 4.94)	
 Not sure	-1.72	2.63	-0.65	0.514	-1.72 (-6.86 ~ 3.43)	0.55	2.67	0.21	0.837	0.55 (-4.69 ~ 5.79)	
Using IBD medicine	
 Irregular					0.00 (Reference)					0.00 (Reference)	
 Stop	6.15	2.61	2.36	0.019	6.15 (1.03 ~ 11.28)	5.95	2.53	2.36	0.020	5.95 (1.00 ~ 10.90)	
 Regular	3.86	1.61	2.40	0.017	3.86 (0.71 ~ 7.01)	2.15	1.64	1.31	0.192	2.15 (-1.07 ~ 5.37)	

Discussion

This study investigated the impact of the COVID-19 pandemic on the HRQoL of IBD patients. Previous research has examined the influence of COVID-19 on the health of patients with chronic diseases, including IBD. The relationship between chronic illnesses and psychological disorders is multifaceted. On one hand, psychological stress can exacerbate organic diseases through neuroendocrine and inflammatory mechanisms. On the other hand, chronic illnesses can act as a source of stress, leading to subjective stress and excessive health problems due to sustained overload [18]. IBD patients are particularly susceptible to psychological symptoms such as anxiety, fear, and depression compared to the general population [19, 20]. Consequently, the COVID-19 pandemic appears to have had a significant impact on IBD patients [21].

In our study, the majority of IBD patients were being treated with mesalazine (5-ASA). Literature suggests that medications used to treat IBD can influence the immune system, modulate immunity, and potentially increase the susceptibility of IBD patients to COVID-19 infection [22]. Specifically, IBD patients using steroids and 5-ASA are considered to be at a higher risk of contracting COVID-19 [23]. Conversely, biological agents (anti-TNF-α) are considered a protective factor against severe COVID-19, possibly due to the overexpression of TNF-α in COVID-19 [22]. However, the mechanisms of these medications are not yet fully understood, necessitating further research to comprehensively assess the risk of COVID-19 infection in IBD patients and the efficacy and risks associated with immunomodulators. This research will guide clinicians in making informed decisions regarding drug selection.

Our study underscores that UC patients generally report a higher HRQoL than CD patients. However, multivariate linear regression results indicate that the type of IBD, whether UC or CD, does not affect SIBDQ scores, which may be due to the influence of other factors. CD and UC have different pathogenic mechanisms. CD can affect various segments of the gastrointestinal tract, has the potential for transmural involvement, and can lead to complications such as intestinal perforation and fistulas. In contrast, UC primarily affects the mucosal layer of the rectum and colon and is typically associated with fewer systemic symptoms compared to CD [24].

Moreover, delayed diagnosis of IBD, particularly in CD, is common and associated with adverse outcomes, contributing to the lower HRQoL among CD patients [25]. It is worth noting that previous literature reports have yielded inconsistent findings regarding the relationship between IBD type and HRQoL. While some studies suggest no significant differences in HRQoL based on IBD type [19, 21, 26], others report worse HRQoL in UC patients [23]. Nevertheless, certain studies align with our findings, indicating improved HRQoL in UC patients [27]. We speculate that the discrepancies in reported outcomes across different literature may be attributed to variations in sample sizes and differences in statistical methods employed in various studies.

Our research further illustrates that IBD patients who maintain a positive outlook during the COVID-19 pandemic exhibit higher HRQoL compared to those who experience depression. In our study, multivariate linear regression results showed that IBD patients who believed their work or studies were affected by COVID-19 had lower scores compared to those who believed they were not affected. Relevant literature indicates that the COVID-19 pandemic has had a substantial impact on the physical and mental well-being of individuals [28]. During the pandemic, the general public in many countries reported elevated levels of depression, anxiety, psychological distress, and post-traumatic stress disorder [29–31]. Furthermore, the prevalence of anxiety and depression among IBD patients is at least twice as high as that of the general population. Previous reports indicate that during the COVID-19 pandemic, IBD patients experiencing depression and anxiety are more likely to report reduced sleep quality and a diminished quality of life compared to those who maintain an optimistic outlook [32]. This aligns with our study's findings.

