title: Mood and nonmood components of perceived stress and exacerbation of Crohn's disease.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Rafael J A
authors.initials: RJ
authors.lastname: Cámara
authors.forename: Alain M
authors.initials: AM
authors.lastname: Schoepfer
authors.forename: Valérie
authors.initials: V
authors.lastname: Pittet
authors.forename: Stefan
authors.initials: S
authors.lastname: Begré
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
mesh_terms: D000328:Adult; D000341:Affective Disorders, Psychotic / Q000209:etiology*; D001008:Anxiety Disorders / Q000209:etiology; D003424:Crohn Disease / Q000150:complications* / Q000523:psychology*; D003866:Depressive Disorder / Q000209:etiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010465:Perception; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires