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Background
Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients’ quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and req...
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etiopathogenesis of the disease, although their specific role throughout its clinical
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associated with IBD development...
Inflammatory bowel disease (IBD), comprised of Crohn’s disease (CD) and ulcerative colitis (UC), is a group of chronic inflammatory disorders. IBD is regarded as a severe healthcare problem worldwide, with high morbidity and lethality. So far, despite of numerous studies on this issue, the specific mechanisms of IBD still remain unclarified and ide...
This study aimed to describe the trends, inpatient outcomes, and disease burden of hospitalizations for ulcerative colitis (UC) and Crohn's disease (CD). Our study included data on hospitalizations with a principal discharge diagnosis of CD and UC gathered from the Nationwide Inpatient Sample for the years 2008, 2010, 2012, 2014, 2016, and 2018. In...
The incidence of IBD has been rising over the last decades. The trend applies not only to well-developed countries but also to the regions with limited number of cases so far, e.g., Asia or Middle East.
Aim:
The aim of the study was to determine the incidence of paediatric IBD in the district of Lower Silesia, Poland, between 2016 and 2018.
Meth...
Background:
Multiple sclerosis (MS) and inflammatory bowel disease (IBD) are two autoimmune diseases that seriously affect patients' quality of life. Previous studies have established an association between MS and IBD, including Crohn's disease (CD) and ulcerative colitis (UC), but the results were inconsistent. The aim of this study was to quanti...
Citations
... While the scientific community acknowledges the multifactorial etiology of obesity, discrepancies persist in the weighting of etiological factors contributing to the rise of this disease [22]. The inconsistencies could be attributed to the dominant model of causality in epidemiology, the Bradford-Hill model [23][24][25][26], which, although it identifies the etiological factors, limits the estimation of the type of cause and its weight in the etiology of the disease. In 1976, Rothman [27] proposed an alternative model that addresses this limitation, bridging the gap between the metaphysical notions of cause and fundamental epidemiological parameters [28]. ...
Obesity is currently one of the most alarming pathological conditions due to the progressive increase in its prevalence. In the last decade, it has been associated with fine particulate matter suspended in the air (PM2.5). The purpose of this study was to explore the mechanistic interaction of PM2.5 with a high-fat diet (HFD) through the differential regulation of transcriptional signatures, aiming to identify the association of these particles with metabolically abnormal obesity. The research design was observational, using bioinformatic methods and an explanatory approach based on Rothman's causal model. We propose three new transcriptional signatures in murine adipose tissue. The sum of transcriptional differences between the group exposed to an HFD and PM2.5, compared to the control group, were 0.851, 0.265, and −0.047 (p > 0.05). The HFD group increased body mass by 20% with two positive biomarkers of metabolic impact. The group exposed to PM2.5 maintained a similar weight to the control group but exhibited three positive biomarkers. Enriched biological pathways (p < 0.05) included PPAR signaling, small molecule transport, adipogenesis genes, cytokine-cytokine receptor interaction, and HIF-1 signaling. Transcriptional regulation predictions revealed CpG islands and common transcription factors. We propose three new transcriptional signatures: FAT-PM2.5-CEJUS, FAT-PM2.5-UP, and FAT-PM2.5-DN, whose transcriptional regulation profile in adipocytes was statistically similar by dietary intake and HFD and exposure to PM2.5 in mice; suggesting a mechanistic interaction between both factors. However, HFD-exposed murines developed moderate metabolically abnormal obesity, and PM2.5-exposed murines developed severe abnormal metabolism without obesity. Therefore, in Rothman's terms, it is concluded that HFD is a sufficient cause of the development of obesity, and PM2.5 is a component cause of severe abnormal metabolism of obesity. These signatures would be integrated into a systemic biological process that would induce transcriptional regulation in trans, activating obesogenic biological pathways, restricting lipid mobilization pathways, decreasing adaptive thermogenesis and angiogenesis, and altering vascular tone thus inducing a severe metabolically abnormal obesity.
... First, stress is suggested to be correlated with Crohn's disease activity. 3 With high levels of stress and anxiety being noted during the pandemic, 4 disease flares could be suspected in IBD patients. Second, immunosuppressive agents are used to treat IBD, which raises concern among patients for being more easily infected and at risk of more severe disease. ...
