Psychologic stressand disease activity in patients with inflammatory bowel disease: A multicentercross-sectionalstudy.

Mikiya Araki ,Takahiro Inoue,Shoko Arimitsu,Sachiko Nakajima,Hiroyuki Ogawa,Kazuo Kinoshita,Shinichiro Shinzaki,Masahiko Tsujii,Masahide Oshita,Yoko Murayama,Shinji Kitamura,Masato Komori,Yuichi Yasunaga,Hitoshi Tanimukai,Akira Mukai,Shoichiro Kawai,Eiji Masuda,Hideki Iijima,Takuya Yamada,Satoshi Hiyama,Tetsuo Takehara,Narihiro Shibukawa,Hirokazu Fukui

doi:10.1371/journal.pone.0233365

Abstract

Psychologic stress can affect the pathogenesis of inflammatory bowel disease (IBD), but the precise contribution of psychologic stress to IBD remains unclear. We investigated the association of psychologic stress with disease activity in patients with IBD, especially in terms of mental state and sleep condition. This was a multi-center observational study comprising 20 institutions. Data were collected using survey forms for doctors and questionnaires for patients, and the association of psychologic stress with clinical parameters was investigated. Mental state was evaluated using the Center for Epidemiologic Studies Depression (CES-D) scale, and sleep condition was evaluated by querying patients about the severity of insomnia symptoms. A total of 1078 IBD patients were enrolled, including 303 patients with Crohn's disease and 775 patients with ulcerative colitis. Seventy-five percent of IBD patients believed that psychologic stress triggered an exacerbation of their disease (PSTE group) and 25% did not (non-PSTE group). The CES-D scores were significantly higher for patients with clinically active disease than for those in remission in the PSTE group (median (interquartile range) = 7 (4-9.5) vs. 5 (3-7), p < .0001), but not in the non-PSTE group (5 (2-8) vs. 4 (3-7), p = 0.78). Female sex and disease exacerbation by factors other than psychologic stress were independent factors of psychologic stress-triggered disease exacerbation. Also, patients with insomnia had higher disease activity than those without insomnia, especially in the PSTE group. A worsened mental state correlates with disease activity in IBD patients, especially those who believe that their disease is exacerbated by psychologic stress.

Highlights

Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), is a refractory disease with repeated remission and exacerbation of symptoms
A worsened mental state correlates with disease activity in IBD patients, especially those who believe that their disease is exacerbated by psychologic stress
Analysis of all the questionnaires revealed that 75.1% of the IBD patients responded that they believed their disease activity was exacerbated by psychologic stress, and psychologic stress was the most common factor for exacerbation among the alternative responses (Fig 2)

Summary

Introduction

Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), is a refractory disease with repeated remission and exacerbation of symptoms. [3] Other environmental factors, such as psychologic stress and sleep condition, may be associated with the IBD disease course: IBD patients are significantly more depressive than healthy controls, [4] and psychologic stress is associated with an exacerbation of IBD symptoms. [8, 10] In contrast, other reports demonstrated no association between psychologic stress and disease exacerbation, [11,12,13,14] and the precise etiology of insomnia in patients with IBD is not established. Some environmental factors, such as diet [15] and smoking [16], are known to affect disease activity in patients with IBD, but no studies have focused on psychologic stress and disease activity. We investigated the association of psychologic stress with disease activity in patients with IBD, especially in terms of mental state and sleep condition

Objectives

Methods

Results

Conclusion