Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease: a protocol for systematic review of prospective cohort studies.
BACKGROUND
Inflammatory bowel disease is an idiopathic chronic disease that affects around 28 million people worldwide. Symptoms are distressing and have a detrimental effect on patients' quality of life. A possible link between exacerbation of symptoms and psychological factors has been suspected but not established. Previous reviews concerned with this link had conceptual and methodological limitations. In this paper we set out a protocol that lays the foundations for a systematic review that will address these shortcomings. The aim of this review is to provide researchers and clinicians with clarity on the role of psychological factors in inflammatory bowel disease symptom exacerbation.


METHODS
We will identify all original, published, peer reviewed studies relevant to the topic and published in English from inception to November 2012. The databases MEDLINE, EMBASE, CINAHL and PsychINFO will be systematically searched. The search terms will include: inflammatory bowel disease, Crohn's disease, ulcerative colitis, psychological stress, mental stress, life stress, family stress, hassles, social stress, coping, mood disorders, anxiety and depression in sequential combinations.Studies will be screened according to predetermined inclusion and exclusion criteria by two reviewers. We will include clinical prospective cohort studies of all human participants aged 18 years or over with a diagnosis of inflammatory bowel disease. All eligible papers will be independently and critically appraised using the Critical Appraisal Skills Programme (CASP) tool by two reviewers. Two reviewers will independently extract and synthesise data from the studies using a predefined data extraction sheet. Disagreements will be resolved by discussion between reviewers and a third party will be consulted if agreement is not reached. Synthesised data will be analysed using Bradford Hill criterion for causality. If data permits, meta-analysis will be performed.


CONCLUSIONS
This study will provide the most comprehensive review and synthesis of current evidence around the link between psychological factors and symptom exacerbation in inflammatory bowel disease. Results will inform clinicians in appropriate intervention development for this patient group that would reduce symptom exacerbation and therefore improve patients' quality of life.
Centre for Health Science, School of Nursing, Midwifery and Health, University of Stirling, Inverness, Scotland, UK. ms84@stir.ac.uk
Mariyana
M
Schoultz
Iain
I
Atherton
Gill
G
Hubbard
Angus Jm
AJ
Watson
D000328:Adult; D001007:Anxiety / Q000150:complications; D003093:Colitis, Ulcerative / Q000209:etiology / Q000523:psychology; D003424:Crohn Disease / Q000209:etiology / Q000523:psychology; D003863:Depression / Q000150:complications; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000209:etiology* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications; D000078202:Systematic Reviews as Topic