Patient anxiety and depression as well as spousal caregiving burden and psychological stress affect marital adjustment in spouses of middle-aged and young adults with inflammatory bowel disease: a multicenter cross-sectional study

Inflammatory bowel disease (IBD) is characterized by a protracted course and recurrent symptoms, and the long-term disease-related stress on patients not only impairs their own psychological status, but may also affect their spouses’ marital adjustment through marital interaction and caregiving processes. Based on a patient-spouse dyadic perspective, this study aims to investigate the current status of marital adjustment among spouses of young and middle-aged patients with IBD, and to analyze the relationships of patient anxiety and depression, and spouse caregiving burden and psychological stress with spousal marital adjustment, with the goal of providing a reference for family support and couple-based coping interventions for IBD patients.

A multicenter cross-sectional study design was adopted. From March to July 2025, a total of 123 pairs of middle-aged and young IBD adults and their spouses who were admitted to the gastroenterology departments of 3 tertiary grade A hospitals in Chongqing, Xi’an, and Zhengzhou were recruited with convenience sampling. The participants were investigated using general information questionnaires, Hospital Anxiety and Depression Scale (HADS), Marital Adjustment Test (MAT), Zarit Burden Interview (ZBI), and Stress Response Questionnaire (SRQ). Spearman correlation analysis was adopted to examine the correlations among the main variables. Hierarchical multiple linear regression was performed with the total MAT score of the spouse as the dependent variable to identify the factors associated with spousal marital adjustment, and a sensitivity analysis was conducted by replacing the total ZBI score with the total SRQ score.

The total HADS score was 11.00 (8.00, 16.00) for patients and 9.00 (6.00, 15.00) for spouses, indicating significantly higher anxiety and depression levels in the patients than the spouses (Z=-3.45, P=0.001). For the spouses, the total ZBI score was 16.00 (10.00, 23.00), and the total SRQ score was 37.00 (32.00, 47.00), and the scores of emotional response, physical response, and behavioral response subscales of SRQ were 16.00 (13.00, 20.00), 12.00 (10.00, 15.00) and 7.00 (6.00, 9.00), respectively. Spearman correlation analysis showed that the total MAT score of spouses was negatively correlated with patients’ total HADS score (r_s=-0.50), and spouses’ total HADS score (r_s=-0.45), total ZBI score (r_s=-0.56) and total SRQ score (r_s=-0.56) (all P<0.01); the patients’ total HADS score was positively correlated with spouses’ total HADS score (r_s =0.62, P<0.01); and spouses’ total ZBI score was positively correlated with their own total SRQ score (r_s=0.77, P<0.01). Hierarchical multiple linear regression analysis showed that Model 1, after adjusting for spouses’ age and education level and disease severity, explained 15.0% of the variance in spousal marital adjustment (R²=0.15, adjusted R²=0.13, P<0.001). After further incorporating patients’ total HADS score, and spouses’ total HADS score and total ZBI score into Model 2, the explanatory power was markedly increased to 62% (R²=0.62, adjusted R²=0.60, ΔR²=0.47, F=47.53, P<0.001). The results of Model 2 demonstrated that spouses’ age (B=3.64, 95%CI: 1.01 to 6.28, β=0.20, P=0.01), education level (B=6.31, 95%CI: 1.04 to 11.58, β=0.16, P=0.02), and total ZBI score (B=-0.75, 95%CI:-0.99 to -0.51, β=-0.52, P<0.001), and patients’ total HADS score (B=-0.80, 95%CI:-1.39 to -0.21, β=-0.23, P=0.01) were significantly associated with the total MAT score of spouses. Collinearity diagnostics presented that the variance inflation factor (VIF) of each variable in Model 2 was <5. Sensitivity analysis indicated that the total SRQ score remained negatively associated with the total MAT score of spouses after replacing the total ZBI score with the total SRQ score (B=-0.70, 95%CI:-0.93 to -0.46, β=-0.56, P<0.001).

The spouses of young and middle-aged IBD patients have relatively poor marital adjustment. Patients’ anxiety and depression levels, as well as spouses’ caregiving burden and psychological stress, are all associated with decreased spousal marital adjustment. Clinical nurses should adopt a patient-spouse dyadic perspective, pay close attention to the psychological states of IBD patients and their spouses, and implement targeted interventions including disease education, psychological support, caregiving skill training and dyadic coping interventions for both spouses.