Objective:
The emergence of the COVID pandemic affected daily living and healthcare access of IBD patients, due to delays of elective procedures and in-hospital treatments. Our aim is to determine the repercussions of the pandemic on the daily habits of IBD patients and on their compliance to follow-up and treatment.
Methods:
This was a cross-sectional observational study. A questionnaire was administered in between 2020 and 2022 to IBD patients in a tertiary center in Lebanon. The outcomes measured were patient perceptions regarding COVID and how it affected their treatment.
Results:
A total of 201 answers were included in the analysis with male predominance. Two-thirds had Crohn's disease. Near 80% were afraid of being infected by COVID-19 and 87.6% were afraid of physical contact. 91.5% reduced their daily habits and 96.0% have used personal protective equipment. 47.3% of the patients report that there are factors that reduced their worries, the most common factor being contacting their physician (61.0%). The main source of information was the treating physician (37.8%). A quarter of patients think that their condition predisposed to COVID-19 infection and about two-thirds believe that immunosuppressive therapy did so. The same amount reported concern regarding visiting the hospital. 27.4% preferred telemedicine and 44.8% preferred over-The-phone consultation to an in-person visit. Three-quarters were in favor of vaccination. 59.6% delayed their in-center treatment, which was associated with a reduction in daily life activities. 13.9% wanted to discontinue their treatment, which was associated with smoking, cardiovascular, and rheumatological comorbidities, but only 4% did so.
Conclusion:
The pandemic had significant repercussions on the everyday life of IBD patients, with some preferring to consult via telemedicine and others considering stopping their treatment.
... Moreover, the association between psychological distress and disease activity might be bidirectional, since it has been suggested that perceived psychological distress may affect the onset and course of IBD [5]. However evidence is scarce and inconsistent [5,6]. ...
Background
Many patients with Inflammatory Bowel Diseases (IBD) suffer from psychological distress, fatigue and sleep disturbances, which are associated with reduced quality of life (QoL) and increased societal costs. Only limited psychosocial treatment options are available. As Mindfulness-Based Cognitive Therapy (MBCT) has demonstrated to improve psychological distress, QoL and sleep in other populations, MBCT might also be effective in patients with IBD.
Methods
The MindIBD study is a prospective, multicentre, randomised controlled trial comparing MBCT plus Treatment As Usual (TAU) versus TAU alone in a targeted number of 136 IBD patients in remission, aged 16 years and older with at least mild psychological distress (Hospital Anxiety and Depression Scale (HADS) total score ≥ 11). Primary outcome is reduction of psychological distress post-intervention, measured by the HADS. In addition, the effect of MBCT on sleep quality (including actigraphy and electroencephalography recordings), fatigue, disease activity, perceived disease control, QoL and positive mental health will be examined. Assessments will be conducted at baseline and at 3, 6, 9 and 12 months follow-up. Cost-effectiveness will be determined and a process evaluation will be conducted.
Discussion
This study will provide valuable insight into the clinical effect of MBCT on psychological distress, sleep quality, fatigue and QoL in IBD patients and into the cost-effectiveness. If effective, MBCT can be a valuable addition to the available psychosocial interventions for patients with IBD. Moreover, findings from this study may also be applicable in patients with other chronic conditions.
Trial registration
ClinicalTrials.gov: NCT04646785, registered on 30/11/2020.
... Therefore, sharing of information and education for the purpose of symptom management may help to control the severity of IBD symptoms. Besides, IBD is characterized by repeated relapses and remissions and patient's anxiety about relapse adversely affecting their psychological condition [65]. Accordingly, symptom management is thought to lead to psychological stability. ...
Introduction: Previous studies have reported the effectiveness of inflammatory bowel disease (IBD) self-management. However, it is unclear which types of self-management interventions are effective. We conducted a systematic literature review to clarify the status and efficacy of self-management interventions for IBD.
Methods: Searches were performed in databases including Embase, Medline, and Cochrane Library. Randomized, controlled studies of interventions in adult human participants with IBD involving a self-management component published in English from 2000 to 2020 were included. Studies were stratified based study design, baseline demographic characteristics, methodological quality and how outcomes were measured, and analyzed for statistically significant improvements in outcomes such as psychological health, quality of life, and healthcare resource usage.
Results: Among 50 studies included, 31 considered patients with IBD and 14 and 5 focused on patients with ulcerative colitis and Crohn’s disease, respectively. Improvements in an outcome were reported in 33 (66%) studies. Most of the interventions that significantly improved an outcome index were based on symptom management and many of these were also delivered in combination with provision of information. We also note that among effective interventions, many were conducted with individualized and patient-participatory activities, and multidisciplinary healthcare practitioners were responsible for delivery of the interventions.
