Systematic review: the role of psychological stress in inflammatory bowel disease

Abstract

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.

FIGURE 1

Stages of the transactional model of stress (Lazarus and Folkman ⁹ ).

FIGURE 2

PRISMA flow chart. Adapted from: Page et al. For more information, visit: http://www.prisma‐statement.org/.

FIGURE 3

Summary of relationships found between psychological stress and disease outcomes by stress subtype. *No association was found between anxiety and hopeless measures of distress and disease activity but # positive association was found between depression measures of distress and disease activity. ¹All studies measured disease activity as their disease outcome except Langhorst 2007 (neuroendocrine–immune interactions), Luo 2018 (hospitalisation) and Mawdsley 2006 (systemic and rectal mucosal measures).