Reviewer’s report
Title: Associations between disease activity, social support and health-related quality of life in
patients with inflammatory bowel diseases: the mediating role of psychological symptoms
Version: 1 Date: 07 Oct 2019
Reviewer: Lea Ann Chen
Reviewer's report:
This  is  a  revised  submission  of  a  single-center,  cross-sectional  evaluation  of  various  metrics  of
psychological symptoms, social support, IBD activity and health-care related quality of life at an
institution in China. The authors have largely addressed mentioned concerns, and the revised betas for
the DAI and HRQoL correlations are appreciated. 
Regarding comment/response #2 and #4. I believe the wording confusion is related to the statement
"Identifying  the  variables  involved  in  the  impairment  of  HRQoL is  necessary…."  The  currently
suggested revision is largely a rewording of the original sentence. However, since the major variables
that impact HRQoL are already known, I believe the authors mean something along the lines of:
Understanding  the  relationship  and  interdependence  of  the  variables  contributing  to  IBD-related
HRQoL is important in developing tailored interventions to improve HrQoL. 
....That is, the variables that impact HRQoL are known, but the way they interact with each other needs
to be better defined. 
Regarding comment/response #8. The reference is very much appreciated, but I believe it does not
address the original concern. Given that the HBI (for CD) is scored on a 0-43 scale and the SCCAI (for
UC) is scored on a 0-19 scale, it is unclear that these scores can be combined together to represent IBD
as a whole in statistical analyses.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare i have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named report
including any attachments I upload will be posted on the website along with the authors'
responses. I agree for my report to be made available under an Open Access Creative Commons
CC-BY license (http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
Reviewer’s report
Title: Associations between disease activity, social support and health-related quality of life in
patients with inflammatory bowel diseases: the mediating role of psychological symptoms
Version: 1 Date: 07 Oct 2019
Reviewer: Lea Ann Chen
Reviewer's report:
This  is  a  revised  submission  of  a  single-center,  cross-sectional  evaluation  of  various  metrics  of
psychological symptoms, social support, IBD activity and health-care related quality of life at an
institution in China. The authors have largely addressed mentioned concerns, and the revised betas for
the DAI and HRQoL correlations are appreciated. 
Regarding comment/response #2 and #4. I believe the wording confusion is related to the statement
"Identifying  the  variables  involved  in  the  impairment  of  HRQoL is  necessary…."  The  currently
suggested revision is largely a rewording of the original sentence. However, since the major variables
that impact HRQoL are already known, I believe the authors mean something along the lines of:
Understanding  the  relationship  and  interdependence  of  the  variables  contributing  to  IBD-related
HRQoL is important in developing tailored interventions to improve HrQoL. 
....That is, the variables that impact HRQoL are known, but the way they interact with each other needs
to be better defined. 
Regarding comment/response #8. The reference is very much appreciated, but I believe it does not
address the original concern. Given that the HBI (for CD) is scored on a 0-43 scale and the SCCAI (for
UC) is scored on a 0-19 scale, it is unclear that these scores can be combined together to represent IBD
as a whole in statistical analyses.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare i have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named report
including any attachments I upload will be posted on the website along with the authors'
responses. I agree for my report to be made available under an Open Access Creative Commons
CC-BY license (http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’s report
Title: Associations between disease activity, social support and health-related quality of life in
patients with inflammatory bowel diseases: the mediating role of psychological symptoms
Version: 1 Date: 07 Oct 2019
Reviewer: Lea Ann Chen
Reviewer's report:
This  is  a  revised  submission  of  a  single-center,  cross-sectional  evaluation  of  various  metrics  of
psychological symptoms, social support, IBD activity and health-care related quality of life at an
institution in China. The authors have largely addressed mentioned concerns, and the revised betas for
the DAI and HRQoL correlations are appreciated. 
Regarding comment/response #2 and #4. I believe the wording confusion is related to the statement
"Identifying  the  variables  involved  in  the  impairment  of  HRQoL is  necessary…."  The  currently
suggested revision is largely a rewording of the original sentence. However, since the major variables
that impact HRQoL are already known, I believe the authors mean something along the lines of:
Understanding  the  relationship  and  interdependence  of  the  variables  contributing  to  IBD-related
HRQoL is important in developing tailored interventions to improve HrQoL. 
....That is, the variables that impact HRQoL are known, but the way they interact with each other needs
to be better defined. 
Regarding comment/response #8. The reference is very much appreciated, but I believe it does not
address the original concern. Given that the HBI (for CD) is scored on a 0-43 scale and the SCCAI (for
UC) is scored on a 0-19 scale, it is unclear that these scores can be combined together to represent IBD
as a whole in statistical analyses.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare i have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named report
including any attachments I upload will be posted on the website along with the authors'
responses. I agree for my report to be made available under an Open Access Creative Commons
CC-BY license (http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant