Comparison of stress indices in gauging clinical activity in patients with inflammatory bowel disease

Stress indices are widely available but few have been validated or used for monitoring clinical disease activity in chronic inflammatory disorders. One hundred twenty-three outpatients with inflammatory bowel disease (IBD) participated in this prospective investigation. Stress events (major events, daily strains, perceived stress) and disease activity were monitored for six consecutive follow-ups using standardized instruments. We present effect estimates of daily strains on clinical disease activity separately from the effect of major stress events. Our results indicate that the stress measures were moderately correlated, correlation coefficients ranged from .64 to .66. In relation to disease, self-perceived stress using a stress ladder (r=.31, p<.001) was comparable to probing stress event checklists (major events:r=.34, p<.001; daily strains:r=.20, p=NS). A multiple linear regression analysis revealed that each of the three methods of evaluating stress makes a significant contribution, even after adjustment for potential confounders. No substantial increase in the proportion of explained variance was evident in an analysis based on a composite index of major events and daily strains. A clinical implication of these results is that while self-perceptions of emotional stress may be less objective measures, influencing changes in stress perceptions may be useful in the treatment and prevention of IBD.