Conclusion: Ongoing interventions that focus on symptom management with provision of information may support self-management behavior in patients with IBD. A participatory intervention targeting individuals was suggested as an effective intervention method.
... The impact of stress on the QoL of patients with IBD has been widely examined 2,16,37,38 ; however its role in SD and ED is not well defined. This current study used the PSS-10 32 to assess for stress because of its previous use in patients with IBD [39][40][41] and to assess the effect of stress on sexual function in the general population. 42,43 This study found an association between moderate or high levels of perceived stress and SD and ED in men and women, respectively. ...
Background
Increased disease activity may be a risk factor for sexual dysfunction (SD) in patients with inflammatory bowel disease (IBD). This study investigated associations between objective measures of disease activity and sexual function.
Methods
Adults with IBD undergoing ileocolonoscopy were prospectively recruited. Demographic, sexual function (Female Sexual Function Index and International Index of Erectile Function), disease activity (endoscopic, biomarker, and symptoms), psychological symptoms, and quality-of-life data were collected. Rates of SD and erectile dysfunction (ED) were compared between patients with active and inactive inflammation and symptoms using the Fisher’s exact test. Logistic regression examined associations between SD and ED, and disease characteristics and psychological symptoms.
Results
A total of 159 participants were included, 97 had Crohn’s disease and 85 were women. SD was reported in 36 of 59 and 13 of 59 sexually active women and men, respectively and ED in 22 of 59 sexually active men. Rates of SD and ED were similar between individuals with active and inactive IBD based on endoscopic indices (P > .05) and biomarkers (P > .05). Women with active IBD symptoms experienced significantly higher rates of SD (P < .05), but men did not (P > .05). Multivariable logistic regression identified that symptoms of severe depression (odds ratio, 5.77; 95% confidence interval, 1.59-20.94) were associated with SD in women, and severe anxiety (odds ratio, 15.62; 95% confidence interval, 1.74-140.23) was associated with ED in men.
Conclusions
Objective measures of disease activity are not associated with SD or ED in patients with IBD. Clinicians should consider concomitant psychological symptoms contributing to the sexual health of patients with IBD.
... 6 A recent meta-analysis on whether there was a causal link between anxiety and depression, and symptom exacerbation was inconclusive. 7 Psychological interventions have limited beneficial effects on quality of life and depression in people with IBD, with more trials needed to determine their impact on disease activity. 8 There remains a need to better understand the psychological factors affecting people with IBD. ...
... These reviews have raised concerns about heterogeneity in study design, participant samples and disease activity and stress measures that have made establishing the relationship between stress and disease activity difficult. 7,17,18 This review re-examines how stress relates to IBD activity. It focuses on prospective studies as the inclusion of cross-sectional designs in previous reviews has prevented a discussion of any temporal links between stress and disease activity. ...
... This implies that psychological therapeutic techniques, stress management and greater knowledge of IBD can all have a positive impact on stress.The included studies involved some large (100+) samples with comprehensive follow-up and used robust disease outcome measures. However, data on medication, surgery and other confounders were often not collected.Researchers have recruited heterogeneous samples (both in terms of IBD subtypes and baseline disease activity), despite recommendations to the contrary.7,17,18 This can obscure any differences that disease type may play in the association between stress and disease activity where studies are not sufficiently large to analyse these separately. ...
Background
Psychological stress is a possible factor in the disease course and poor psychosocial outcomes in inflammatory bowel disease (IBD). Understanding the exact relationship between stress and health has been hampered by methodological issues and how stress has been defined and measured.
Aims
To explore the association between stress and disease outcomes, investigate the impact of stress on psychosocial outcomes, and evaluate the efficacy of interventions in reducing stress for people with IBD.
Methods
We performed a systematic review, searching Medline, CINAHL, Embase and PsycInfo databases on 21 January 2021. We included prospective studies that recruited people with IBD who were aged 16 or over and that measured psychological stress or distress. Analyses included Critical Appraisal Skills Programme quality assessments of included studies and narrative analyses against each research question.
