N12 Systematic Review: The role of psychological stress in Inflammatory Bowel Disease

Black, J.(1);Sweeney, L.(1);Yuan, Y.(1);Singh, H.(2);Norton, C.(1);Czuber-Dochan, W.(1);

(1)King's College London, Florence Nightingale Faculty of Nursing- Midwifery & Palliative Care, London, United Kingdom;(2)Study Advisory Group, n/a, London, United Kingdom;


Psychological stress is a possible factor in the disease course and poor psychosocial outcomes in Inflammatory Bowel Disease (IBD). Understanding the exact relationship between stress and health has been hampered by methodological issues and how stress has been defined and measured. This study aims to explore the association between stress and disease outcomes, investigate the impact of stress on psychosocial outcomes, and evaluate the efficacy of interventions in reducing stress for people with IBD.


A systematic review was performed. Medline, CINAHL, Embase, and PsycInfo databases were searched. Prospective studies recruiting people with IBD 16 years old or over and measuring psychological stress or distress were included.


Thirty-eight studies, from 41 reports, with 4757 people with IBD were included in the review. Studies used thirty-six different instruments to measure stress. Perceived stress was the most frequently studied concept and was found to precede IBD disease exacerbation. Depression and helplessness were positively associated with perceived stress, while social support, resilience, and quality of life were negatively associated. Cognitive-behavioural group programmes may reduce stress and education, stress management, and exercise and other group programmes may reduce disease-specific stress, but more studies are needed where groups have comparable baseline characteristics and potential harms are considered alongside benefits.


Psychological stress appears to precede IBD disease exacerbation, though what role it plays in psychosocial outcomes and how it is best managed is unclear. Further research is needed to examine the differential effects of stress on disease subtypes and IBD in flare and remission.