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Do Life Events or Depression Exacerbate Inflammatory Bowel Disease?: A Prospective Study

Carol S. North, MD; David H. Alpers, MD; John E. Helzer, MD; Edward L. Spitznagel, PhD; and Ray E. Clouse, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Carol S. North, MD, Dept. of Psychiatry, Washington University School of Medicine, 4940 Audubon Avenue, St. Louis, MO 63110.

Current Author Addresses: Dr. North: Dept. of Psychiatry, Washington University School of Medicine, 4940 Audubon Avenue, St. Louis, MO 63110.

Dr. Alpers: Dept. of Biostatistics, Washington University School of Medicine, 660 Euclid Avenue, St. Louis, MO 63110.

Dr. Spitznagel: Dept. of Mathematics, Washington University School of Medicine, St. Louis, MO 63110.

Dr. Clouse: Digestive Disease Clinical Center, One Barnes Hospital Plaza, St. Louis, MO 63110.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(5):381-386. doi:10.7326/0003-4819-114-5-381
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Objective: To determine whether depressed mood or life events are associated with an exacerbation of inflammatory bowel disease.

Design: A prospective study of a consecutive sample of patients with relapsing inflammatory bowel disease, followed by monthly questionnaires and periodic office visits.

Setting: A referral-based gastroenterology clinic at a medical school.

Patients: A consecutive sample of 32 patients with inflammatory bowel disease who had had at least one relapse in a 2-year period after entry into the study.

Measurements and Main Results: The Social Readjustment Rating Scale (measuring life events), the Beck Depression Inventory (a visual analog scale for depressed mood) and an inventory of intestinal symptoms were completed monthly by each subject with a 78% rate of compliance. A mean of 2.2 exacerbations was seen per subject during the study period. Life events were not temporally associated with changes in intestinal symptoms. Significant associations were found between intestinal symptoms and the two mood scales (P < 0.05 for each), but no directionality in symptom occurrence could be detected in a time-lagged analysis. The results were similar when the months preceding exacerbations of inflammatory bowel disease were analyzed separately.

Conclusions: Although these findings suggest that mood changed concurrently with exacerbation of inflammatory bowel disease, no evidence indicated that stressful life events or depressed mood precipitated exacerbations in this study group.





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