Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease: a systematic review utilising Bradford Hill criteria and meta-analysis of prospective cohort studies

Abstract

Background: Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients' quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach. Aim: The aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill's criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations. Methods: Medline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation. Results: The searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings.

The impact of disease activity on psychological symptoms and quality of life in patients with inflammatory bowel disease—results from the Stress, Anxiety and Depression with Disease Activity (SADD) Study

“…2,7 Psychological illness, particularly stress, has long been anecdotally reported to increase IBD activity; patients with IBD frequently cite stress as a cause for disease flares, and many studies have reported active intestinal inflammation to be associated with symptoms of psychological illness. 8,9 This has led to the concept that intestinal inflammation might negatively impact psychological health, and alternatively poor psychological health may trigger worsening intestinal inflammation. This possible bidirectional relationship has contributed to the "brain-gut axis" paradigm.…”

Impact of the lockdown period due to the COVID-19 pandemic in patients with inflammatory bowel disease

“… 19 Anxiety and depression have been noticed as important factors leading to a lower quality of live and thereby a worse course of the disease, which could lead to a further worsening of IBD symptoms as could have happened during the lockdown period. 16 This highlights the connection between both physical and mental sphere 17 , 18 and stresses the importance of taking patient's mental health into account.…”

No Impact of Psychosocial Stress on Glioblastoma Development

“…The only factor that signi cantly and negatively affected PFS and OS in this study was the multifocal location. Although stress represents an ambivalent response that can be bene cial in certain situations (concept of " ght or ight response") [13], the association between stress and pathologies are numerous [14] and concern almost all medical specialties (depression [15], metabolic syndrome, coronary artery disease [16], psoriasis [17], in ammatory bowel disease [18] etc,). Most epidemiological studies a rm that the prolonged perception of a high level of stress remains associated with reduced physical and mental condition.…”