Diverse psychological factors are involved in the pathophysiology of stress. In order to devise effective intervention strategies, it is important to elucidate which factors play the most important role in the association between psychological stress and exacerbation of Crohn's disease (CD). We hypothesized that the association between perceived stress and exacerbation of CD would remain after removal of mood and anxiety components, which are largely involved in stress perception.
In all, 468 adults with CD were recruited and followed in different hospitals and private practices of Switzerland for 18 months. At inclusion, patients completed the Perceived Stress Questionnaire and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. During the follow-up, gastroenterologists assessed whether patients presented with a CD exacerbation. By means of binary logistic regression analysis, we estimated the factor by which one standard deviation of perceived stress would increase the odds of exacerbation of CD with and without controlling for anxiety and depression.
The odds of exacerbation of CD increased by 1.85 times (95% confidence interval 1.43–2.40, P < 0.001) for 1 standard deviation of perceived stress. After removing the anxiety and depression components, the residuals of perceived stress were no longer associated with exacerbation of CD.
The association between perceived stress and exacerbation of CD was fully attributable to the mood components, specifically anxiety and depression. Future interventional studies should evaluate the treatment of anxiety and depression as a strategy for potential prevention of CD exacerbations. (Inflamm Bowel Dis 2011;)
1Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
2Farncombe Family Institute of Digestive Health Research, McMaster University, Hamilton, Ontario, Canada
3Healthcare Evaluation Unit, Institute of Social & Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
*Reprints: Professor of Medicine, Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland
Received 18 November 2010; Accepted 5 December 2010
Published online 1 February 2011 in Wiley Online Library (wileyonlinelibrary.com).
Supported by grant 33CSCO-108792 from the Swiss National Science Foundation (to R.v.K., S.B.) (mental health core project of the Swiss inflammatory bowel disease cohort study).