Results
We reviewed 38 studies with 4757 people with IBD, and included 23 observational and 15 interventional studies using 36 different instruments to measure stress. Perceived stress was the most frequently studied concept and preceded IBD exacerbation. Only three studies examined the relationship between stress and psychosocial factors. Cognitive behavioural interventions may reduce stress and other interventions with disease‐specific stress, but more studies are needed where groups have comparable baseline characteristics and potential harms are considered alongside benefits.
Conclusion
Psychological stress appears to precede IBD exacerbation, although what role it plays in psychosocial outcomes and how it is best managed is unclear. Further research needs to examine the differential effects of stress on disease subtypes and IBD in flare and remission.
... Some studies reported that distress symptoms were found to increase the likelihood of CD flare-ups (Chiang et al., 2019a;Cohen, 2016), intensify disease symptoms (Eugenicos & Ferreira, 2021;Korzenik, 2019;Mikocka-Walus et al., 2016;Nahon et al., 2012;Vedamurthy & Ananthakrishnan, 2019), and exacerbation of the disease (Agostini et al., 2017;Targownik et al., 2015). However, a recent meta-analysis concluded that distress symptoms do not increase the risk for IBD symptom exacerbation (Schoultz et al., 2020). ...
Crohn's disease (CD) is a chronic disease that belongs to the family of chronic
inflammatory bowel diseases, characterized by life-long recurrent symptoms
with severe physical manifestations in the intestines and extra-intestinally. CD
patients suffer from higher comorbidity of emotional distress compared to
healthy people and report lower levels of well-being. Previous studies showed
that IBD patients' health-related quality of life (HRQoL) and emotional well-being needs are usually unmet in conventional medical care settings. Prior
studies report that cognitive-behavioral or mindfulness interventions increase
IBD patients' well-being; yet, there is a shortage of high-quality RCT studies
focused solely on large CD patient cohorts.
Based on Taylor's theoretical model, a bio-psycho-social model is
proposed to describe the fixed and adjustable variables that affect the well-being of adult CD patients and the associations between the psychosocial
variables. The proposed model introduces a novel psychological component
comprised of a three-month digital cognitive-behavioral and mindfulness with
daily exercise (COBMINDEX) intervention. In this dissertation, we assessed
the effect of the intervention on psychosocial variables such as coping
resources, emotional distress, and overall well-being of adult CD patients with
mild-to-moderate disease activity.
The COBMINDEX intervention uses the advantages of telehealth
platforms to teach stress reduction skills during seven private video conferencing sessions with a social worker. According to COBMINDEX's
unique protocol, during these sessions, patients learn behavioral relaxation
exercises and guided imagery techniques. They learn and practice to identify
maladaptive thought patterns and cognitive distortions and challenge them
using more adaptable and facts-based thinking practices. The patients also
learn core mindfulness principles and meditations. The patients are requested
to exercise the learned skills daily, using digital means such as podcasts,
auto-reminding text messages, and a link to an online self-reporting
application with self-monitoring abilities.
II
The dissertation is chapter-based and presents three principal analyses
regarding the proposed model. The first chapter (pg. 31) illustrates a cross-sectional analysis conducted at the time of study recruitment before receiving
any intervention (T1), comprising 134 clinically disease-active adult Israeli CD
patients. The focus was on the association between mindfulness disposition
and emotional distress and their effect on the health-related quality of life
(HRQoL) of the CD patients.
The second chapter (pg. 42) was published in the leading journal in the
field of inflammatory bowel disease (Goren et al., 2021). It presents a three�month longitudinal analysis of clinical, biological, and psychosocial data pre
(T1) versus post (T2) COBMINDEX intervention. For this analysis, 116
patients were randomized into an intervention group (n=55) or a control wait�list group (n=61). Both groups received medical treatment as usual. The
relative change of the different variables was compared. Additionally, each
participant served as their own control.
In the third chapter (pg. 62), we analyzed the effect of COBMINDEX
intervention on the psychosocial coping resources of 45 men and 75 women
with active CD. A gender-wise analysis was also conducted, and the
associations between the relative change in coping resources was assessed
with the relative change of the patient's emotional distress and satisfaction
with life.
