# Predictors of Stress, Anxiety, Depression and Quality of Life in Patients Diagnosed with Chronic Inflammatory Bowel Disease in Romania: A Cross-Section Observational Case-Report Study

## TL;DR

This study in Romania finds that patients with inflammatory bowel disease experience higher stress, anxiety, and depression than healthy people, and identifies factors like UC diagnosis and corticosteroid use as contributors.

## Contribution

The study identifies specific predictors of psychological distress in IBD patients and highlights self-reported rest as a protective factor.

## Key findings

- IBD patients showed significantly higher stress, anxiety, and depression compared to healthy controls.
- UC diagnosis, female sex, and corticosteroid use were linked to higher stress and depression scores.
- Self-reported rest was found to be a protective factor against psychological distress in IBD patients.

## Abstract

Background/Objectives: Inflammatory bowel disease (IBD), mainly encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is strongly linked to psychological comorbidities such as depression, anxiety, and stress. These mental health factors negatively impact disease progression, healthcare utilization, and quality of life (QoL). Methods: Participants completed the Depression–Anxiety–Stress Scale 21 (DASS-21) and EuroQol (EQ-5D-5L) questionnaires. Statistical analyses included multivariate linear regressions to identify predictors of psychological distress. Results: We conducted a cross-sectional case–control study involving 355 participants: 55 with CD, 90 with UC, and 210 healthy controls. Patients with IBD reported significantly higher levels of stress (p < 0.01), anxiety (p = 0.016), and depression (p < 0.01) compared to controls. Severe or very severe symptoms were more prevalent in those with CD and UC. The relative risk for stress was high (RR = 2.1), and the risk for depression was significantly elevated (RR = 1.54) in the IBD population. Quality-of-life analysis revealed lower EQ visual analog scale scores and increased difficulties across all domains, particularly in emotional well-being and pain. Multivariate analysis showed UC diagnosis, female sex, and corticosteroid use as predictors of higher stress and depression scores, while self-reported rest was consistently protective. Conclusions: This study confirms the psychological burden of IBD and underscores the importance of regular screening for stress, anxiety, and depression in clinical care. Self-reported rest emerged as a key protective factor, suggesting potential benefits from interventions targeting sleep quality and emotional support. Future research should explore longitudinal outcomes and personalized psychological interventions in IBD populations.