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The Role of Psychological Stress in Inflammatory Bowel Disease: Quality Assessment of Methods of 18 Prospective Studies and Suggestions for Future Research
Open accessAbstract
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 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]
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“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]
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“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]
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“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]
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“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]
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“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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Cites
“Stress: appraisal and coping,”
Folkman, S. (2013) · Encyclopedia of Behavioral Medicine · doi:10.1007/978-1-4419-1005-9_215 · Cited by 27,833
Protective and Damaging Effects of Stress Mediators
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“If severity, duration, or frequency of the stress response exceed a critical degree, the associated psychobiological alterations may cause physical damage giving raise to the initiation, acceleration, and exacerbation of various somatic diseases [”
Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., & Hellhammer, D. H. (2003) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(02)00108-7 · Cited by 3,638
The Concepts of Stress and Stress System Disorders: Overview of Physical and Behavioral Homeostasis
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Inflammatory bowel disease: cause and immunobiology
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Inflammatory bowel disease: clinical aspects and established and evolving therapies
Baumgart, D. C., & Sandborn, W. J. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60751-x · Cited by 1,968
Mittermaier, C., Dejaco, C., Waldhoer, T., Oefferlbauer-Ernst, A., Miehsler, W., Beier, M., Tillinger, W., Gangl, A., & Moser, G. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000106907.24881.f2 · Cited by 532
Health Psychology: Why Do Some People Get Sick and Some Stay Well?
Adler, N. E., & Matthews, K. A. (1994) · Annual Review of Psychology · doi:10.1146/annurev.ps.45.020194.001305 · Cited by 506
Stress and Exacerbation in Ulcerative Colitis: A Prospective Study of Patients Enrolled in Remission
Levenstein, S., Prantera, C., Varvo, V., Scribano, M. L., Andreoli, A., Luzi, C., Arcà, M., Berto, E., Milite, G., & Marcheggiano, A. (2000) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.02012.x · Cited by 451
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- 10.1159%2f000098981 · DOI
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Inflammatory Bowel Disease: Interlinking Psychological Resilience and Anxiety
Chester, M. A., & Keefer, L. (2024) · Springer eBooks · doi:10.1007/978-3-031-32046-0_25-1
Social stress causes gut dysbiosis in male, female, and aggressor micePreprint
Garcı́a, I., Kiliç, F., Bryan, C.-A., Castro-Vildosola, J., Jonnalagadda, S. A., Kasturi, A., Tilly, J., Smith, J. L., Valentin, S., Moncayo, S., et al. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.06.26.661806
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
Ettinger, G. (2014) · Scholarship@Western (Western University)
Vagus Nerve Modulation of the Gut–Brain Axis: Implications for Mental Health and Cognitive Function
Álvarez-Mejía, D., Mascialino, G., & León-Rojas, J. E. (2026) · The Neuroscientist · doi:10.1177/10738584261464980
Metadata
- 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
- Health Sciences › Medicine › Gastroenterology › 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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