Integrated results of all three analyses showed that COBMINDEX is an
intervention that elevates the well-being of adult CD patients with mild-to-moderate disease activity over a short period of three months. It is associated
with enhanced use of adaptable coping strategies (emotional- and problem-focused strategies) and with the decreased use of dysfunctional coping
strategies. COBMINDEX is also associated with elevated mindfulness
disposition and decreased emotional distress assessed by the global severity
index symptoms (GSI), fatigue (FACIT-Fatigue), and perceived stress (PSS�4). After COBMINDEX, clinical improvement of the patient's disease activity
and reduced inflammatory biomarkers such as CRP and fecal calprotectin
were reported as well. COBMINDEX is best suited to CD patients with higher
III
emotional distress, lower mindfulness disposition, and lower HRQoL, and is
more beneficial for women than men.
A possible mechanism for the patients' improved well-being is the
implementation of those adaptive disease-related coping skills which the
patients learned and practiced. The intervention serves as a platform that
enhances the use of effective coping with disease-related everyday stress,
replacing already well-established dysfunctional strategies with more
adaptable strategies. Departing from dysfunctional coping use was associated
with higher satisfaction with life. However, it is suggested that embracing more
adaptive coping skills is easier than relinquishing unhealthy and dysfunctional
coping strategies. Nonetheless, relinquishing the dysfunctional strategies was
found to be a crucial factor in improving patients' satisfaction with life.
A gender-wise analysis showed that altering coping resources is
gender-associated. While there were no significant mindfulness and coping
resource differences at baseline between the genders, except for higher use
of venting and instrumental support among women, after COBMINDEX
women showed a more positive change in more coping strategies than men.
Women reported more frequent use of both emotion- and problem-focused
coping, whereas men reported a significant increase only in emotion-focused
coping. Women used significantly less dysfunctional coping (calculated with
its venting subscale removed from the index), and less self-blame and denial.
Furthermore, results showed that mindfulness disposition is negatively
associated with emotional distress and positively associated with HRQoL. A
path analysis showed that the effect of mindfulness on HRQoL is mediated by
emotional distress, so greater levels of mindfulness were linked with lower
emotional distress, which in turn led to improved HRQoL. Mindfulness
disposition was also positively associated with adaptable coping strategies
and negatively associated with dysfunctional strategies. As far as we know,
this is the first study that assessed the relationships between coping
strategies and mindfulness among CD patients, based on the assumption that
mindfulness is an adaptable coping strategy.
One of this dissertation's theoretical contributions is the use of Taylor's
theoretical model. To the best of my knowledge, this is the first study in Israel
IV
and in the world to use a multivariate bio-psycho-social model as a structure
for explaining the well-being of CD patients following a short-term
COBMINDEX intervention. Our intervention altered the coping resources and
therefore acts as a mediating factor between gender and CD patients" well-being.
Another theoretical contribution of this dissertation is the use of
innovative statistical analyses. First, we assessed the associations between
the relative change of the variables, which enables us to show how a change
in one variable is related to a change in other variables. Secondly, we used
quantile regressions. These regressions are best used in non-normally
distributed data and show the slopes of the regression line and more detailed
results. These regressions are innovative and are less commonly used in
social science research.
A practical contribution is the use of a telehealth platform for the
intervention. One of the main concerns about online psychological video
session interventions is the lack of in-person (face-to-face) feeling. Our results
and a relatively low dropout rate of 8.4% across the COBMINDEX intervention
support the notion that therapeutic relationships between social workers and
their patients can be delivered via digital platforms using tele-psychotherapy.
It should also be noted that this digital intervention format, which initially
aimed to be accessible for CD patients from all over the country, proved to be
suitable, particularly in the COVID-19 era.
Conclusions
CD patients' well-being is affected by bio-psycho-social variables.
COBMINDEX is a short-term digital psychological intervention that improves
the well-being of adult CD patients with mild-to-moderate disease by teaching
them the use of more adaptive coping resources and decreasing their
emotional distress. COBMINDEX can be implemented relatively easily in CD
centers' health care programs.
Similar to other recent studies in the IBD field, there is a need to
institutionalize and integrate a bio-psycho-social health care model into the
treatment of CD policy and practice. The patients' health should not be
V
defined only according to their physical state and needs but should also
include emotional and psychosocial status. The treatment for CD patients
should be multidisciplinary, with integrated teams diagnosing and introducing
treatments that include screening and managing psychological distress by
professional social workers and mental health practitioners. Mental health
care should be aided by digital means that make the treatment accessible to
the various CD populations. This treatment should not be considered a
privilege or a recommendation for complementary care, but rather a standard
mandatory treatment.
