Psychological Distress Is Associated With Inflammatory Bowel Disease Manifestation and Mucosal Inflammation

Abstract Background Stress is a potentially significant risk factor for the occurrence and progression of inflammatory bowel disease (IBD). Methods The study analyzed the level of stress, anxiety, and depression in patients with Crohn’s disease (CD; n = 50) and ulcerative colitis (UC; n = 54) in comparison with non-IBD controls (n = 100), using Perceived Stress Scale (PSS), Patient Health Questionnaire (PHQ-9), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Additionally, a correlation between psychological scores and expression of IL17A, IL17F, and IL23A genes in the intestinal mucosa of IBD patients was assessed. Results Compared to controls, CD and UC patients had higher PSS (P = 4 × 10−14, P = 2.5 × 10−16), PHQ-9 (P = 2 × 10−16, P = 2 × 10−16), HADS depression (P = 2.6 × 10−10, P = 2.5 × 10−11), and HADS anxiety (P = 3.5 × 10−9, P = 1.2 × 10−11). We found a positive correlation between PSS and IL17F mRNA (rs = 0.43, P = .036) while HADS depression and HADS anxiety positively correlated with the IL23A mRNA in inflamed ileal mucosa of CD subjects (rs = 0.55, P = .0048; rs = 0.53, P = .0062). Conclusions A significantly higher psychological distress was identified in IBD patients. CD patients with increased ileal expression of IL17F and IL23A genes had higher PSS and HADS, suggesting a potential interplay between psychological distress and inflammation.