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: 0 Date: 15 Aug 2019
Reviewer: Sita Chokhavatia
Reviewer's report:
Please include all comments for the authors in this box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting
materials or other aspects of your report which cannot be included in a text format.
Please overwrite this text when adding your comments to the authors.
Patients with inflammatory bowel diseases may have a high burden of psychological comorbidities
including depression and anxiety. Psychosocial issues in addition to depression, anxiety can impact
their disease course as wells as disease severity and also patient's health related quality of life-HRQoL.
(Clinical Gastroenterol and Hepatol 2017;15:986-997. Curr Pharm Des 2017; 23(27):3997-4002.)
The authors present their data on a cross sectional study collecting data from patients on various self
administered questionnaires. Patients answered questions on psychological symptoms (HAD), disease
activity (CAI and CDAI), health related quality of life (IBDQ) and social support (SSRS) and these
were analyzed to evaluate how the psychological symptoms mediated patients' disease activity, social
support and HRQoL. 
Their results are consistent with previous reports of the negative correlation between psychological
symptoms, disease  activity and  HRQoL. Their conclusion  regarding  the psychological  symptoms'
mediation effect on social support as it relates to HRQoL is interesting, albeit based on a small sample. 
Additional article which may be of interest to the authors: 
PLOS ONE DOI:10.1371/journal.pone.0171864 February 10/2017: Patient self reported concerns in
IBD:A gender specific subjective quality of life indicator. Pittet, V, Vaucher C, Froehlich F, et al
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.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Unable to assess
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 that 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: 0 Date: 15 Aug 2019
Reviewer: Sita Chokhavatia
Reviewer's report:
Please include all comments for the authors in this box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting
materials or other aspects of your report which cannot be included in a text format.
Please overwrite this text when adding your comments to the authors.
Patients with inflammatory bowel diseases may have a high burden of psychological comorbidities
including depression and anxiety. Psychosocial issues in addition to depression, anxiety can impact
their disease course as wells as disease severity and also patient's health related quality of life-HRQoL.
(Clinical Gastroenterol and Hepatol 2017;15:986-997. Curr Pharm Des 2017; 23(27):3997-4002.)
The authors present their data on a cross sectional study collecting data from patients on various self
administered questionnaires. Patients answered questions on psychological symptoms (HAD), disease
activity (CAI and CDAI), health related quality of life (IBDQ) and social support (SSRS) and these
were analyzed to evaluate how the psychological symptoms mediated patients' disease activity, social
support and HRQoL. 
Their results are consistent with previous reports of the negative correlation between psychological
symptoms, disease  activity and  HRQoL. Their conclusion  regarding  the psychological  symptoms'
mediation effect on social support as it relates to HRQoL is interesting, albeit based on a small sample. 
Additional article which may be of interest to the authors: 
PLOS ONE DOI:10.1371/journal.pone.0171864 February 10/2017: Patient self reported concerns in
IBD:A gender specific subjective quality of life indicator. Pittet, V, Vaucher C, Froehlich F, et al
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.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Unable to assess
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 that 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: 0 Date: 15 Aug 2019
Reviewer: Sita Chokhavatia
Reviewer's report:
Please include all comments for the authors in this box rather than uploading your report as an
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting
materials or other aspects of your report which cannot be included in a text format.
Please overwrite this text when adding your comments to the authors.
Patients with inflammatory bowel diseases may have a high burden of psychological comorbidities
including depression and anxiety. Psychosocial issues in addition to depression, anxiety can impact
their disease course as wells as disease severity and also patient's health related quality of life-HRQoL.
(Clinical Gastroenterol and Hepatol 2017;15:986-997. Curr Pharm Des 2017; 23(27):3997-4002.)
The authors present their data on a cross sectional study collecting data from patients on various self
administered questionnaires. Patients answered questions on psychological symptoms (HAD), disease
activity (CAI and CDAI), health related quality of life (IBDQ) and social support (SSRS) and these
were analyzed to evaluate how the psychological symptoms mediated patients' disease activity, social
support and HRQoL. 
Their results are consistent with previous reports of the negative correlation between psychological
symptoms, disease  activity and  HRQoL. Their conclusion  regarding  the psychological  symptoms'
mediation effect on social support as it relates to HRQoL is interesting, albeit based on a small sample. 
Additional article which may be of interest to the authors: 
PLOS ONE DOI:10.1371/journal.pone.0171864 February 10/2017: Patient self reported concerns in
IBD:A gender specific subjective quality of life indicator. Pittet, V, Vaucher C, Froehlich F, et al
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.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Unable to assess
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 that 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