Mood and nonmood components of perceived stress and exacerbation of Crohnʼs disease
Abstract
BACKGROUND: Diverse psychological factors are involved in the pathophysiology of stress. In order to devise effective intervention strategies, it is important to elucidate which factors play the most important role in the association between psychological stress and exacerbation of Crohn's disease (CD). We hypothesized that the association between perceived stress and exacerbation of CD would remain after removal of mood and anxiety components, which are largely involved in stress perception. METHODS: In all, 468 adults with CD were recruited and followed in different hospitals and private practices of Switzerland for 18 months. At inclusion, patients completed the Perceived Stress Questionnaire and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. During the follow-up, gastroenterologists assessed whether patients presented with a CD exacerbation. By means of binary logistic regression analysis, we estimated the factor by which one standard deviation of perceived stress would increase the odds of exacerbation of CD with and without controlling for anxiety and depression. RESULTS: The odds of exacerbation of CD increased by 1.85 times (95% confidence interval 1.43-2.40, P < 0.001) for 1 standard deviation of perceived stress. After removing the anxiety and depression components, the residuals of perceived stress were no longer associated with exacerbation of CD. CONCLUSIONS: The association between perceived stress and exacerbation of CD was fully attributable to the mood components, specifically anxiety and depression. Future interventional studies should evaluate the treatment of anxiety and depression as a strategy for potential prevention of CD exacerbations.
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Eleven studies included only participants with inactive IBD at baseline.
“11 studies 24 , 25 , 28 , 29 , 30 , 34 , 39 , 41 , 42 , 49 , 57 included only participants with inactive IBD at baseline”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [25]
The Setting, Design, and Patients section says the study included both asymptomatic and symptomatic patients. The sample description confirms that 47 patients who later experienced exacerbation were already symptomatic at recruitment. This paper therefore did not include only participants with inactive IBD at baseline. (LLM, conf=0.94)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredHigh perceived stress was associated with subsequent disease exacerbation in nine studies.
“High perceived stress was associated with subsequent disease exacerbation in nine studies 15 , 16 , 25 , 27 , 28 , 29 , 30 , 31 , 32 with one of these studies reporting a bidirectional relationship.”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [25]
The most common stress measures were the Perceived Stress Questionnaire (PSQ) in 10 studies and the Perceived Stress Scale (PSS) in eight studies.
“The most common stress measures used were the Perceived Stress Questionnaire (PSQ) in 10 studies 25 , 29 , 30 , 34 , 35 , 37 , 39 , 41 , 42 , 49 and the Perceived Stress Scale (PSS) in eight studies. 12 , 15 , 24 , 27 , 29 , 31 , 46 , 55”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [25]
Stress preceded disease exacerbation in 11 studies.
“Stress preceded disease exacerbation in 11 studies 15 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 47 , 48”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [25]
IBD are an important risk factor for mood and anxiety disorders, and these psychiatric conditions increase the risk of exacerbation of IBD.
“In line, IBD are important risk factor for mood and anxiety disorders (111), and these psychiatric conditions increase the risk of exacerbation of IBD (112).”
From Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders (2018) · cites this paper as [112]
In a Swiss study of 468 adults with CD followed for 18 months, among those under perceived stress, patients with anxiety and depression were more likely to develop worsening of the disease.
“A study in Switzerland recruited 468 adults with CD, who were followed-up for 18 months. The results of the study showed that, among those who were under perceived stress, patients with anxiety and depression were more likely to develop worsening of the disease, indicating the significance of emotional elements (97).”
From Stress triggers flare of inflammatory bowel disease in children and adults (2019) · cites this paper as [97]
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Chester, M. A., & Keefer, L. (2024) · Springer eBooks · doi:10.1007/978-3-031-32046-0_25-1
Inflammatory Bowel Disease: Interlinking Psychological Resilience and Anxiety
Chester, M. A., & Keefer, L. (2025) · Springer eBooks · doi:10.1007/978-3-031-73363-5_25
- Authors
- Cámara, R. J. A., Schoepfer, A. M., Pittet, V., Begré, S., & von Känel, R.
- Affiliations
- University Hospital of Bern (CH)
- McMaster University (CA)
- Venue
- Inflammatory Bowel Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-11
- Volume
- 17
- Issue
- 11
- Pages
- 2358-2365
- ISSN
- 1078-0998 (ISSN-L)
- OpenAlex
- W2065135778
- Semantic Scholar
- 54fedb686d1e54f5b637991705066d04ee3cf1fc
- Cited by
- 67
- References
- 26
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 4 · 2020: 2 · 2019: 6 · 2018: 7 · 2017: 11 · 2016: 10 · 2015: 3 · 2014: 3 · 2013: 3 · 2012: 2
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Inflammatory Bowel Diseases (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (108792)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- Crohn's disease, perceived stress
- MeSH terms
- Adult, Affective Disorders, Psychotic, Anxiety Disorders, Crohn Disease, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Perception, Prognosis, Psychiatric Status Rating Scales, Surveys and Questionnaires, Stress, Psychological
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