Self-Efficacy Mediates the Dyadic Relationship Between Psychological Distress and Self-Care in Individuals With Inflammatory Bowel Disease and Their Caregivers

Emotional distress is common among individuals with inflammatory bowel disease (IBD) and their caregivers, potentially impairing illness management and daily functioning. The psychological mechanisms underlying how depression, anxiety, and stress influence selfcare and caregiver contribution to self-care remain unclear in IBD dyads. This study examined the dyadic associations between emotional distress and self-care behaviours in IBD, testing the mediating role of self-efficacy in both patients and caregivers. A multicentre cross-sectional study was conducted in accordance with STROBE guidelines across nine Italian IBD units. Emotional distress was assessed using the Depression Anxiety Stress Scale (DASS-21), self-efficacy using the Self-Care Self-Efficacy Scale (SCSES) for patients and the Caregiver Self-Efficacy in Contributing to Self-Care (CSE-CSC) for caregivers, and self-care behaviours using the Self-Care of Chronic Illness Inventory (SCCII) and its caregiver version (CC-SC-CII). The Actor–Partner Interdependence Mediation Model (APIMeM) with Bayesian estimation was applied to test direct and indirect effects while adjusting for demographic and clinical covariates. A total of 274 patient–caregiver dyads were enrolled. Patient depression showed credible indirect associations with selfcare through lower self-efficacy. Anxiety showed weak and inconsistent associations, with only one credible negative total association between patient anxiety and patient self-care monitoring. Patient stress showed credible positive direct associations with patient selfcare outcomes. Caregiver-to-patient partner effects were generally non-credible. Depression undermines self-care in IBD primarily via diminished self-efficacy, whereas patient stress may be linked to adaptive vigilance in patient self-care. Strengthening patient selfefficacy and addressing depressive symptoms may represent relevant targets for supporting self-care in individuals with IBD, while caregiver-focused strategies require further investigation in longitudinal or interventional designs.