title: The Relationship Among Perceived Stress, Symptoms, and Inflammation in Persons With Inflammatory Bowel Disease.
abstract: OBJECTIVE
  Previous studies have demonstrated that stress is associated with increased disease activity in individuals with inflammatory bowel disease (IBD). The association between perceived stress and gastrointestinal inflammation is not well described.
  
  
  METHODS
  Participants were recruited from a population-based registry of individuals with known IBD. Symptomatic disease activity was assessed using validated clinical indices: the Manitoba IBD Index (MIBDI) and Harvey Bradshaw Index (HBI) for Crohn's disease (CD), and Powell Tuck Index (PTI) for ulcerative colitis (UC). Perceived stress was measured using Cohen's Perceived Stress Scale (CPSS). Intestinal inflammation was determined through measurement of fecal calprotectin (FCAL), with a level exceeding 250 μg/g indicating significant inflammation. Logistic regressions were used to evaluate the association between intestinal inflammation, perceived stress, and disease activity.
  
  
  RESULTS
  Of the 478 participants with completed surveys and stool samples, perceived stress was associated with symptomatic activity (MIBDI) for both CD and UC (1.07 per 1-point increase on the CPSS, 95% confidence interval (CI) 1.03-1.10 and 1.03-1.11, respectively). There was no significant association between perceived stress and intestinal inflammation for either CD or UC. Active symptoms (MIBDI ≤3) were associated with intestinal inflammation in UC (odds ratio (OR) 3.94, 95% CI 1.65-9.43), but not in CD (OR 0.98, 95% CI 0.51-1.88).
  
  
  CONCLUSIONS
  Symptomatic disease activity was unrelated to intestinal inflammation in CD and only weakly associated in UC. Although there was a strong relationship between perceived stress and gastrointestinal symptoms, perceived stress was unrelated to concurrent intestinal inflammation. Longitudinal investigation is required to determine the directionality of the relationship between perceived stress, inflammation, and symptoms in IBD.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Targownik
authors.affiliation: Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Sexton
authors.affiliation: Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bernstein
authors.affiliation: Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Brooke
authors.initials: B
authors.lastname: Beatie
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Sargent
authors.affiliation: Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: Walker
authors.affiliation: Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Graff
mesh_terms: D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000523:psychology; D003424:Crohn Disease / Q000523:psychology; D003430:Cross-Sectional Studies; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007249:Inflammation; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000378:metabolism / Q000523:psychology*; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D016015:Logistic Models; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D012042:Registries; D057566:Self Report; D012720:Severity of Illness Index; D012938:Social Perception; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires
chemical_list: D039841:Leukocyte L1 Antigen Complex