Psychologic stress and disease activity in patients with inflammatory bowel disease: A multicenter cross-sectional study
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BACKGROUND AND AIMS: Psychologic stress can affect the pathogenesis of inflammatory bowel disease (IBD), but the precise contribution of psychologic stress to IBD remains unclear. We investigated the association of psychologic stress with disease activity in patients with IBD, especially in terms of mental state and sleep condition. METHODS: This was a multi-center observational study comprising 20 institutions. Data were collected using survey forms for doctors and questionnaires for patients, and the association of psychologic stress with clinical parameters was investigated. Mental state was evaluated using the Center for Epidemiologic Studies Depression (CES-D) scale, and sleep condition was evaluated by querying patients about the severity of insomnia symptoms. RESULTS: A total of 1078 IBD patients were enrolled, including 303 patients with Crohn's disease and 775 patients with ulcerative colitis. Seventy-five percent of IBD patients believed that psychologic stress triggered an exacerbation of their disease (PSTE group) and 25% did not (non-PSTE group). The CES-D scores were significantly higher for patients with clinically active disease than for those in remission in the PSTE group (median (interquartile range) = 7 (4-9.5) vs. 5 (3-7), p < .0001), but not in the non-PSTE group (5 (2-8) vs. 4 (3-7), p = 0.78). Female sex and disease exacerbation by factors other than psychologic stress were independent factors of psychologic stress-triggered disease exacerbation. Also, patients with insomnia had higher disease activity than those without insomnia, especially in the PSTE group. CONCLUSIONS: A worsened mental state correlates with disease activity in IBD patients, especially those who believe that their disease is exacerbated by psychologic stress.
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Female sex may play an independent role in stress-triggered disease exacerbation.
“female sex may play an independent role in stress‐triggered disease exacerbation. 66”
From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [66]
The Results section identifies female sex as an independent factor associated with reported psychologic stress-triggered exacerbation (Table 2). But the analysis compared patients by whether they believed stress exacerbated their disease; it does not establish an independent role for female sex in actual exacerbations. (LLM, conf=0.84)
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- Authors
- Araki, M., Shinzaki, S., Yamada, T., Arimitsu, S., Komori, M., Shibukawa, N., Mukai, A., Nakajima, S., Kinoshita, K., Kitamura, S., Murayama, Y., Ogawa, H., Yasunaga, Y., Oshita, M., Fukui, H., Masuda, E., Tsujii, M., Kawai, S., Hiyama, S., Inoue, T., Tanimukai, H., Iijima, H., & Takehara, T.
- Affiliations
- The University of Osaka (JP)
- Osaka National Hospital (JP)
- Osaka Rosai Hospital (JP)
- NTT (Japan) (JP)
- Sumitomo Hospital (JP)
- Toyonaka Municipal Hospital (JP)
- Otemae Hospital (JP)
- Sakai City Medical Center (JP)
- Itami City Hospital (JP)
- Nishinomiya Municipal Central Hospital (JP)
- Hyogo Prefectural Nishinomiya Hospital (JP)
- Osaka Police Hospital (JP)
- YAO Municipal Hospital (JP)
- Osaka Minami Medical Center (JP)
- Kyoto University (JP)
- Corresponding author
- Iijima, Hideki
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-05-26
- Volume
- 15
- Issue
- 5
- Pages
- e0233365
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7250441
- OpenAlex
- W3031795583
- Cited by
- 65
- References
- 39
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 17 · 2023: 10 · 2022: 14 · 2021: 6 · 2020: 2
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- A Grant-in-Aid from the Japan Society for the Promotion of Science (26460969)
- 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, Crohn's disease, ulcerative colitis, disease activity, depression, insomnia, sleep quality, sex differences, remission
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Severity of Illness Index, Sex Factors, Sleep Wake Disorders, Stress, Psychological, Inflammatory Bowel Diseases
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