King's College London, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, James Clerk Maxwell Building, London, UK.
King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Aliment Pharmacol Ther. 2022 Oct;56(8):1235-1249. doi: 10.1111/apt.17202. Epub 2022 Sep 8.
Psychological stress is a possible factor in the disease course and poor psychosocial outcomes in inflammatory bowel disease (IBD). Understanding the exact relationship between stress and health has been hampered by methodological issues and how stress has been defined and measured.
To explore the association between stress and disease outcomes, investigate the impact of stress on psychosocial outcomes, and evaluate the efficacy of interventions in reducing stress for people with IBD METHODS: We performed a systematic review, searching Medline, CINAHL, Embase and PsycInfo databases on 21 January 2021. We included prospective studies that recruited people with IBD who were aged 16 or over and that measured psychological stress or distress. Analyses included Critical Appraisal Skills Programme quality assessments of included studies and narrative analyses against each research question.
We reviewed 38 studies with 4757 people with IBD, and included 23 observational and 15 interventional studies using 36 different instruments to measure stress. Perceived stress was the most frequently studied concept and preceded IBD exacerbation. Only three studies examined the relationship between stress and psychosocial factors. Cognitive behavioural interventions may reduce stress and other interventions with disease-specific stress, but more studies are needed where groups have comparable baseline characteristics and potential harms are considered alongside benefits.
Psychological stress appears to precede IBD exacerbation, although what role it plays in psychosocial outcomes and how it is best managed is unclear. Further research needs to examine the differential effects of stress on disease subtypes and IBD in flare and remission.
心理压力可能是炎症性肠病（IBD）病程和不良心理社会结局的一个因素。由于方法学问题以及压力的定义和测量方式，人们对压力与健康之间的确切关系仍了解有限。
探讨压力与疾病结局之间的关联，研究压力对心理社会结局的影响，并评估干预措施在减轻 IBD 患者压力方面的疗效。
我们于 2021 年 1 月 21 日在 Medline、CINAHL、Embase 和 PsycInfo 数据库中进行了系统评价，纳入了招募年龄≥16 岁且测量心理压力或痛苦的 IBD 患者的前瞻性研究。分析包括对纳入研究的批判性评估技能计划质量评估以及针对每个研究问题的叙述性分析。
我们共审查了 38 项研究，涉及 4757 名 IBD 患者，包括 23 项观察性研究和 15 项干预性研究，使用 36 种不同的工具来测量压力。感知压力是研究最多的概念，且发生在 IBD 恶化之前。只有 3 项研究检验了压力与心理社会因素之间的关系。认知行为干预可能会降低压力，而其他针对特定疾病的压力的干预措施也可能有效，但需要更多研究，其中组间具有可比的基线特征，并考虑到潜在的危害和益处。
心理压力似乎发生在 IBD 恶化之前，但它在心理社会结局中的作用以及如何最好地管理压力尚不清楚。进一步的研究需要检查压力对疾病亚型和缓解期与活动期 IBD 的不同影响。
