Acceptance and Perceived Control Distinguish Health Outcomes Across Immune-Mediated Inflammatory Diseases

Patients with immune-mediated inflammatory diseases (IMIDs) often experience substantial impairments in health-related quality of life that cannot be fully explained by clinical disease activity alone. The Subjective Health Experience (SHE) model offers a framework, capturing how patients experience their health through the psychological constructs of disease acceptance and perceived control. This study aimed to refine the SHE model for clinical use in IMIDs by identifying demographic, disease-related, and psychosocial characteristics associated with distinct patient segments based on acceptance and perceived control.

In this cross-sectional study, 500 patients with IMIDs (inflammatory bowel disease, psoriasis, rheumatoid arthritis, and axial spondyloarthritis) completed questionnaires assessing demographics, subjective health experience, health-related quality of life, psychological distress, disease activity, and disease impact. Based on sample-specific median thresholds for acceptance and control, patients were classified into four SHE segments. Differences between segments were examined using ANOVA, chi-square tests, and multinomial logistic regression.

Similar distributions of the four SHE segments across IMIDs supported the disease-agnostic applicability of the model. Patients in the high acceptance/high control segment reported better subjective health experience, higher health-related quality of life, less psychological distress, and lower disease activity and impact than those in the low acceptance/low control segment. In adjusted multinomial regression analyses, worse subjective health experience was associated with membership of all three other segments compared with the high acceptance/high control segment (OR 0.51-0.71), while worse health-related quality of life was independently associated with the high acceptance/low control and low acceptance/low control segments (OR 1.19 and 1.27, respectively).

Segmenting patients by acceptance and perceived control revealed meaningful differences in quality of life, psychological distress, and disease impact across IMIDs. These findings provide clinically actionable profiles that can inform targeted supportive strategies and support more personalised care pathways and efficient allocation of healthcare resources.