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Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

Gracie, David J., Irvine, Andrew J., Sood, Ruchit, Mikocka-Walus, Antonina, Hamlin, P. John and Ford, Alexander C. 2017, Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis, Lancet: gastroenterology & hepatology, vol. 2, no. 3, pp. 189-199, doi: 10.1016/S2468-1253(16)30206-0.

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Title Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis
Author(s) Gracie, David J.
Irvine, Andrew J.
Sood, Ruchit
Mikocka-Walus, AntoninaORCID iD for Mikocka-Walus, Antonina orcid.org/0000-0003-4864-3956
Hamlin, P. John
Ford, Alexander C.
Journal name Lancet: gastroenterology & hepatology
Volume number 2
Issue number 3
Start page 189
End page 199
Total pages 11
Publisher Lancet Publishing
Place of publication Amsterdam, The Netherlands
Publication date 2017-03
Summary BackgroundInflammatory bowel disease is associated with psychological comorbidity and impaired quality of life. Psychological comorbidity could affect the natural history of inflammatory bowel disease. Psychological therapies might therefore have beneficial effects on disease activity, mood, and quality of life in patients with inflammatory bowel disease. We did a systematic review and meta-analysis examining these issues.MethodsIn this systematic review and meta-analysis, we searched MEDLINE, Embase, Embase Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials for articles published between 1947 and Sept 22, 2016. Randomised controlled trials (RCTs) recruiting patients with inflammatory bowel disease aged at least 16 years that compared psychological therapy with a control intervention or usual treatment were eligible. We pooled dichotomous data to obtain relative risks of induction of remission in active disease or prevention of relapse of quiescent disease, with 95% CIs. We pooled continuous data to estimate standardised mean differences in disease activity indices, anxiety, depression, perceived stress, and quality-of-life scores in patients dichotomised into those with clinically active or quiescent disease, with 95% CIs. We extracted data from published reports and contacted the original investigators of studies for which the required data were not available. We pooled all data using a random-effects model.FindingsThe search identified 1824 studies, with 14 RCTs of 1196 patients eligible for inclusion. The relative risk of relapse of quiescent inflammatory bowel disease with psychological therapy versus control was 0·98 (95% CI 0·77–1·24; p=0·87; I2=50%; six trials; 518 patients). We observed a significant difference in depression scores (standardised mean difference −0·17 [–0·33 to −0·01]; p=0·04; I2=0%; seven trials; 605 patients) and quality of life (0·30 [0·07–0·52]; p=0·01; I2=42%; nine trials; 578 patients) with psychological therapy versus control at the end of therapy for patients with quiescent disease. However, these beneficial effects were lost at final point of follow-up (depression scores −0·11 [–0·27 to 0·05], p=0·17, I2=0%, eight trials, 593 patients; quality of life 0·15 [–0·05 to 0·34], p=0·14, I2=22%, ten trials, 577 patients). When we assessed the effect of individual physiological therapies on quality of life, only cognitive behavioural therapy had any significant beneficial effect (0·37 [0·02–0·72]). We noted no effect on disease activity indices or other psychological wellbeing scores when compared with control in patients with quiescent disease. Dichotomous data for induction of remission and continuous data for change in clinical disease activity indices, depression, anxiety, and perceived stress scores were only reported in one RCT of patients with active disease. Quality of life was assessed in two RCTs of patients with active disease, but was not significantly different between intervention and control groups (0·27 [–0·05 to 0·59]).InterpretationPsychological therapies, and cognitive behavioural therapy in particular, might have small short-term beneficial effects on depression scores and quality of life in patients with inflammatory bowel disease. Further RCTs of these interventions in patients with coexistent psychological distress are required.
Language eng
DOI 10.1016/S2468-1253(16)30206-0
Field of Research 110307 Gastroenterology and Hepatology
170106 Health, Clinical and Counselling Psychology
Socio Economic Objective 920105 Digestive System Disorders
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, Lancet Publishing
Persistent URL http://hdl.handle.net/10536/DRO/DU:30091417

Document type: Journal Article
Collection: School of Psychology
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