Positive Orientation and Health-related Quality of Life in Adult Patients Born With Anorectal Malformations

Objectives: Anorectal malformations (ARMs) are rare congenital colorectal anomalies, which may have a negative impact on health-related quality of life (HRQoL) due to long-lasting consequences, like fecal incontinence. The aim of the present study was to test whether a pervasive mode of appraising and viewing life experiences from a positive stance (ie, positivity) mediates the effect of fecal continence on HRQoL. Methods: Participants were enrolled from the Italian Association for Anorectal Malformations. Adult patients with ARMs who completed measures of fecal continence (Hirschsprung Disease/Anorectal Malformation Quality of Life Questionnaire), positivity (Life Satisfaction Scale, Rosenberg Self-esteem Scale, and Life Orientation Test), and mental/physical HRQoL (SF-36) were included. Data were analyzed using the PROCESS macro for SPSS statistical software (Model 4). Results: The study included 66 adult patients with ARMs. Mediated regression analyses showed a significant total effect in which patients with higher fecal continence perceived higher physical (beta = 0.210, SE = 0.038, 95% CI [0.133, 0.286]) and mental HRQoL (beta = 0.226, SE = 0.056, 95% CI [0.115, 0.338]) than patients with lower fecal continence. The indirect effects were also significant, indicating that positivity mediated the impact of fecal continence on physical (beta = 0.026, SE = 0.017, 95% CI [0.002, 0.068]), and mental HRQoL (beta = 0.146, SE = 0.058, 95% CI [0.047, 0.275]). Conclusions: The findings extend previous literature on ARM patients and additional evidence that an optimistic view of oneself, one's life, and one's future contribute to explain the effects of functional impairments on quality of life.