The Role of Psychological Stress in Inflammatory Bowel Disease: Quality Assessment of Methods of 18 Prospective Studies and Suggestions for Future Research
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Background: Enquiries among patients on the one hand and experimental and observational studies on the other suggest an influence of stress on inflammatory bowel diseases (IBD). However, since this influence remains hypothetical, further research is essential. We aimed to devise recommendations for future investigations in IBD by means of scrutinizing previously applied methodology. Methods: We critically reviewed prospective clinical studies on the effect of psychological stress on IBD. Eligible studies were searched by means of the PubMed electronic library and through checking the bibliographies of located sources. Results: We identified 20 publications resulting from 18 different studies. Sample sizes ranged between 10 and 155 participants. Study designs in terms of patient assessment, control variables, and applied psychometric instruments varied substantially across studies. Methodological strengths and weaknesses were irregularly dispersed. Thirteen studies reported significant relationships between stress and adverse outcomes. Conclusions: Study designs, including accuracy of outcome assessment and repeated sampling of outcomes (i.e. symptoms, clinical, and endoscopic), depended upon conditions like sample size, participants’ compliance, and available resources. Meeting additional criteria of sound methodology, like taking into account covariates of the disease and its course, is strongly recommended to possibly improve study designs in future IBD research.
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Previous systematic reviews have found a significant association between stress and IBD disease activity in 13/18 studies.
“Previous reviews have found a significant association between stress and IBD disease activity in 13/18 studies 17”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [17]
The Comparison of the Study Results section reports significant associations between stress and IBD outcomes in 13 of 18 prospective studies. The Publications and Aims section shows that those outcomes included relapse, symptoms, treatment response, and inflammatory measures—not solely disease activity—so the claim describes the 13/18 finding too narrowly. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPrevious reviews have raised concerns about heterogeneity in study design, participant samples and disease activity and stress measures that have made establishing the relationship between stress and disease activity difficult.
“These reviews have raised concerns about heterogeneity in study design, participant samples and disease activity and stress measures that have made establishing the relationship between stress and disease activity difficult. 7 , 17 , 18”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [17]
References were searched from included studies and previous systematic reviews to ensure all relevant papers were included.
“References were searched from included studies and previous systematic reviews 17 , 18 to ensure all relevant papers were included.”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [17]
A manual search of citations did not result in any additional inclusions.
“A manual search of citations in previous systematic reviews 17 , 18 and included studies did not result in any additional inclusions.”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [17]
The review updated the findings of previous reviews including 21 more recent studies from the last decade.
“Moreover, we were able to update the findings of previous reviews 17 , 18 including 21 more recent studies from the last decade.”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [17]
Researchers have recruited heterogeneous samples (both in terms of IBD subtypes and baseline disease activity), despite recommendations to the contrary.
“Researchers have recruited heterogeneous samples (both in terms of IBD subtypes and baseline disease activity), despite recommendations to the contrary. 7 , 17 , 18”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [17]
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- Authors
- Cámara, R. J. A., Ziegler, R., Begré, S., Schoepfer, A. M., & von Känel, R.
- Affiliations
- University of Bern (CH)
- McMaster University (CA)
- Venue
- Digestion
- Publisher
- S. Karger AG
- Published
- 2009
- Volume
- 80
- Issue
- 2
- Pages
- 129-139
- ISSN
- 0012-2823 (ISSN-L)
- 1421-9867
- OpenAlex
- W2088360186
- Cited by
- 106
- References
- 35
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 9 · 2023: 4 · 2022: 6 · 2021: 8 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 3 · 2016: 7 · 2015: 8 · 2014: 6 · 2013: 5 · 2012: 8
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Digestion (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion, other-oa)
- Open Access CRIS of the University of Bern
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (108792)
- China Scholarship Council
- 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
- psychological stress, inflammatory bowel disease, methodological quality, prospective study, psychometric scale, outcome measurement, sample size, covariates, Crohn's disease, ulcerative colitis
- MeSH terms
- Humans, Prospective Studies, Research Design, Stress, Psychological, Reproducibility of Results, Inflammatory Bowel Diseases
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