Psychosocial determinants of relapse in ulcerative colitis: a longitudinal study.
OBJECTIVE
To determine the association between psychosocial characteristics and time to relapse in patients with inactive ulcerative colitis.


METHODS
Sixty patients with clinically and endoscopically inactive ulcerative colitis were followed for 1 yr, or less if they relapsed. Demographic, psychosocial, and clinical data were obtained. Stressful life events (Psychiatric Epidemiology Research Interview Life Events Scale), psychological distress (Symptom Checklist-90R), and perceived stress (Perceived Stress Scale) were recorded monthly by self-report. Multivariate time-dependent Cox regression was used to identify the independent determinants of earlier time to clinical relapse.


RESULTS
The patients' mean age was 39 yr (SD = 9.4), 37 (62%) were female, and 22 (37%) relapsed during the 1-yr follow-up. Univariate Cox regression indicated a weak association between number of stressful events in the preceding month and time to relapse (p = 0.09). This association strengthened in multivariate analysis (p = 0.02, hazard ratio = 1.26 per event, 95% CI = 1.04-1.53) after adjustment for significant covariates.


CONCLUSIONS
After controlling for demographic and clinical variables, more recent stressful events were associated with earlier time to relapse. These findings, which support a biopsychosocial model of disease, might help clinicians identify patients who might benefit from more intensive maintenance medical therapy and behavioral medicine interventions to reduce stress and improve coping.
Department of Medicine, McGill University, Montréal, Québec, Canada.
Alain
A
Bitton
Maida J
MJ
Sewitch
Mark A
MA
Peppercorn
Michael D
MD
deB Edwardes
Samir
S
Shah
Bernard
B
Ransil
Steven E
SE
Locke
D000328:Adult; D017677:Age Distribution; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011584:Psychology; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013315:Stress, Psychological