The mediating role of psychological inflexibility on internalised stigma and patient outcomes in a sample of adults with inflammatory bowel disease.

Abstract

Background: This study examined the relationship between psychological inflexibility, internalised stigma, and patient outcomes in adults with Inflammatory Bowel Disease (IBD). It aimed to explore if psychological inflexibility mediated the relationship between internalised stigma and patient outcomes.

Methods: 382 participants with IBD took part in a cross-sectional quantitative study conducted via an online survey from May to December 2020. Participants completed questionnaires which assessed psychological inflexibility, committed action, internalised stigma related to IBD, psychological distress, IBD self-efficacy, self-concealment, beliefs about emotions, and fatigue. Participants also completed a sociodemographic and clinical questionnaire in addition to a bespoke Covid-19 questionnaire. Pearson's correlations and exploratory simple mediation analyses were used to examine relationships between variables and the mediating effect of psychological inflexibility.

Results: 40.5% of participants experienced internalised stigma. Higher psychological inflexibility was associated with higher internalised stigma, lower committed action, poorer health-related quality of life, lower IBD self-efficacy, higher self-concealment, higher fatigue, and more negative beliefs about emotions. Psychological inflexibility partially mediated the relationship between internalised stigma and several patient outcomes (psychological distress, IBD health-related quality of life, IBD self-efficacy, and self-concealment) and completely mediated the relationship between internalised stigma and fatigue.

Conclusion: Psychological inflexibility significantly impacts quality of life in individuals with internalised stigma related to IBD and mediates the relationship between internalised stigma and patient outcomes. Increasing psychological flexibility in adults with IBD may reduce distress and enhance quality of life. Longitudinal studies and trials of psychological interventions targeting psychological flexibility warrant exploration.