Psychosocial determinants of relapse in ulcerative colitis: A longitudinal study
Abstract
OBJECTIVES: To determine the association between psychosocial characteristics and time to relapse in patients with inactive ulcerative colitis. METHODS: Sixty patients with clinically and endoscopically inactive ulcerative colitis were followed for 1 yr, or less if they relapsed. Demographic, psychosocial, and clinical data were obtained. Stressful life events (Psychiatric Epidemiology Research Interview Life Events Scale), psychological distress (Symptom Checklist-90R), and perceived stress (Perceived Stress Scale) were recorded monthly by self-report. Multivariate time-dependent Cox regression was used to identify the independent determinants of earlier time to clinical relapse. RESULTS: The patients' mean age was 39 yr (SD = 9.4), 37 (62%) were female, and 22 (37%) relapsed during the 1-yr follow-up. Univariate Cox regression indicated a weak association between number of stressful events in the preceding month and time to relapse (p = 0.09). This association strengthened in multivariate analysis (p = 0.02, hazard ratio = 1.26 per event, 95% CI = 1.04-1.53) after adjustment for significant covariates. CONCLUSIONS: After controlling for demographic and clinical variables, more recent stressful events were associated with earlier time to relapse. These findings, which support a biopsychosocial model of disease, might help clinicians identify patients who might benefit from more intensive maintenance medical therapy and behavioral medicine interventions to reduce stress and improve coping.
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Stress is associated with disease activity and severity in IBD.
“Growing evidence suggests that stress—in particular—is associated with disease activity and severity while conflicting evidence suggests that stress may also be involved in the initial development of IBD [9,15].”
Comorbid psychological difficulties in IBD are associated with disease activity, flares, treatment response, and the necessity of surgical intervention.
“Indeed, comorbid psychological difficulties are associated with disease activity, flares, treatment response, and the necessity of surgical intervention [2,6,8,9,10,11,12,13,14,15].”
The ACT intervention protocol was informed by previous research employing ACT for IBD and single-session ACT interventions.
“The ACT intervention protocol was developed by the first and last authors and was informed by previous research employing ACT for IBD and single-session ACT interventions [9,34,35,37,70].”
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- Authors
- Bitton, A., Sewitch, M. J., Peppercorn, M. A., de B Edwardes, M. D., Shah, S., Ransil, B., & Locke, S. E.
- Affiliations
- McGill University (CA)
- Université de Montréal (CA)
- Beth Israel Deaconess Medical Center (US)
- Harvard University (US)
- Corresponding author
- Bitton, Alain
- Venue
- American Journal of Gastroenterology
- Published
- 2003-10
- Volume
- 98
- Issue
- 10
- Pages
- 2203-2208
- ISSN
- 0002-9270 (ISSN-L)
- OpenAlex
- W2092717271
- Cited by
- 226
- References
- 26
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 12 · 2023: 4 · 2022: 14 · 2021: 10 · 2020: 9 · 2019: 12 · 2018: 17 · 2017: 7 · 2016: 5 · 2015: 11 · 2014: 7 · 2013: 9 · 2012: 14
- FWCI
- 5.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r24mh056217-05)
- National Institute of Mental Health (MH-56217)
- 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
- ulcerative colitis, relapse, psychosocial factors, life events, psychological distress, perceived stress, time to relapse, biopsychosocial model, maintenance therapy, behavioral medicine, coping
- MeSH terms
- Adult, Colitis, Ulcerative, Female, Humans, Longitudinal Studies, Male, Middle Aged, Probability, Prognosis, Prospective Studies, Psychology, Recurrence, Risk Factors, Severity of Illness Index, Stress, Psychological, Incidence, Multivariate Analysis, Proportional Hazards Models, Age Distribution, Sex Distribution
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