In our study, patients who took IBD medication irregularly had lower SIBDQ scores compared to those who either discontinued or consistently took their medication. Those who discontinued their medication were considered to have experienced alleviation of IBD symptoms. Multivariate linear regression results also indicate that patients who took IBD medication irregularly had lower scores compared to those who discontinued the medication. Earlier literature has also yielded consistent findings, suggesting that the decrease in HRQoL is linked to irregular use of IBD medication during the COVID-19 pandemic [19]. Due to the pandemic, many IBD patients may encounter challenges in seeking medical care or resort to online consultations, making it difficult to obtain prescription medications, such as biologics and immunosuppressants. The pandemic may also lead to shortages of these medications [18, 19, 22]. Consequently, some IBD patients may struggle to adhere to their prescribed medication regimens. Particularly for IBD patients, irregular medication intake during periods of remission and relapse could exacerbate their condition and reduce their HRQoL [18, 22]. Our recommendation is that all IBD patients should regularly take their prescribed medications for IBD as directed by their healthcare providers during the COVID-19 pandemic. Medication management is a critical measure for controlling IBD symptoms and maintaining remission [26].

Unlike countries such as Australia and New Zealand, which implemented zero-COVID policies [6, 33, 34], China adopted a "dynamic zero" policy, which involves quickly implementing corresponding measures upon detecting an outbreak to thoroughly control the spread of the virus [3]. After a long period of enforcing an extremely strict zero-COVID policy, China suddenly loosed these measures, leading to the transformation of the epidemiological landscape, social environment, and transmission dynamics [4, 5]. This represents a significant innovation in this study, providing new perspectives and references for future policy shifts and the psychological impacts of isolation policies on IBD patients during similar pandemics and localized outbreaks.

Limitations

It is important to note that while this study offers significant insights, there are limitations that should be considered.

First, the data were collected through web-based questionnaires, which may introduce selection bias, as participants may not be representative of all IBD patients. Additionally, there is an imbalance in the proportion of CD and UC patients within our study sample, with a higher percentage of CD patients. This imbalance may have introduced potential bias in our study results. Moreover, self-reporting in questionnaires may lead to recall bias and inaccuracies in responses, making it impossible for us to assess the severity of the patients' disease using scores such as CDAI, HBI, and SCCAI.

Second, given there was no parallel survey conducted with healthy controls without IBD, it is not possible to confirm that these results are worse than those that would have been elicited from participants without IBD. Third, the cross-sectional design of this study does not allow for the establishment of causal relationships between variables. Longitudinal studies could provide a more comprehensive understanding of the dynamic changes in HRQoL among IBD patients during the pandemic. Furthermore, given this was a cross-sectional survey and no pre-pandemic comparator survey data is included, it is not possible to confirm that these data are specifically related to the pandemic alone.

Conclusion

The findings highlight the importance of healthcare providers paying close attention to the psychological well-being of IBD patients during pandemic situations. Providing appropriate support and interventions is crucial to help these patients maintain a positive attitude and adhere to their treatment regimens. Given the scarcity of relevant literature, this study is exceptionally valuable and innovative, offering unique insights into the HRQoL of IBD patients during COVID-19 outbreaks worldwide.

Future research could explore the effectiveness of psychological interventions, such as counseling and support groups, in improving the HRQoL of IBD patients during times of crisis. Additionally, investigating the impact of different COVID-19 variants on the experiences and outcomes of IBD patients could provide valuable insights into the evolving nature of the pandemic.

Supplementary Information

Supplementary Material 1.

Acknowledgements

Not applicable.

Authors’ contributions

Study concept and design: T. Z., P.L. and R. W. . Data acquisition, analysis and interpretation: C. F., R. W., J. L., H. J., and T.Z.. Drafting of the Manuscript: T. Z. and R. W. . Critical revision of the manuscript for important intellectual content: J. R., T. Z., and Y.Z.. All authors read and approved the final manuscript.

Funding

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Our research has been approved by the Ethics Committee of Nanjing BenQ Medical Center, with the ethical approval number: 2023-KL022. Our research has been approved by the Ethics Committee of Nanjing BenQ Medical Center for exemption from informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Runnan Wang and Peizhao Liu contributed equally to this work.
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