Network modeling of the impact of social support and illness acceptance on disease activity in Crohn’s disease patients: a cross-sectional study

Background: Crohn's disease (CD) is a chronic inflammatory disorder marked by unpredictable disease activity and complex interactions between biological and psychosocial factors. Although social support and illness acceptance are known to influence patient outcomes, their combined impact on disease activity has not been systematically investigated. Objective: This study aimed to elucidate the interrelationships between social support, illness acceptance, and disease activity in patients with Crohn's disease using network analysis. Methods: In a cross-sectional design, 276 CD patients completed standardized assessments, including the Multidimensional Scale of Perceived Social Support (MSPSS), the Acceptance of Illness Scale (AIS), and the Crohn's Disease Activity Index (CDAI). A regularized partial correlation network was estimated using the graphical LASSO algorithm, with centrality and bridge strength metrics computed to identify influential variables. Subgroup analyses by marital status were conducted. Results: The network revealed key nodes with high centrality, including lack of self-worth (AIS7), feeling unneeded (AIS3), and lack of self-sufficiency (AIS6), along with perceived support from significant others. Bridge centrality analysis identified AIS7, family support, and overall disease activity as key bridging nodes connecting psychosocial and clinical domains. Subgroup analysis revealed distinct patterns: in single patients, family support and self-worth were directly linked to disease activity; in married patients, friend support and autonomy emerged as central, with no direct psychosocial-clinical links. Network structures did not significantly differ in global strength, but key node positions varied by marital status. Conclusion: These findings highlight self-worth, autonomy, and perceived social support as central psychosocial factors influencing disease activity in CD. These pathways differ by relationship status, underscoring the need for personalized psychosocial care strategies tailored to marital context. Longitudinal research is warranted to validate these dynamic relationships.