Mediating effect of health anxiety in patients with inflammatory bowel disease between disease perception and self-management behavior

This study aimed to examine the mediating role of health anxiety in the relationship between illness perception and self-management behavior among individuals with inflammatory bowel disease(IBD). A total of 326 patients with IBD who were treated at our hospital between June 2023, and June 2025 were enrolled. Data were collected using a general information questionnaire, the Brief Illness Perception Questionnaire (BIPQ), the Short Health Anxiety Inventory (SHAI), and the IBD Self-Management Behavior Scale. Among the 326 participants, the mean BIPQ, SHAI, and self-management scores were 47.31 (SD = 12.71), 28.89 (SD = 8.81), and 67.79 (SD = 20.48), respectively. Self-management scores were significantly lower among patients older than 60 years and those with a disease duration of more than five years, whereas higher scores were observed among patients with a monthly income greater than 5,000 yuan (all P < 0.05). BIPQ scores were negatively correlated with self-management behavior (r = -0.660) and positively correlated with SHAI scores (r = 0.417). SHAI scores were negatively correlated with self-management behavior (r = -0.501). Mediation analysis showed that the BIPQ scores had both a direct negative association with self-management behavior (coefficient = -1.180, accounting for 82.69% of the total effect) and an indirect association mediated through health anxiety (coefficient = -0.246, accounting for 17.31% of the total effect). The 95% bias-corrected bootstrap confidence interval for the indirect effect did not include zero. Patients with IBD in this cohort exhibited predominantly negative illness perceptions, elevated health anxiety, and suboptimal self-management behaviors. The findings suggest that illness perception is associated with self-management behavior both directly and indirectly through the mediating role of health anxiety. These cross-sectional findings suggest the potential value of integrating psychological assessment and intervention into routine IBD care to improve patient self-management and long-term health outcomes. However, causal inferences cannot be drawn from the present data.