Evidence of Bidirectional Associations Between Perceived Stress and Symptom Activity: A Prospective Longitudinal Investigation in Inflammatory Bowel Disease
Abstract
BACKGROUND: Our aim was to explore the relationships among perceived stress, intestinal inflammation, and inflammatory bowel disease (IBD) symptoms over time. METHODS: Participants were recruited from a population-based registry of persons with IBD and assessed at months 0, 3, and 6. Key dependent measures were the Manitoba IBD Index (symptom activity), Cohen's Perceived Stress Scale, and fecal calprotectin in stool (intestinal inflammation). RESULTS: Complete data were available for 417 participants at months 0; 369 provided follow-up data. Active symptoms were reported by 54% of those with Crohn's disease (CD) and 40% of those with ulcerative colitis (UC) and approximately one-third consistently had fecal calprotectin measures ≥250 μg/g, suggestive of active inflammation. A significant proportion of participants had indications of inflammation but no active symptoms over the 6 months. Correlations of month 0 perceived stress and disease activity measures with values at months 3 and 6 for both CD and UC indicated strong temporal stability. In hierarchical multiple regression analyses, month 0 symptom activity was thus a strong predictor of later symptom activity for CD and UC. Perceived stress predicted change in symptom activity from 0 to 3 months for CD, as did use of prednisone for UC. Comparably, month 0 perceived stress was a strong predictor of later perceived stress for CD and UC, while month 0 symptom activity predicted change in perceived stress from 0 to 3 months for both CD and UC. CONCLUSIONS: The analysis revealed prospective bidirectional relationships between perceived stress and IBD symptoms but no relationship between perceived stress and change in intestinal inflammation as assessed by fecal calprotectin.
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One of the studies reporting high perceived stress associated with subsequent disease exacerbation reported a bidirectional relationship.
“with one of these studies reporting a bidirectional relationship. 31”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [31]
Two of the studies reporting stress preceding disease exacerbation reported a bidirectional relationship.
“with two of these studies 27 , 31 reporting a bidirectional relationship.”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [31]
No correlation was found between intestinal inflammation, evaluated by fecal calprotectin, and perceived stress.
“Nevertheless, no correlation between intestinal inflammation, evaluated by fecal calprotectin and perceived stress, was found (62).”
From Stress triggers flare of inflammatory bowel disease in children and adults (2019) · cites this paper as [62]
Perceived stress at month 0 was positively correlated with disease activity at months 3 and 6 in both UC and CD.
“Perceived stress at month 0 was found to be positively correlated with disease activity at months 3 and 6 in both UC and CD.”
From Stress triggers flare of inflammatory bowel disease in children and adults (2019) · cites this paper as [62]
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- Authors
- Sexton, K. A., Walker, J. R., Graff, L. A., Bernstein, M. T., Beatie, B., Miller, N., Sargent, M., & Targownik, L. E.
- Affiliations
- University of Manitoba (CA)
- Corresponding author
- Sexton, Kathryn A.
- ORCID
- Venue
- Inflammatory Bowel Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-03
- Volume
- 23
- Issue
- 3
- Pages
- 473-483
- ISSN
- 1078-0998 (ISSN-L)
- OpenAlex
- W2588417063
- Cited by
- 79
- References
- 50
- Citations by year
- 2025: 7 · 2024: 13 · 2023: 12 · 2022: 10 · 2021: 9 · 2020: 6 · 2019: 10 · 2018: 8 · 2017: 4
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Inflammatory Bowel Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Manitoba
- Canadian Institutes of Health Research
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- perceived stress, inflammatory bowel disease
- MeSH terms
- Adult, Colitis, Ulcerative, Crohn Disease, Feces, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Perception, Prospective Studies, Registries, Regression Analysis, Severity of Illness Index, Stress, Psychological, Biomarkers, Leukocyte L1 Antigen Complex
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