This was a cross-sectional study with data collection from July 2013 to June 2016. Patients reported socio-demographic and medical characteristics including gender, year and place of birth, education, economic status, marital status and number of children, religion and religiosity, current and past smoking habits, disease duration, current medications, anytime surgery for CD, and hospitalizations for CD in the past year. Data concerning co-morbidities were collectible from most patients attending at the hospitals. Patients completed the Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36) and Short Inflammatory Bowel Disease Questionnaire (SIBDQ), all of which include questions about pain. In addition, patients completed five socio-psychological questionnaires: Brief Symptom Inventory (BSI), Brief COPE Inventory (COPE), Family Assessment Device (FAD), Satisfaction with Life Scale (SWLS) and Work Productivity and Activity Impairment Questionnaire (WPAI).
P-HBI: This clinical measure of the severity of disease was specifically designed for patients with CD. It consists of 4 items reflecting the previous day's symptoms and signs of CD; the question regarding the physician's assessment of the possible presence of an abdominal mass in the original HBI is removed in the P-HBI, making the questionnaire suitable for completion by the patients themselves. A total score < 5 indicates disease remission, 5-7 mild disease, 8-16 moderate disease, and > 16 severe disease.
SF-36: This generic health-related quality of life measure is comprised of 36 items divided into eight domains, which in turn are grouped as Physical Health Summary Score (physical functioning, role-physical, bodily pain, general health) and Mental Health Summary Score (vitality, role-emotional, social functioning, mental health). Responses refer to the past four weeks. The range of the Physical or Mental Health Summary Score is 0-100. A higher score represents a better quality of life. The Hebrew version has been validated.
SIBDQ: Is an inflammatory bowel disease-specific health-related quality of life tool measuring physical, social, and emotional status. It consists of 10 items: each item refers to the last two weeks, and is rated on a 7 degree scale (1 = all the time, 7 = never). The total score is in the range from 10-70. A higher value indicates a better quality of life. A validated Hebrew version was used.
BSI: This instrument is a measure of psychological stress in the past month. It consists of 53-items that assess nine symptomatic dimensions (depression, somatization, obsession-compulsive, interpersonal sensitivity, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) on a 0-4 scale; a higher score implies more psychological distress. The General Severity Index (GSI) yields a useful global summary score called the GSI with range 0-4. In non-patient normal individuals the GSI was reported as 0.30 ± 0.31. The Hebrew version was validated.
Brief COPE Inventory: This measure comprises 28 items; each item is rated on a 4 degree scale (1 = I do not do it at all, 4 = I do it very much). Items are grouped to yield 14 coping subscales that are grouped into 3 strategies: emotion-focused (emotional support use, positive reframing, humor, acceptance, religion), problem-focused (active coping, instrumental support use, planning), and dysfunctional coping (self-distraction, denial, substance use, behavioral disengagement, venting, self-blame). A greater score indicates more use of that coping strategy. The Brief COPE presents the present condition of the subject. We used the validated version in Hebrew.
FAD: This is a scale that measures the level of perceptions of family functioning and communication. It consists of 12 items; each item can be rated on a 4 degree scale (1 = strongly agree, 4 = not agree at all). A higher value indicates a worse family functioning. This measure has a Cronbach's Alpha = 0.89. It has been validated in Hebrew.
SWLS: This instrument measures the individual's level of satisfaction with life at that moment in time. It includes five questions (q): "q1, my life is close to ideal; q2, conditions of my life are excellent; q3, I am satisfied with my life; q4, I have gotten the important things I want in life; q5, if I could live my life over, I would change almost nothing." Each question is rated on a 7-point scale (1 = not agree at all with the item, 7 = strongly agree). The possible range of this scale is from 1-7 per question. The summary score has a range of 5-35, with a higher value indicating a higher level of satisfaction with life. Cronbach's alpha was 0.89. This measure has been validated in Hebrew.
WPAI: This measure evaluates the effect of disease on the patient's ability to work and to perform regular activities in the past 7 d (not including the present day). This instrument yields 4 scores: absenteeism (work time missed due to disease), presenteeism (impairment while working, i.e., reduced on-the-job effectiveness due to disease) work productivity loss (overall work impairment, i.e., the sum of absenteeism plus presenteeism) and activity impairment (degree that disease impairs regular activities). Scores are expressed as percentages. Higher scores indicate greater impairment at work or when performing activities. The Hebrew version of this measure was accessed from the internet.