Keywords: cognitive-behavioral intervention; mindfulness; distress; Crohn's
disease; chronic diseases; self-exercise; well-being; coping
... The only factor that signi cantly and negatively affected PFS and OS in this study was the multifocal location. Although stress represents an ambivalent response that can be bene cial in certain situations (concept of " ght or ight response") [13], the association between stress and pathologies are numerous [14] and concern almost all medical specialties (depression [15], metabolic syndrome, coronary artery disease [16], psoriasis [17], in ammatory bowel disease [18] etc,). Most epidemiological studies a rm that the prolonged perception of a high level of stress remains associated with reduced physical and mental condition. ...
Purpose: Psychosocial stress represents an important source of questions in the potential implication of origin of cancer. The aim of the study was to assess stress prevalence prior to diagnosis of wild-type IDH glioblastoma.
Methods: This prospective single-center study enrolled consecutive new cases of wild-type IDH glioblastoma diagnosed between December 2019 and March 2021 at the University Hospital of Bordeaux. A standardized patient self-assessment stress questionnaire explored both the presence of stressor exposure and the intensity of patient stress level prior to the diagnosis. Four groups were included: high stressors/high stress, high stressors/low stress, low stressors/low stress, and low stressors/high stress. Patient characteristics were collected. Statistical analysis was based on the Chi-square test and the Kaplan-Meier survival estimator.
Results: Sixty-four patients with a median age of 66 years were included. Glioblastoma involved predominantly the frontal lobe (39%). Thirty-six patients (56.3%) presented a low stressor/low stress profile. Stress corresponded mainly to the death of a loved one or to family health problems. Among working professionals, 20 patients (67.5%) reported low-intensity work stress. A history of depression was found in 30%. Progression-free survival at 6 months was 45.3% and median overall survival was estimated to be 16.5 months. Level and presence of stress did not differ based on location of tumour. No association was found between stress and tumour progression or overall survival.
Conclusion: A majority of patients in this study had low exposure to stressors as well as low stress level. Psychological stress did not seem to favour the emergence of glioblastoma or survival.
... A recent systematic review and meta-analysis hints at this relationship being weak at best. 4 Mules et al 5 ...
LINKED CONTENT
This article is linked to Mules et al papers. To view these articles, visit https://doi.org/10.1111/apt.16616 and https://doi.org/10.1111/apt.16649
... 2,7 Psychological illness, particularly stress, has long been anecdotally reported to increase IBD activity; patients with IBD frequently cite stress as a cause for disease flares, and many studies have reported active intestinal inflammation to be associated with symptoms of psychological illness. 8,9 This has led to the concept that intestinal inflammation might negatively impact psychological health, and alternatively poor psychological health may trigger worsening intestinal inflammation. This possible bidirectional relationship has contributed to the "brain-gut axis" paradigm. ...
Background
Disease activity may be a risk factor for psychological illness in patients with inflammatory bowel disease (IBD).
Aim
To correlate objective measures of disease activity with psychological symptoms.
Methods
Adult patients with IBD undergoing ileocolonoscopy were prospectively recruited. Demographic, psychological symptoms (depression, anxiety, stress), disease activity (symptoms, biomarkers, endoscopy), and quality of life (QoL) data were collected. One-way ANOVA and multivariable analyses examined the associations between disease activity and symptoms of psychological illness, and identified other predictors of mental illness and reduced QoL.
Results
A total of 172 patients were included, 107 with Crohn’s disease (CD) and 65 with ulcerative colitis (UC). There was no significant association between objective disease activity (endoscopic scores, faecal calprotectin or C-reactive protein) and depression, anxiety or stress scores (P > 0.05 for all comparisons). Gastrointestinal symptoms were significantly associated with symptoms of depression, anxiety and stress in patients with CD and UC (P < 0.05). On multivariable analysis, only gastrointestinal symptoms were associated with severe symptoms of depression (OR 20.78 [6.71-92.37], P < 0.001) and anxiety (OR 4.26 [1.70-12.25], P = 0.004). Anti-TNF and corticosteroid use, the presence of severe depressive, moderate–severe stress and gastrointestinal symptoms, and endoscopically active IBD were associated with a reduced QoL (P < 0.05). Longer duration of IBD predicted an improved QoL (P < 0.05).
Conclusions
Objective measures of disease activity are not associated with symptoms of psychological illness in patients with IBD. Clinicians should consider underlying mental illness in patients with IBD with active gastrointestinal symptoms.
