Psychosocial determinants of relapse in ulcerative colitis: a longitudinal study

• Published in: The American journal of gastroenterology Vol. 98; no. 10; pp. 2203 - 2208
• Main Authors: Bitton, Alain, Sewitch, Maida J, Peppercorn, Mark A, deB Edwardes, Michael D, Shah, Samir, Ransil, Bernard, Locke, Steven E
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2003
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1016/S0002-9270(03)00750-0

To determine the association between psychosocial characteristics and time to relapse in patients with inactive ulcerative colitis. Sixty patients with clinically and endoscopically inactive ulcerative colitis were followed for 1 yr, or less if they relapsed. Demographic, psychosocial, and clinical data were obtained. Stressful life events (Psychiatric Epidemiology Research Interview Life Events Scale), psychological distress (Symptom Checklist-90R), and perceived stress (Perceived Stress Scale) were recorded monthly by self-report. Multivariate time-dependent Cox regression was used to identify the independent determinants of earlier time to clinical relapse. The patients' mean age was 39 yr (SD = 9.4), 37 (62%) were female, and 22 (37%) relapsed during the 1-yr follow-up. Univariate Cox regression indicated a weak association between number of stressful events in the preceding month and time to relapse ( p = 0.09). This association strengthened in multivariate analysis ( p = 0.02, hazard ratio = 1.26 per event, 95% CI = 1.04–1.53) after adjustment for significant covariates. After controlling for demographic and clinical variables, more recent stressful events were associated with earlier time to relapse. These findings, which support a biopsychosocial model of disease, might help clinicians identify patients who might benefit from more intensive maintenance medical therapy and behavioral medicine interventions to reduce stress and improve coping.