title: Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission.
abstract: OBJECTIVE
  We sought to determine whether psychosocial factors influence the course of ulcerative colitis, hypothesizing that high perceived stress among patients with inactive disease will increase the risk of subsequent exacerbation.
  
  
  METHODS
  Sixty-two patients with known ulcerative colitis were enrolled into a prospective cohort study while in clinical remission. Their perceived stress, depressive symptoms, and stressful life events were followed, along with potential confounders, for up to 45 months; exacerbation status was monitored for up to 68 months.
  
  
  RESULTS
  The 27 patients who experienced an exacerbation were compared with those who remained in remission. Having a score in the upper tertile on the long-term (past 2 yr) baseline Perceived Stress Questionnaire significantly increased the actuarial risk of exacerbation (hazards ratio = 2.8, 95% confidence interval 1.1-7.2). At any given study visit, high long-term stress tripled the risk of exacerbation during the next 8 months (risk for the three tertiles, 8.3%, 16.7%, and 26.2%, p = 0.02). Shorter sleep time, briefer remission, histological activity, and use of nonsteroidal antiinflammatory drugs, antibiotics, or oral contraceptives also increased the medium- and/or long-term risk of exacerbation, but adjustment for these variables did not eliminate the associations with stress. Exacerbation was not associated with stressful life events, depressive symptoms, short-term (past month) perceived stress, smoking, disease extent or duration, or severity of recent course.
  
  
  CONCLUSIONS
  Short-term stress does not trigger exacerbation in ulcerative colitis, but long-term perceived stress increases the risk of exacerbation over a period of months to years.
authors.affiliation: Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Levenstein
authors.forename: C
authors.initials: C
authors.lastname: Prantera
authors.forename: V
authors.initials: V
authors.lastname: Varvo
authors.forename: M L
authors.initials: ML
authors.lastname: Scribano
authors.forename: A
authors.initials: A
authors.lastname: Andreoli
authors.forename: C
authors.initials: C
authors.lastname: Luzi
authors.forename: M
authors.initials: M
authors.lastname: Arcà
authors.forename: E
authors.initials: E
authors.lastname: Berto
authors.forename: G
authors.initials: G
authors.lastname: Milite
authors.forename: A
authors.initials: A
authors.lastname: Marcheggiano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000473:pathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires